Navigating birth control and sexual health in a larger body

Navigating birth control and sexual health in a larger body

In a time where both body positivity and body neutrality are being delved into and discussed both on social media and IRL, it is crucial to include sexual health in these conversations. We can’t ignore the fact that plus size individuals face unique challenges when it comes to navigating birth control and sexual health. One size does not fit all, not when it comes to Brandy Melville’s skimpy summer tops or birth control. Luckily, we’re here to dispel myths, talk through the best birth control options, and equip you with the knowledge you need to advocate for yourself.

What birth control is best if I’m plus size?

We’ve already established that birth control is more personal than comedy, the order you get ready in, and your favorite spotify playlist combined. However, for people in larger bodies, there are additional factors to consider when choosing a contraceptive method. 

Studies have shown that plus size women are at an increased risk for a number of side effects from birth control. A leading risk is venous thromboembolism, also known as VTE. This happens when blood clots form in your veins. There are a few birth control methods that increase the risk of VTE, including combination birth control pills (progestin and estrogen), the patch, and the ring. A heavier weight does not rule out these options, but we strongly recommend talking through any concerns you may have with a primary care provider. 

The safest and most effective birth control choices for plus size women include: 

  • Progestin-only birth control pill
  • IUD
  • Nexplanon arm implant
  • Condoms

Luckily, the progestin-only birth control pill was recently approved by the FDA for over-the-counter use. This makes it one of the most accessible options, you don’t need a prescription to get it! For answers to all of your Opill questions, check out our Q&A with a doctor. Estrogen is the component in the combination pill that leads to VTE. By taking a progestin-only pill, you minimize this risk. The only thing to note is that this pill must be taken at the same time every day to be most effective!

Implants like IUDs and the arm implant, also known as Nexplanon, are safe and effective forms of birth control for bigger bodies. No estrogen, no problem! Copper IUDs do not contain hormones, while hormonal IUDs, like the mirena, are progestin-only. Arm implants use only progestin to prevent pregnancy. 

And, of course, condoms. With proper use, condoms are safe and effective for all bodies. Condoms prevent pregnancy (and STIs!) with their barrier method. BTW, if you’re in college hit us up for free condoms!

Does the morning-after pill have a weight limit?

The FDA states that there are no concerns that would prevent someone from using levonorgestrel emergency contraceptives safely — regardless of how much they weigh. But safety and efficacy are not the same thing.

The FDA conducted an independent review of the available scientific data and studies related to the effectiveness of levonorgestrel emergency contraceptives and weight. In their review, the FDA determined that these data are conflicting and too limited to make a definitive conclusion on how weight can affect how effective levonorgestrel emergency contraceptives are. But it is important to note there are studies that suggest efficacy may decrease as body weight and BMI increase. 

If you weigh over 165 lbs or have a BMI over 25, the morning-after pill available without a prescription may not be as effective, and you may want to consider the prescription morning-after pill, ella®. If you have concerns about whether the morning-after pill is right for you, always reach out to your doctor.

While everyone — at any weight — should be able to use the morning-after pill and trust that it will work effectively, we know that this is not the reality. As a team, we’re committed to advocating for accessible emergency contraception for all and will work to offer better options to our customers as they become available. We urge the FDA to approve a higher dose of emergency contraception that is effective for all bodies, regardless of size.

No matter your weight, getting certain IUDs as emergency contraception works within 120 hours (5 days) after having unprotected sex. An IUD must be inserted by a health care provider.

Doctors, nurses, and other resources

We always recommend talking with your doctor about which birth control option might be best for you. This is why it’s essential that you have a trusted doctor who listens to you. Unfortunately, both medical weight bias and medical misogyny are common. Medical misogyny is the tendency of medical professionals to believe, consciously or unconsciously, that women, as compared to men, are inaccurate and unreliable reporters of their own symptoms. Medical professionals also may ignore health issues and attribute the problems to weight. 

If your doctor isn’t listening to you, there are steps you can take to find another doctor. Ask your friends and family if they have a doctor they like and feel comfortable with. Use your insurer’s website or public review websites like Zocdoc to see how other patients feel about doctors in your area. Use services like iCareBetter to find vetted specialists, if necessary. You can also search for additional information from reputable sources, such as peer-reviewed medical journals or trusted organizations like the International Society for the Study of Women’s Sexual Health. 

Additionally, speak with your community. We live in a world where information and experiences are available at the touch of a button, or the scroll of a smartphone. Platforms like Reddit can be a good place to learn about others' experiences with birth control in larger bodies. A quick peruse of this thread reveals hundreds of plus size people sharing what contraceptive method worked best for them. 

A National Library of Medicine published a study that concluded, “our findings suggest that women in larger bodies have unmet contraceptive needs.” More research is needed on sexual health and birth control for larger bodies. In the past 10 years, obesity in the US has increased over ten percent. This makes it more important than ever to understand the effects of birth control on all bodies, and develop options that work for everyone.

The fact that birth control and sexual health look different in a larger body should not be some dark hidden secret. In fact, it should be the opposite. Education begets empowerment. When we equip ourselves with the knowledge, we can make the best decisions for our personal health.

This article was written in partnership with Womanly Magazine.

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