There are several factors that can compromise your birth control method's effectiveness. One characteristic that could cause birth control failure is a woman's weight. Obese or overweight women may not realize that their weight may be making their birth control method less effective. Research on available birth control methods usually does not include obese and overweight women in clinical trials. Because of this, there is a limited amount of information regarding birth control method effectiveness in overweight and obese women.
Even though there is evidence to suggest that hormonal methods like the pill, Implanon and the patch may be less effective in obese women, several methods have been shown to be effective alternatives if you are overweight.
Tubal ligation is a permanent birth control option. Often referred to as having your tubes tied, this is a surgical procedure that closes off a woman's fallopian tubes. Once the tubes are sealed, sperm will not be able to fertilize an egg, so pregnancy can't take place. There are several types of surgical sterilizations.
There is no evidence to suggest that your weight will compromise the effectiveness of a tubal ligation. However, tubal sterilization procedures can more difficult in obese and overweight women. They are usually also associated with longer operating times, more anesthetic and surgical complications, and prolonged hospitalization. Typically, if a woman is overweight, her doctor may suggest she undergo a laparotomy (open tubal ligation) procedure.
Essure and Adiana
An alternative to surgical sterilization is hysteroscopic sterilization. This birth control method is also permanent and involves "plugging up" the fallopian tubes to prevent fertilization. This is an effective birth control method for obese and overweight women. This may be the safest sterilization procedure for obese women because it can be done without general anesthesia and doesn't require entrance into the abdominal cavity.
With Essure, two small metal springs (known as micro-inserts) are placed in each fallopian tube. Over time, the coil implants will trigger scar tissue to grow around them and permanently block the tubes.
With Adiana, two tiny, soft inserts are placed inside your fallopian tubes. The inserts stimulate your body's own tissue to grow in around them, completely blocking the fallopian tubes.
The ParaGard (copper) IUD, as well as Mirena (levonorgestrel-releasing) IUD, are both very effective birth control methods for overweight women. The only issue regarding IUD use has to do with the IUD insertion. In a very obese woman, it may be more difficult to locate the cervix and determine the size and direction of the uterus. Your doctor can overcome this challenge by using special equipment or ultrasound to assist in the IUD insertion.
Research appears to indicate that IUDs seem to be the best and most effective birth control method for obese women who have no conditions or factors that make this procedure inadvisable. Additionally, as obesity is a risk factor for endometrial cancer and hyperplasia (when the lining of the uterus or endometrium grows too much), one noncontraceptive benefit of ParaGard and Mirena is that they can both help lower these risks.
This is the newer version of the original Depo Provera shot and is a reversible birth control method. The Depo-subQ Provera 104 injection slowly releases 104 mg of medroxyprogesterone acetate (a synthetic form of progesterone -- 31% less hormone than the original Depo shot). The "subQ" stands for subcutaneous, so this shot only has to be injected under the skin (not into a muscle). You'll need to have an injection four times a year (every 12 to 14 weeks).
Two major studies on Depo-subQ Provera 104 reveal that none of the obese women in one study who used this birth control method became pregnant. The other study showed that the median medroxyprogesterone levels of the study subjects remained above the level needed to prevent ovulation, even in overweight women.
One common issue with Depo Provera use, regardless of weight, is that it can take an average of 9-10 months (or even longer) to regain fertility after receiving your last shot. It is now believed that how long ovulation is suppressed after stopping Depo Provera is related to weight. That means it may take overweight women longer to ovulate/conceive once discontinuing Depo Provera than women with lower body weights.
A side effect of Depo Provera is weight gain. This may worry obese or overweight women. Research has found that obese and overweight teens gain more weight when using Depo Provera than when using other birth control methods, whereas a study in adults showed that normal and overweight women gained weight with Depo Provera but obese women did not.
Barrier Birth Control Methods
If properly used, these birth control methods should be effective in obese and overweight women, and because they have no hormones, barrier methods typically have fewer side effects.
A barrier birth control method is a device that physically blocks sperm from entering the opening of uterus. Though these contracpetives can be very reliable, they are dependant on correct usage. Because of this, barrier methods may be more prone to user-related contraceptive failure (due to not being inserted correctly, at the right time, etc).
Making sure that these methods work as effectively as possible is even more important given the fact that obese and overweight women are at greater risk of pregnancy-related complications. You can increase the effectiveness of these birth control methods by using a double barrier method (such as a condom and spermicide or a diaphragm and a condom -- but NOT male and female condoms or two condoms).
Barrier methods include:
Where to Purchase These Birth Control Methods?
Prescription methods, such as diaphragm and cervical cap, need to be fitted by your doctor. IUDs, Essure and Adiana all require a medical professional to insert. The Depo-subQ Provera 104 is provided as an injection at your doctor’s office or family planning clinic.
Over-the-counter methods can usually be found in the family planning aisle at your local grocery store or convenience/drug store.
You can also buy them online:
Edelman, Alison and Kaneshiro, Bliss. "Contraception counseling for obese women." UptoDate. Accessed May 2011 via private subscription.