In the brave and daring new Hulu series “Shrill,” leading lady Annie (played by Aidy Bryant) learns that, much to her shock, she is pregnant. She’s especially surprised to find out she’s pregnant despite having taken the morning-after pill after hooking up with her beau.
Annie is even more horrified to learn that the popular over-the-counter emergency contraception known as the Plan B pill is significantly less effective for overweight women like herself.
This news came not only as a major surprise to our heroine but undoubtedly to plenty of viewers who were learning this fact for the first time right alongside her. In fact, according to a 2014 study, the “levonorgestrel 1.5 mg, (Plan B pill) loses its potency in women weighing about 165 pounds and does not work at all in women weighing 175 pounds or more.”
The study also points out, “Women with a body mass index (BMI) of 25 or higher experienced decreased efficacy, and the pill stopped working entirely in obese women with a BMI of 30 or higher.”
Those are some pretty disheartening numbers when you consider that 59.8 percent of adult women are considered overweight in the United States. So, what, if any, are the options for overweight adult women who need access to effective contraception?
Why IUDs Are a Good Option for Overweight Women
While Plan B is easily accessible (there is no prescription needed) and arguably the most well-known, if you are worried about possible ineffectiveness due to your weight, there are alternatives.
“There are a few types of emergency contraception, and some work better than others. It’s best to use the most effective method of emergency contraception you can to prevent pregnancy after unprotected sex,” says Courtney Benedict, the Associate Director of Medical Standards Implementation at Planned Parenthood Federation of America.
Benedict suggests the copper IUD, known as ParaGuard, and says it is “the most effective form of emergency contraception—no matter how much you weigh.” She isn’t the only one to recommend the copper IUD, which Benedict says “lowers your chances of getting pregnant by 99.9 percent.”
Kathryn Garren, WHNP-BC, of Ideal Gynecology in Atlanta, explains, “It has to be inserted within five days after unprotected sex and…it provides up to 10-12 years of contraception if desired, but is reversible and can be removed at any time.”
Copper IUDs or hormonal IUDs (such as Mirena and Liletta) “help to thicken the cervical mucus and thin the lining of the uterus making it very difficult for sperm and egg to reach one another,” Garren explains. Benedict says that hormonal IUDs can last up to 3-12 years, depending on which kind you get.
When it comes to IUDs, Benedict notes that you may experience cramping or backaches when the IUD is first inserted, “However, these side effects will usually go away in about 3-6 months, and pain medicine can usually help with any cramping.”
While the IUD is a highly recommended choice, Garren acknowledges, “The copper IUD is also less convenient than emergency contraceptive pills that are readily available at most retail pharmacies without the need for a prescription.”
“The copper IUD can also be costly for women without insurance. At a standard GYN office, the cost can be upwards of $1,000,” Garren says, adding that if this is an issue for you, places like local health departments and Planned Parenthood typically offer for less than half of this cost.
More Alternatives to Plan B for Overweight Women
In addition to IUDs, another Plan B alternative is an anti-progesterone pill called Ella, which contains ulipristal acetate. Benedict says Ella “works better in people who are of higher weight and maintains effectiveness up to 120 hours after unprotected sex.” However, you do need a prescription from a doctor, nurse, or pharmacist to get Ella.
If you have had unprotected sex or your protection method has failed and you don’t know what to do next, Westberg says the best thing you can do is to “reach out to a health care professional—either an OB-GYN provider, primary care, or your pharmacist—to discuss the situation.”
“The health care provider can help assess the potential likelihood of pregnancy and recommend next steps most appropriate for the individual woman,” Westberg says.
Other Things to Consider When It Comes to Emergency Contraception and Pregnancy
Pregnancy, as Benedict notes, doesn’t happen right after you have sex, which is why it’s possible to prevent pregnancy a few days after. But, as she points out, “Any form of emergency contraception can only work to prevent pregnancy up to five days (or 120 hours) after unprotected sex.
Dr. John Thoppil of River Place OB-GYN in Austin, adds that when it comes to pregnancy, “The timing related to peak fertility still matters. In other words, if you have sex the day before ovulation without protection there is a 4x higher chance of pregnancy than other days.”
So, whether you’re overweight or not, the morning-after pill is not equally effective across all fertile days. Because, as Benedict notes, “Birth control is not one-size-fits-all.”
Still, whether you are using IUDs or taking other forms of morning-after pills that contain levonorgestrel, Benedict says “it’s important to keep in mind that emergency contraception is safe. Millions of people have used different kinds of emergency contraception for more than 30 years—there have been no reports of serious complications.”
While emergency contraception like Plan B (which is not the abortion pill) is readily available, Sarah M. Westberg, Pharm.D., FCCP, BCPS, the Co-Associate Dean at the University of Minnesota College of Pharmacy says that in addition to having an understanding of all these options, she encourages women to “have an ongoing plan for adequate contraception long term as much as possible to prevent the need for emergency contraception. It’s always better to be proactive rather than reactive.”