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Why Your Birth Control Pill May Not Be Working (And What Your Doctor Isn’t Telling You)

Posted Dec 10 2013 1:34am


 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 – 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?


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