Joshua Galyon
Choosing the right birth control can be overwhelming for anyone. You may have to undergo an awkward and potentially uncomfortable gynecological checkup. Then there’s deciding between dozens of different options. You might have to deal with a judgy pharmacist at the pickup counter. For pills and some other methods, you have to remember to stay on schedule. And whatever method you choose, you have to weigh the risk of different side effects or potential pregnancy.
But for plus size women, choosing a birth control method comes with even more considerations. Medical exams can come with offensive questions or shaming comments from insensitive healthcare providers. Certain birth control methods can be much more dangerous for higher-weight women, or they might not be as effective. Many doctors don’t know enough about hormonal birth control to warn their plus size patients about the risks. Here are some things to think about before deciding on the right birth control method for you.
1. Some Methods Might Not Work for You
Some hormonal birth control methods may not work as well for people over a certain weight. Studies show that standard morning after pills containing levonorgestrel, like Plan B, may not be as effective for women over 165 pounds. Transdermal contraceptives, aka birth control patches, have also shown less efficacy in women over 200 pounds. Changes in hormone levels associated with being overweight or obese may affect the way contraceptives are metabolized in the body. Additionally, if you’ve had certain types of bariatric surgery, certain types of oral birth control pills might also be less effective.
Some of the most effective birth control methods for higher-weight women include shots, implants, the Nuvaring, and progestin-only pills. Barrier methods like condoms and diaphragms work for people of any size and don’t come with side effects. If you need the morning after pill, Ella (ulipristal) has been proven effective for women up to 195 pounds. No matter your size or situation, a quick, private online birth control consult can match you with the right method.
2. You Could Be at Risk for Venous Thromboembolism
Even if your hormonal birth control method is effective in preventing pregnancy, it could be riskier for you. People with obesity who use combined oral contraceptive pills are at much greater risk for venous thromboembolism. VTE refers to blood clots in the veins, including deep vein thrombosis and pulmonary embolism. These clots can obstruct blood flow, damaging tissues or organs and potentially causing death. Obese women on oral contraceptives may also be at higher risk for cerebral venous thrombosis, a rare type of stroke.
The shot (Depo Provera) and progestin-only pills do not seem to carry the same risk of VTEs as other hormonal contraceptives. These are also two of the hormonal methods that seem to work well in higher-weight women. One downside to progestin-only pills is that they need to be taken at the exact same time every day. If you take the progestin-only pill more than three hours late even one time, you could become pregnant. The shot might be an easier choice because you only need it once every three months.
3. An IUD Might Be a Better Option
If you don’t already have one inserted, an IUD can be an effective birth control method. An IUD is another birth control method that can be safe and effective for plus size women. There are two main types of IUDs, copper and hormonal. Both are small, T-shaped pieces of flexible plastic that are inserted into the uterus. Both prevent pregnancy by stopping sperm from reaching your eggs in different ways.
Having an IUD inserted up to five days after unprotected sex can prevent pregnancy regardless of body size. IUDs can also be effective for between 3 and 10 years, depending on which kind and brand you get. One challenge to IUDs for plus size women is they can be harder to insert. It can be harder for a clinician to determine the size and positioning of the uterus and cervix. Obese women are also more likely than other women to experience IUD expulsion, meaning the IUD falls out after insertion.
4. It’s a Good Idea to Use a Backup Barrier Method
Regardless of body size, it’s always a good idea to use a barrier method as a backup for your hormonal birth control. You can also use a barrier method as your primary method of birth control if you wish. Barrier methods include condoms, diaphragms, cervical caps, and the contraceptive sponge. These methods, used alone or in addition to hormonal birth control, lower the risk of pregnancy without side effects. Unlike other birth control methods, they can also help protect you from STIs.
Even though they don’t directly cause side effects, there are some risks and challenges associated with barrier methods. Condoms and the spermicide in some types can carry a risk of irritation or even a serious allergic reaction. People with latex allergies should use polyurethane or polyisoprene condoms instead of standard latex condoms. Some higher-weight women may have difficulty correctly placing internal barrier methods like cervical caps, diaphragms, and internal condoms (female condoms). An incorrectly-placed barrier method will not be as effective in preventing pregnancy.
Making the Right Choice for You
For plus size women, choosing the right hormonal birth control method comes with added frustrations not all women experience. There are extra health risks associated with some methods and an increased risk of accidental pregnancy with others. Unfortunately, not all the healthcare providers you deal with will be aware how each method might affect your body differently. With time and advocacy, awareness will hopefully become more prevalent in the healthcare community. In the meantime, stay informed about all your options, so you can advocate for yourself when necessary.
