Birth Control for Overweight Women

5 Best Surgical and Non-Surgical Contraceptive Options

There are several factors that can compromise the effectiveness of your birth control. One of these is weight. Being overweight or obese can cause your body to metabolize the drugs far faster than normal, rapidly clearing them from your system and lowering the amount of active drug in your bloodstream.

This can undermine the protective benefit of certain hormonal contraceptives including as the pill, Nexplanon, and the patch. To ensure this doesn't happen, there are a few things that you can do.

Tubal Ligation

Tubal Ligation
Science Picture Co./Getty Images

Tubal ligation is a permanent method of birth control. Often referred to as "having your tubes tied," it is a surgical procedure designed to close off the fallopian tubes. Once the tubes are sealed, the sperm will not be able to reach the egg. It is one of several surgical sterilization techniques.

While there is no evidence that your weight will compromise the effectiveness of a tubal ligation, the surgery itself is often more difficult to perform. In this population of women, the surgery usually takes longer, requires more anesthesia, and is more prone to post-operative complications.

To minimize risk, doctors will often recommend a less-invasive laparotomy (keyhole surgery) if you are obese or overweight.

Essure

Essure-Inserts.jpg
Essure micro-coils. Dawn Stacey

An alternative to surgical sterilization is the Essure procedure (also called known as hysteroscopic sterilization). This permanent birth control method involves "plugging up" the fallopian tubes to prevent fertilization.

This is an effective birth control method for obese and overweight women as it can be performed 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. Once implanted, the coil implants will trigger the development of scar tissue which eventually blocks the tubes

Intrauterine Devices (IUDs)

IUDs
Mirena IUD. Saturn Stills/Science Photo Library

Intrauterine devices (IUDs) such as ParaGard copper IUD and Skyla levonorgestrel-releasing IUD are a very effective means of birth control in overweight women.

The only real complication may be the actual insertion of the device. If you are obese, it can sometimes be difficult to locate the cervix or determine the size and direction of your uterus. Your doctor can usually overcome this by using an ultrasound and other special equipment to help guide the IUD insertion.

Research also suggests that IUDs may be the safest and most effective means of birth control for obese women. IUDs may also help reduce the risk endometrial cancer and hyperplasia, conditions to which obese women are more vulnerable.

Depo subQ Provera
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There is a newer version of the original Depo Provera shot known as Depo-subQ Provera 104. This non-permanent form of birth control has 31 percent less hormone that the previous version and, as a result, a lower incidence of adverse side effects.

It is also injected beneath the skin as opposed to in the muscle. Shots are delivered quarterly, or every 12 to 14 weeks.

Depo-subQ Provera 104 was shown to be effective in obese women in two different studies. However, the one major downside is that the drug is known to cause weight gain, a major consideration if you are already struggling with weight control.

Another consideration is that it can take an average of nine and 10 months to fully restore fertility once treatment is stopped. In heavier women, it may take even longer.

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Barrier Birth Control Methods

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A diaphragm with a spermicidal gel. Jules Selmes and Debi Treloar/Dorling Kindersley Collection/Getty Images

A barrier birth control method is a device that physically blocks sperm from entering the opening of the uterus. Although these contraceptives can be very reliable, they need to be used correctly. Failure is most often associated with improper or inconsistent use rather than a problem with the product itself.

Barrier birth control options include male condoms, female condoms, spermicides, the sponge, diaphragms, and the cervical cap.

You can further increase the effectiveness by using a double barrier method, such using a condom with a spermicide or a diaphragm with a condom. If uncertain how to use a product, speak with your doctor or ask your pharmacist.

Sources:

Batur, P.; Bowersox, N.; and McNamara. M. "Contraception: Efficacy, Risks, Continuation Rates, and Use in High-Risk Women." Journal of Women's Health. 2016; 25(8):853-856. DOI: 10.1089/jwh.2016.5942.

Reifsnider, E.; Mendias, M.; Davila, Y. et al. "Contraception and the obese woman." J Am Assoc Nurse Pract. 2013; 25(5):223-233. DOI: 10.1111/1745-7599.12011.

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