So, this came up in conversation with one of my best friends just a few minutes ago.

Y’all DO know that the Pill, our good friend birth control, is less effective on fat women, right?

Paul at Big Fat Blog wrote about this three years ago and nothing seems to have changed in the meantime. So when my friends ask me if I’m on the Pill yet (since the boyfriend and I DO live together now), I kind of cringe. Not because they are asking, but because the reality is, while they SHOULD have this down by now (as my friend said), they just don’t. And I am left with less than ideal choices.

Don’t get me wrong, I’m glad those choices exist. I can walk into any drugstore or grocery store or store with any sort of health and hygiene section and walk out with the condoms of our choice. But unless I want to be something like 60% more likely than a thin woman to get pregnant while on the pill, even though we are in a monogamous relationship and we’re both clean for other issues….

You know, given how afraid people are of zombie fat, you’d think the development of effective¬† birth control for fat women would be a top priority!

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  1. Pattie
    Posted July 9, 2007 at 12:00 pm | Permalink

    I’ve been using Depo-Provera, and although I know it has many reported side effects that are horribly unpleasant, I’ve had no problems while on it. My favorite part is not getting my period at all. The pill, patch, and ring were all not options for me partly due to my weight but also partly due to my blood pressure.
    I sometimes wonder if the lack of proper birth control for fat women is based on some screwed up idea that we don’t get to have sex so we don’t really need it.

  2. admin
    Posted July 9, 2007 at 12:02 pm | Permalink

    I don’t actually MIND getting my period. So I can’t decide how I feel about the Depo shots. And I can’t find any info on the effectiveness for fat women.

    As for the rest, I have often wondered the same thing!

  3. GiniLiz
    Posted July 9, 2007 at 12:19 pm | Permalink

    I do wish they would test more pills on us fat women and dose them accordingly. I believe Ovcon (?) is the only one that has been. That said, I have still recommend that my fat patients consider the pill if they are uninterested in an IUD, as it is still more effective than many other options, just slightly less effective than it would be for smaller folks. (Even being 300% more likely to get pregnant, when the original likelihood for thinener folks is just 1 in 100, means a 3 in 100 risk, which many patients feel okay about.) I just tell them to use a second option (condom, contraceptive film, etc) in addition to the pill if they are dead set against getting pregnant. Your comment about the zombie fat is so true, though. But don’t you know we fat women don’t have sex? After all, the zombie fat theory is based on fat women who are currently appearing thinner!

  4. alison
    Posted July 9, 2007 at 12:27 pm | Permalink

    I was on the pill when I got pregnant with my son…so, yep, I can say it didn’t work as well for this fattie.

    I tried Norplant, and finally made the connection for myself that the hormones really did affect my daily life quite adversely. Not to mention that about a week after mine was ‘implanted’ in my arm they had a recall of them (according to the nurse practitioner the expiration date was in question–2 years as compared with the 5 years it was ‘advertised’), so I had it removed soon after.

    So, I now have the IUD (comes with or without hormones). The first 3 or 4 days were hell. But now I don’t even think about it, and since I’ve been in a monogamous relationship for going on three years now, it is a great option for our situation. I’m nervous about getting it removed, but I’ll cross that bridge when I come to it.

    Wishing you a stress free decision process…

  5. admin
    Posted July 9, 2007 at 12:32 pm | Permalink

    I really am deadset against an IUD – it’s the one method of birth control that REALLY kind of freaks me out unreasonably.

    I guess I don’t understand WHY they can’t figure out the doses. It seems like something that would be, well, pretty damn straight forward.

  6. admin
    Posted July 9, 2007 at 12:32 pm | Permalink

    Thank you, alison!

  7. Eve
    Posted July 9, 2007 at 12:34 pm | Permalink

    Yipes. I’d heard about this but my NP told me that the difference was very small I’ve been on Ortho Evra for hmmm… 6 months now and it seems to be working. Or maybe I’m just lucky. Meanwhile, my boyfriend’s thin sister got pregnant while using it.
    I don’t know – I’m only about 30 lbs out of the range where it’s supposed to work (the cut-off is 198 lbs) so maybe that’s close enough that the difference is negligible.

  8. admin
    Posted July 9, 2007 at 12:37 pm | Permalink

    Well, the risk is that you’ll be 60% more likely to be the 1 out of a 100 women that the Pill doesn’t work for. So the risk isn’t the hugest. Just enough, especially at my size, that it is a concern.

  9. Jess
    Posted July 9, 2007 at 1:07 pm | Permalink

    Hm, I’ll have to talk to my endo about this… I’m asposta be on the Pill for PCOS, but I’m off it right now for other reasons. I was going to ask about other means of hormone regulation and this might be a good reason to discuss it.

  10. Baconsmom
    Posted July 9, 2007 at 1:11 pm | Permalink

    Have you thought about Fertility Awareness Method? It’s the same charting process used for conceiving or Natural Family Planning, but you use a barrier method during fertile times in your cycle. I’ve been using it for almost three years, and haven’t even had a scare. No side effects at all, effective with everyone, virtually free, and available without a prescription.

    I’m told the best info on it is found in the book Taking Charge of Your Fertility, but I just took a short “course” via email at

    It’s one more option.

  11. admin
    Posted July 9, 2007 at 1:14 pm | Permalink

    That’s a really interesting concept but I am wary of it because my cycle is not regular. It does sound like another option for a lot of people though!

  12. NameChanged
    Posted July 9, 2007 at 1:36 pm | Permalink

    I was on the pill for 11 years. Over that time I gained much weight. When I got close to 200 lbs, my dr told me that being heavy could lead to an unwanted pregnancy and that I should try super hard to get under 195. Well I tried, and I got heavier. I did not get pregnant, despite continual weight gain and mucho sex.

    I missed a week of pills (due to appointment scheduling and perscription expiration) and became pregnant.

    I think that the possibility of getting pregnant on the pill depends on your hormones throughout your cycle and life, which can affect your weight. I do not believe that it is the weight that makes you more likely to get pregnant.

    I was on Ortho-trycyclene Lo if you are interested. I did not have any blood pressure issues, and I did not have any period issues. It also helped with my excessively heavy periods and painful cramps.

    Happy sexing! :)

  13. Posted July 9, 2007 at 2:03 pm | Permalink

    I have Implanon (I think it’s called Norplant over there) – the little plastic implant that goes in your arm and lasts three years. Works on progesterone-only, like Depo, only if you have a bad reaction to it like some women, it can be removed instead of having to wait for the Depo to wear off. 1.5 years of plenty of sex and no problems so far. Had a few crampy mini-periods in the first 6 months but everything’s settled down nicely now.

  14. Posted July 9, 2007 at 2:05 pm | Permalink

    I have Implanon (I think it’s called Norplant over there) – the little plastic implant that goes in your arm and lasts three years. Works on progesterone-only, like Depo, only if you have a bad reaction to it like some women, it can be removed instead of having to wait for the Depo to wear off. 1.5 years of plenty of sex and no problems so far. Had a few crampy mini-periods in the first 6 months but everything’s settled down nicely now. I’m about 270lbs, I think.

  15. mary
    Posted July 9, 2007 at 2:25 pm | Permalink

    Interesting discussion.

    I’m using the Nuva Ring now and LOVE it but I am no longer overweight.

    However, I was extremely heavy for many years and was on the pill during that time. Never once did my gyn (not the same one I now go to) tell me I had an increased risk of pregnancy due to my weight.

    The only issue I remember is having to go off a prescription for antibiotics because antibiotics can lessen pill effectiveness. But I heard that not only from my gyn, but other readily available sources too (including the package insert from the pill, which also warns you about smoking and blood clots and eighteen million other possible problems).

    I consider myself pretty intelligent and well read (or so I thought…) so I’m surprised I never knew about this pill/weight/pregnancy connection. I don’t recall this being in the package insert?

  16. Posted July 9, 2007 at 4:04 pm | Permalink

    Eek, I’d never heard that either…

  17. admin
    Posted July 9, 2007 at 4:24 pm | Permalink

    Yeah, the thing with the Pill isn’t really publicized – it’s like doctors don’t know or don’t care that it isn’t as effective…. I know which one I believe is true in most cases.

  18. alison
    Posted July 9, 2007 at 4:53 pm | Permalink

    OMG! I forgot about the NuvaRing!

    Yep, tried that too, but I was really nervous to insert it “too far” so prolly wasn’t doing it right.
    My husband kept ‘hitting it’.

    lol…sorry, I had to go there…

    What a joke. I just wasn’t savvy enough with it.

  19. Baconsmom
    Posted July 9, 2007 at 5:25 pm | Permalink

    FAM actually works well for irregular cycles; I should have mentioned that. Just in case anyone else was interested, too.

  20. Posted July 9, 2007 at 7:10 pm | Permalink

    I’d heard that. I’ve been on Pills of one kind or another for about eight years, most of which I weighed between 200-250 lbs and was on a low-dose pill. I had to switch doctors when I finished college, and my new doctor put me on a higher dose because of my weight. I don’t know that I’m happy with the dose because I get migraines on my off week (which, I think, is the same reason I switched to a low-dose pill to start with). The only pregnancy scares I had were in a year that I was off the Pill entirely.

    No idea if it’s because of metabolism, weight (if my doctors took BMI or body fat percentage into account, they didn’t tell me), body type, or fertility.

  21. Posted July 9, 2007 at 7:54 pm | Permalink

    Wow, actually I never knew the pill’s effectiveness to be lower the higher one’s weight. According to the statistics Paul cited, I fall right in line with the percentage of women for whom the pill might be only 60 percent effective for. You would think, the two doctors who prescribed me the pill in the past might have told me this. Or, at least I should expected them to have informed me.

    I’m still convinced the pill causes weight gain so I won’t take it. Disordered thinking prevails still. The boy and I use other means and so far we’ve been lucky.

  22. Posted July 9, 2007 at 10:41 pm | Permalink

    I find it kind of ironic – half the doctors are telling us fat women that we can’t get pregnant because we’re so fat, and the other half are telling us we’re more likely to get pregnant even on the Pill because we’re so fat.

  23. GiniLiz
    Posted July 10, 2007 at 3:46 am | Permalink

    Rachel, a point of clarification, it is not that the pill is only 60% effective for us. It has a 60% reduction in effectiveness. That still leaves it well over 98% effective. It’s amazing how medical reporters choose to word their statistics to be scarier and play up on the “obesity crisis,” isn’t it?

  24. Posted July 10, 2007 at 7:38 am | Permalink

    Whoa! Less effective for fatties? For rizzle? Uh-oh…

  25. Posted July 10, 2007 at 8:18 am | Permalink

    There was some discussion about the pill on the Fat Studies list awhile back, but I’m not sure we got to the bottom of things; I’ll have to go back and check.

    The Planned Parenthood doc here has been the only one to tell me of these things. I was on Depo when I moved here, and the PP doc told me you should not be on it for more than 2 or 3 (I can’t remember which) years, which I had, and you shouldn’t be on it if you are over 200lbs, which I was.

    When I finally got a primary phys, she did my checkup and prescirbed some other form of the pill that I was on for a year. Recently, I went back to PP for this because my insurance was all out of whack and they had walk-ins. The PP doc then told me she didn’t know why my doc had me on those, that I needed something with a higher dose because it gets absorbed into fat and can be less effective.

    I think at the Fat Studies list we were attempting to understand how the fat absorption thing would work. Personally, I’m not really concerned about the tidbit less affectiveness (also haven’t gotten prego, and imagine if I did I’d be a bit more concerned about the effectiveness thing)…but perhaps there are some pills/dosages that are better for some since the PP doc switched me. I am just above 300lbs and am on Microgestin Fe 1.5/30

  26. abs
    Posted July 11, 2007 at 3:33 am | Permalink

    I have a slight warning on the Depo shot.
    A close friend of mine got pregnant while on the shot. To cut a long story short, she has a very large firm butt, and her doctor was mistakenly injecting into fat, not muscle, which can interfere with the delivery of the hormones.
    It can be worth remembering that doctors seeing a beautiful firm ass don’t always think about what it’s made of, so if you are lucky enough to have one, remind them gently.

    Re: withoutscene’s comment, I was on the pill at 210lbs for a while, until a Dr noticed and recommended an Implanon. It happened because I’m 5’11”, and 210 on me doesn’t ‘look fat enough’ to trigger every practicioners’ fat-dar.

  27. Posted July 11, 2007 at 8:55 am | Permalink

    IUD, I tell ya. I can’t take hormonal birth control for un-fat-related reasons (autoimmunce disease that doesn’t care for the hormones), but I’ve had my IUD for nine years, and I love, love, love it. It’s coming out on Friday because the sweetie and I are going to try to breed, and I’ll miss that little paperclip!

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