Birth Uncontrol
by Audrey Ference
Dear Audrey,
I am a fat woman. I have used birth control pills since I was a teenager (I’m now in my 20s) and have never gotten pregnant, but recently I read that the pill isn’t as effective in people over 160 lbs. I talked to my doctor about it and she sort of shrugged. Should I be worried?
It seems like nobody really knows what the deal is with hormonal birth control and fat ladies. I looked into it and found one study with a small sample size that reported a higher instance of unintended pregnancy in women with BMIs over 25, but other studies hadn’t found a connection. And of course pill companies are not required to test efficacy on people of different body sizes, so nobody really knows for sure.
It makes sense on an instinctual level that larger bodies would need a higher dosage of hormone, but based on the evaluations of the studies that I read, it seems the metabolization of those drugs is extremely complex.
As I’m sure you’re aware, the general medical community’s response to questions about fat people (fat women especially) and health is: FUCK YOU FATTY LOSE WEIGHT. Unhelpfulness to the point of hostility is par for the course, and there’s a lot more I could say about this, but this is neither the time nor the place. So while brushing off your concerns is kind of a dick move for a doctor, I’m not sure there’s much more she could’ve told you.
What you do going forward will depend on how important not getting pregnant is to you. If getting an abortion/having a baby is not the end of the world, go ahead and roll the dice. Seems like you’ve been good so far. If pregnancy is not an option, you might think about an IUD (which shouldn’t be affected by weight) or condoms. Sucks that those are your only options, but medicine in general seems to give very few shits about things that don’t affect white, normative men.
Dear Audrey,
My girlfriend uses the pill for birth control. She also takes St. John’s Wort, which is an herbal anti-depressant. My friend happened to see her taking them and mentioned that the wort can interfere with her birth control. Is that for real? Now I’m freaked out.
To what extent it has been studied (a very small extent), St. John’s Wort does seem to have interactions with hormonal birth control. Of course, nobody really seems to know much about why or how or dosage or anything like that, because, see above. Why bother figuring out all of that lady stuff anyway, right, doctor dudes? Plus, also, why bother studying cheap non-prescription herbal remedies when pharma corps only want to fund studies about shit they can sell for $$$? ANYWAY, I seem to be ranty today, but there’s definitely a chance the wort could fuck up your lady’s birth control.
Now would be a great time to have a conversation about what you would do if she got pregnant, if you haven’t already. And if that conversation freaks you out, then I would definitely advise you to condom it up. Granted, there is always a chance that she could get pregnant every time you have penis-in-vagina sex. Condoms fail and so do birth-control pills. Every action we take in this life is a calculated risk. Only you can decide how risk-averse you are in this case.
