Ah the good ol’ days! I’m surprised they didn’t include a stork net in there too!
“Did you know about this??” I emailed one of my editors.
“Um, NO! I was just going to e-mail you about it!” She replied almost immediately.
“I’ve never heard this either!” my other editor chimed in. “It’s crazy!”
“WHY HAVE WE NEVER HEARD OF THIS BEFORE?!” all three of us collectively e-screamed. (E-screaming, it’s very dramatic and not just for teens anymore! Try it. Nothing bonds people in different time zones like a coordinated capsy freakout.)
So what was all the hue and cry over? Birth control. They immediately assigned me the story because – and you may have noticed this – I’m pretty much the go-to girl for gynecological research issues these days for Shape. In the last two months alone I’ve done nine articles on various “down there” topics – which makes me happy because being a possessor of lady bits, I’m deeply invested in the subject.
Normally I’m not overly surprised by the research but this time it really threw me. Specifically it was the announcement by HRA Pharma, the European manufacturer of the Plan B one-step emergency contraception, that it will be adding a box warning telling women that Plan B is less effective for women weighing over 165 pounds and not effective for women weighing over 176 pounds.
Now, I’m not a user of Plan B and never have been but it’s the same hormones used in the regular birth control pill. And I’ve been a regular, if not very satisfied, user of hormonal birth control for nearly two decades now. And if there was any possibility that the pill was compromised by weight – and let’s be honest 165 pounds is really not that much and isn’t even considered overweight for taller women – why had I never heard of it in all those 20 years?
As I interviewed expert after expert in the field two startling facts quickly became apparent:
1) Hormonal birth control pills don’t work well for women over 165 pounds (and it has nothing to do with BMI or fat vs muscle or where you carry your weight – it’s strictly a mass issue).
2) This is not new news. Every doctor and researcher I interviewed agreed: They all knew this. The drug manufacturers know this. It’s even referenced in the dosage guidelines in the paperwork that comes with the pill packs, albeit in a rather oblique way.
“It’s been well-known for many years that hormonal birth control pills don’t work as well for women with higher weights,” explained Robert Grossman, MD, a practicing OB-GYN at Las Robles hospital in California. “Unfortunately the reality is most OB-GYNs don’t discuss this with their patients. It’s a very uncomfortable conversation to have,” he says. In addition he says a lack of other options – you’re left with IUDs or surgery – make it hard for doctors to offer different methods for overweight patients.
Another reason Grossman says patients may not have been informed of the possibility of their birth control failing due to their weight is that some doctors simply may not know. “FDA studies generally exclude the obese, by practice. They choose populations with no existing issues to control variables and get ‘cleaner’ data,” he says. “So often this type of information doesn’t come out until ‘after-market’ studies at which point you have to really look at the data to understand which patients are susceptible to which side effects.” This is a time consuming process that many doctors just don’t have the time to devote to. He adds that most pharmaceutical companies, in a CYA move, will simply slap a “not evaluated” for patients over a certain weight label on the pills and let doctors draw their own conclusions.
The reason the hormonal pills lose their effectiveness at higher weights is because of the way heavier bodies metabolize the drug, making it diluted in their system, explains Sheryl Ross, MD, an OB-GYN at St. John’s Health Center in Santa Monica. If a patient insists on a birth control pill Ross advises one with an estradiol dose greater than 30-35 mg. (But the higher the hormone dose, the greater the likelihood of side effects.) However, both Ross and Grossman insist that for overweight or obese patients, the best option is an IUD (intra-uterine device) like the Paragard or Mirena. “If there’s one thing I’d really like women to learn from this it’s that this is yet another reason why more women should look into IUDs,” Grossman says, adding that according to research they’re the most effective method of contraception for all women, regardless of their weight.
“This is a very timely conversation in regards to how our society needs to deal with the obesity crisis,” said Ross. She points out that for women in their 20’s and 30’s – the most fertile years and therefore the ages most likely to be using the birth control pill – the average weight of a US woman is 166 pounds (186 for African American women), and therefore this new warning will affect a majority of American women. In addition, as reports of side effects like nausea and mood disturbances have increased, Ross says drug makers have responded by lowering the amount of estrogen and progesterone in the pills to mitigate the problems. But an unintended consequence of the popular, new lower-dose pills on the market (like Yaz) is that there is even less of the drug, meaning an even greater risk of failure for overweight or obese women.
And yet apparently nobody is telling us women that.
This seems like pretty pertinent information to have frankly. Even if it is an “uncomfortable” conversation to have. Having control over whether or not we be bun-baking is pretty integral to a woman’s sense of comfort and safety, in my opinion.
You all know I’ve been pretty burned by hormonal birth control in the past. Even though I do fall below the weight limit I’ve still not done well on the dozen or so different varieties of pills I’ve tried, mostly because I’m apparently very sensitive to hormones and any altering of their levels changes my moods drastically. So I guess I shouldn’t have been so surprised by this (not so) new development.
So what does that leave me with? Again, I guess it comes back to the old stand-bys: barrier methods (like condoms and diaphragms), the copper IUD or Natural Family Planning. In the past I’ve kind of mocked the latter. When I was growing up the “rhythm method” was called the “oops baby method” but apparently it’s been unfairly impugned. According to a 2007 study of over 900 women, a type of NFP – called the symptothermal method because it gauges fertility based on the woman’s basal body temperature and cervical secretions – is as effective as the pill when done correctly.
Of course it’s the “done correctly” part that brings out the real fun and games. I’ve actually tried this method, albeit in reverse as we used it to figure out when I was ovulating when I was having difficulty getting pregnant. It definitely worked! But boy did it require some intimate knowledge of myself that I had not planned on! The first step requires you to take your body temperature with a thermometer (I used an oral one but you get as adventurous as you like!) every single day upon waking. And then you have to write it down on a chart. When your temp goes up by a degree, you’re ovulating. The second step has you monitor you cervical mucous. The book I read – Taking Charge of Your Fertility – suggests actually sticking your fingers up there and poking your cervix. It’s been years but I still remember how they described a “firm cervix” as feeling like “pushing on the tip of your nose”, a soft cervix as feeling like “pouty lips” and fertile mucous feeling like “sticky egg whites.”
Someday when you’re bored, go sit on the toilet with your hand half-way up your hoo-ha and let me know how long it takes you to figure out if what you’re poking feels like a nose or lips covered in egg whites. I spent way more time than was probably prudent trying to figure out if my cervix was more ear-lobey or nose-tippy that day. But, like I said, it did work for us. And from friends who use this method it seems like as long as you stay super vigilant about it then it works really well. Plus it has no side effects, is not effected by weight or body mass and doesn’t require a monthly trip to the pharmacist where I always talk myself into buying a crap-ton of random supplements from the attractive displays.
But back to the pill – Ultimately, Ross says, “They call it Plan B for a reason! Every woman, regardless of her weight or circumstance, needs a Plan A.” Which apparently isn’t the pill anymore for many women.
So what’s your Plan A for contraception? Was anyone else surprised by the weight limits for the pill – or am I the only one who’d never heard that before?? Anyone else not tolerate the pill well? And in other slightly related news: The male birth control pill is a step closer to becoming reality with some scientists say it could be on the market within several years. Uhhh… welcome to the club, dudes?
Yeah, I knew about this research.
It’s maddening that this information isn’t readily disseminated to women going on various forms of birth control. Seriously, doctors have to give vitally important information like this to their patients–stop wussing out of “hard” conversations! Find a way to talk about efficacy without being a douchebag!
RAWR.
ps (Suggestion for you (which I’m also looking into)–have you considered Implanon?
http://www.implanon-usa.com/en/consumer/index.asp
It’s good for three years, and can have fewer crazy-ass side effects, since it’s just progestin instead of estrogen and progestin.)
pps (Also, I found out that Plan B cannot prevent pregnancy from an already fertilized egg–it simply makes it more difficult for the sperm to both reach and implant an unfertilized egg. I found that to be a weight off of my mind.)
Good to know about Plan B! And yeah, I’ve looked into Implanon but ultimately I’m trying to stay away from all synthetic hormones all together – I think it’s safer for everyone that way;)
I heard this info years ago – when I weighed around the 165 mark funnily enough. And it was indeed a factor that made me decide that was the time to lose weight.
However it was never ever mentioned by my doctor, I read it in a newspaper. Consequently I didn’t give it much credence, because there was a chance it was made up/flawed study etc, but did note it as another possible reason why being a healthy weight is a good idea.
It should definitely be something doctors mention – and it should be in the packet info too.
Does this only apply to the pill? What about the shot?
I actually don’t know about the shot. My experts didn’t mention that one at all! Sorry:(
Wow I can’t believe I never knew this either! 165 is not that heavy! I know heaps of women who are on the pill and easily that weight or more. I can’t handle it as it makes me insanely depressed!
Wow you would think the info about the weight would be super important to tell women on the pill because clearly they are trying to NOT have a child! That’s a life changer right there. I am amazed this is info is rarely disclosed.
I’ve never, ever heard of this and I’m shocked! What seems particularly frustrating is that most of us put up with some side effects of the pill because it seems worth it, but if it’s not going to work, it’s obviously not worth it.
Is it truly metabolized differently, or is it just a matter of adjusting the dose for different sizes? Seems pretty dumb to me that doctors (and the companies that make the pills) don’t consider this. I bet veterinarians weigh their patients before prescribing a dose of anything.
It seems to be a matter of scale up to a point. When I asked the doctors about titrating the dose they said that is only effective up to a certain weight. Not sure why exactly…
I will just tack this on to the list of “Things I Wish My Doctor Had Told Me Before Going on the Pill”. (This hypothetical list is about 3 pages long now!)
I know, right?? I went on the pill in such a blissful state of ignorance.
And on the flip side, I hear all the time women saying their doctors don’t want to give IUDs to women who haven’t had any children, leaving the 165+ pound woman who’s never given birth between a rock and a hard place if the pill and the IUD are the two primary methods.
I’m actually a big fan of the diaphragm – no hormones, allows for a little more spontaneity/lack of interruption than a condom since it can be inserted somewhat in advance of the action, etc., (effectiveness rates aren’t as great as other methods, but it can be combined with NFP or condoms for more effectiveness if pregnancy would be a major problem rather than “we’d rather not right now”) but it seems to have fallen out of favor.
I have had the copper IUD (Paragard) for almost 3 years and (mostly) love it. I refuse to use hormonal birth control for a multitude of reasons and we just weren’t being diligent enough about barrier methods. My suggestion to nulliparous (no children) women who want an IUD, or at least want to have a real conversation with their OB-GYN about it: find a good, progressive OB-GYN who has performed a lot of IUD insertions, both on parous and nulliparous women. It’s nonsense that some OB-GYNs will talk their nulliparous patients out of IUDs or will outright deny to insert one and it’s likely due to under-education on the topic and lack of experience in insertion.
My former OB-GYN was amazing and when I explained my history of disordered eating and bouts with severe depression he told me that he would never suggest hormonal BC for someone with my history. Another thing to consider is that non-hormonal IUDs are the most common form of BC in most of the rest of the world. There are many varieties outside of the US, while the US has exactly 1 FDA-approved non-hormonal IUD (Paragard). The US is very pharmaceutical driven.
There are side effects with the Paragard, mostly more intense cramping. As I understand, this is much less a factor for women who have already had children. Also, while my cramps are worse with Paragard, my sister, who is also nulliparous, hasn’t noticed much of a change since she had hers inserted. All in all, I’m happy with my decision. It’s there, I don’t have to think about it, and I would rather deal with cramping than with mood swings or weight gain.
And no, I’m not even a little bit surprised that most forms of hormonal contraceptives are less effective in heavier women. Why haven’t OB-GYNs been telling their patients this? They probably weren’t aware of it. They will be now and hopefully they will adjust their practices accordingly.
Love the copper IUD, I’ve had it both pre and post baby (I should probably clarify, I had it removed so that I could get pregnant then had another one placed postpartum, I didn’t get pregnant with it in place 🙂 Zero side effects for me, I tell anyone who asks how great I think it is.
After being on the pill for 15 years (except for when pregnant, obviously!), we decided to switch to NFP after our 3rd baby because of 2 rounds of postpartum depression. Just trying to avoid any extra hormones that could possibly be contributing to depression. And so far, I’m loving NFP! Took awhile to get into the temperature-taking routine, but now it’s as much second nature as taking a pill every day was – and of course there’s an app for tracking, makes it super easy. I don’t do any cervix-poking, but I do observe cervical mucus, and can usually tell when my fertile time is mostly by that; we do use a backup method during that time of the month! I wish I had been taught more about how my cycles actually work when I was younger, I definitely have a better appreciation for how my body works now.
I can’t take hormonal birth control. About 6 weeks into it I end up suicidally depressed and crying all the time. I did the Paraguard IUD for many years and loved it. It does make your periods slightly heavier but to me, that was a better alternative to uncontrollable sobbing in the line at Costco. I had to have my IUD removed a few years ago because I had a large ovarian cyst that had moved it out of position. We were using condoms religiously while I waited to be able to put it back in and one broken condom and 9 months later we welcomed our twin boys into the family. I made my husband go get snipped pretty much right after I gave birth.
I had no idea there was a weight limit for the pill! Or that it was so low. It kind if ticks me off that doctors have avoided this conversation because it’s “uncomfortable.” When you’re a professional charged with advising a patient about her health, you don’t get to bow out because it’s uncomfortable. In that kind of profession, it’s part of the job.
I have been obese basically my whole life and no Dr has ever told me that the pill would essentially be useless for me! Seems I may have dodged a bullet because the time I was on the pill I was in a (albeit very short-lived) exclusive relationship with someone who had been tested and was disease free so we didn’t use condoms once I’d been on the pill for a month or two.
As it turned out I developed clots a few months after and had to be hospitalised, and being on the pill that time ended up leading to the discovery that I have this genetic blood disorder which means I absolutely cannot take any form of hormones, so the pill is not an option for me at all. Interestingly enough, since I am tall, even the time I was at my lowest weight and was described as “boney” by people who hugged me, I was still in the 170s lbs range so even without my health issues it doesn’t sound like the pill would ever be viable for me anyway.
I am back to NFP which I had used to great success in the past…when you pay attention to your trends I was able to know the exact day my period would start, which is my main purpose for using the method in the first place, lol. The first thing I do before truly awake is reach for the thermometre.
I have sometimes wished for a diaphragm, but have worries that I would not insert it properly to disastrous results. But mainly, since I am a single girl not in a relationship who is rather sexually active, for me it is condoms, ALWAYS condoms anyway. The Drs have told me that with my health issues I should not reproduce and since I don’t want to risk having to make the decision to get an abortion I tend to be dilligent and be extra careful during fertile time. Interestingly, I find that not being on the pill can be a big help in keeping me from having to seriously put my foot down and make a scene when guys insist on trying to sweet talk me into forgoing the condom (since so many men prefer intercourse without them). The convo before sexytimes usually goes something like:
me: you need to wear a condom
him: aw, it’s okay…I’ve been tested, I’m clean
me: I’m not on the pill.
him: Oh *pause* …where are the condoms?
I have discovered that nothing startles some sense into a frisky man better than baldly asking, “Do you want to have a baby with me? No? Then let’s use a condom, kthanx”. Of course once in a while he’ll return with, “I’ve had a vasectomy”, to which I have to reply, “Good for you! Still gotta wear a condom though!” Sorry boys, comdom or GO HOME!
I was always aware that bigger women could not take the pill. and I actually spoke about it with a friend on the phone the other day. Her doctor told her she was too big for the pill. Then again, it might be the difference between the French, UK, Canadian systems I experienced and the US system.
165lbs is not a lot though, especially if a woman is tall!
Myself, I stopped the pill 3 months ago and we are using the natural fertility awareness method. And so far it’s been the best decision I have ever made.
http://healthyfrenchie.wordpress.com/2013/12/05/no-pill-3-months-on/
I started to see stars reading this post: who decided that women who weight more than 165 are OBESE???? I am 5’11” and if I weighed 165 I would be of a completely normal weight, not overweight AT ALL. Some of us are simply tall, and therefore weigh more.
I actually did read an article years ago that talked about this–it was maybe ten years ago. I went off the pill mainly for other reasons, but that was certainly one of them: why suffer the side effects I was having for something that might not even truly be effective?
The other part of me says, well, even if I were overweight, I still deserve effective birth control and since, yes the average woman weighs more than 165 (and I guess ERGO IS OVERWEIGHT) we all deserve effective birth control and more studies and research are needed. And I also call BS on the “uncomfortable”. Just say this, doctors: “research shows the pill is less effective for women who weigh more than 165, like you do.” That would just be a fact, how is that uncomfortable?
Wow, that’s crazy that I’ve never heard that! I’ve been on some form of the pill for ages and no doctor ever mentioned it. You’d think they would, especially because as someone who’s tall 165 isn’t that far away. That pretty much blows my mind. Wow.
After we have our first baby I’m definitely getting an IUD. I’ve done well on most pills (though I had some issues with a generic) but having been on them most of my adult life I’m just getting bored with it.
And can I confess I’m excited to play around with temping, etc when we’re trying to get pregnant? I mostly want to make sure that I’m ovulating since I had some irregular cycles pre-pill but the idea of charts and graphs is oh so exciting. I’m such a scientist at heart!
I knew that, I thought it was common knowledge.
I guess this just proves it. I’m super smart.
Actually, I think my doctor said years ago in sort of an offhand way “and you’re way under the weight necessary for this to work so you should be fine” and I wondered what he meant so I googled it.
Wow, I’m blown away that more women weren’t aware of this! I read about this YEARS ago in Cosmo magazine…years before I ever went on birth control. Once I weighed more than 165 (about a year into college), I made sure to use two forms of birth control (pill + condom) at all times, knowing my pill alone may not be effective enough.
As a commenter mentioned above, many women over 165 who haven’t had children are being turned down for IUDs. I hope those women find another doctor because my doctor simply did an ultrasound to measure my uterus to make sure the IUD would fit since I’ve never had kids.
The fact that many doctors are uninformed is scary because we depend on them to KNOW about these things and guide us toward the right decision. Thank goodness for the internet, right??
Uhh So what your saying is during the entire 5 years that I was prescribed the pill by my doctor and used the pill strictly for birth control and weighed over 180 minimum I was not protected!! As it happens I found out years later that my partner was sterile, but what happened to the 99.9% possibility you would not get pregnant on the pill. Most women I know depended on that number.
For my plan A it’s mostly been the withdrawal method. I know, I know. Everyone sees that as irresponsible, “The old pull and pray eh?” Actually for us it’s been perfect. We have two (planned) kids 4 years a part, I don’t have to be on hormones, there’s no pre-planning, it’s less mess for me, etc. All it really takes is my husband knowing HIS body cues. I trust him and know he’s not trying to “slip one past me” (we’re in a loving, committed relationship so really an “oops” wouldn’t be the end of the world). And isn’t that how it is with all birth control methods anyway? You have sex and hope your birth control works but, as we know, nothing is really 100% so you have to be able to handle what comes next. I always plan to get something more permanent because my OBGYN is so shocked at our method but it’s just been so convenient and effective so far (10 years!). I know it wouldn’t work for a lot of people (religious reasons, ick factor reasons, “it might ruin the moment!” reasons) but there it is, you asked. 😉
I found the withdrawal method fine for the 2 years before menopause. The risk of pregnancy is so low at that point anyway, and my partner preferred it. I have read that there is no sperm in the pre-ejaculate, so if you have a careful partner you should be fine.
Also, I think the diaphragm gets a bad rep because so many women who use it don’t bother to use it when they have their periods. At least that’s how several of my college friends got pregnant. I had to stop using one when I became latex sensitive, and switched to non-latex condoms. I tried progestin-only pills, since I could not take estrogen, but those really messed with my cycle. So eventually withdrawal was my method with my trusted partner. My doctor definitely did not approve.
I’m not sure how well NFP would work for younger women who sometimes ovulate spontaneously after orgasm.
I was on the pill forever (14+ yrs) until I had to go off all hormones when I recently started fighting my breat cancer. I now have a copper IUD and wish I had gotten it years ago.
I had no idea weight was a factor with the pill…but it totally makes sense that it would.
I had no idea there was a weight limit(!), and I’m pretty up on all things medical…I can’t do hormones; they mess me up. We mostly use the withdrawl method, combined with my knowledge o when I ovulate (I get mittleschmerz, my geographic tongue goes wacky, and cervical mucus changes) and we’ve only had 2 ‘whoopsies’ in 15 years…so that’s pretty good. (And what amazing, cute, lovely whoopsies they were!) I wonder how much less effective the pill is when you’re over 165? Like, not at all or just less so?
I heard about this in a news article earlier this year. I’ve been using the pill for about four years now, and none of the four doctors that I saw throughout that period ever mentioned the weight issue to me. I wasn’t at a weight where it would affect me, but I was close! The idea that a doctor wouldn’t discuss something like that with me because it may be “uncomfortable” absolutely infuriates me. It’s also disturbing! I want my DOCTOR to discuss everything uncomfortable with me! I’ve actually also heard this reason given for why fewer and fewer doctors even discuss diaphragms with patients. At the very least, the pharmacy could put a sticker on my pack of pills next to the “effectiveness may be altered by certain medication” and expiration date stickers.
I had no idea at all about this, and I’m amazed. For quite a long time, I was at 170lbs, and went off and on the pill. Not one doctor ever mentioned this to me, so thankfully I was lucky it never failed on me.
I’m really sensitive to the hormones, however, so this time I decided to try an IUD. Not a copper one, I think it’s plastic of some sort. But so far, it’s awesome (well, apart from my cramps being worse). My biggest problem with the pill is remembering to take it at the same time every day, so the IUD is a massive improvement.
Well, right now Plan A is breastfeeding. I know it’s not effective for everyone, but I remain period-free for a looong time with a nursing baby (17 months after my first, going on 14 months with my second). Once my fertility comes back I’m happy with my NFP, once you get the hang of it, it’s pretty easy. But, if NFP by hand seems like too much trouble, and you can’t do hormones, have you looked into fertility monitors? They record and track your basal temperature, and I think there might be some that test your saliva too.
Thanks for your article. I’d appreciate any link that confirms your investigation and what I’ve always thought about this hormone crap. I’ve dealt with terrible menstruation cramps and extra long and hard bleeding since about 2 years ago. Every doctor I saw tells me to take a pill or another, though I have various side- effects. Knowing how a pill would not even work for me, esp. Not in birth control (and I am sooooo damn scared of getting pregnant that it almost kills me), makes it easier. I’m gonna print this text out and show it to every doctor I see about it… Though they will probably call it “US crappy stuff” they don’t wamt to read.
THANK YOU sooo much! I mean it.
PS: I NEVER understood how doctors give people medication in “average” doses. Every vet checks on an animals weight, no matter if it is a guinea-pig or a horse and then decides the dose of medication. NO human doctor does that. And over here in Germany they don’t check your hormone balance before they put you on hormones (you may check but have to pay a fortune on your own). I never understood that and ßi doubt I ever will.
PPS: I still advice women to be careful of ANY hormone- based contraception. Even Mirena can have terrible, terrible side- effects no doctor will tell them about, just because the “average woman” doesn’t have them.
Just because a women is over 170 pounds doesn’t mean she is over weight or obese as you stated multiple times. I am a women who is 6′ and 180 pounds is a perfectly healthy weight for me. But thanks for being just as bad as the main stream media ramming it down our throats that if you are not a size 2 you are overweight.
Sarah
This is why I’m a dyke.