Can Heavy Girls Use Emergency Contraception? ASK AN OBGYN

Dear SuzyKnew!

Tell me more about emergency contraception.  I’m a big girl, and I heard that I can’t use it.  Is this true?


Dear Reader,

Emergency Contraception (EC) – also called The Morning After Pill – can be a lifesaver for women who experience unprotected sex and want to avoid getting pregnant.   The short answer to your question is that women of all shapes and sizes can use EC, however, for heavier women, progestin-only EC may be less effective.

First, some quick facts about EC: EC can be used up to 120 hours after unprotected sex.  It does not end a pregnancy and does not work if you are already pregnant.  It acts like birth control pills, which is what most EC is after all.

There are three types of EC.  1) Pills that contain progesterone (Plan-B, Take Action, Next Choice) is the most common and available without a prescription.   2) Pills that contain Ulipristal acetate (ella) is a newer product that you can only get from a doctor and may be a better option if you are overweight.  3) The IUD, is less commonly used, but it has the added benefit is becoming your long-term (and very reliable) birth control method.

How can I get EC if I need it?:  The good news is that brand name and generic products are now available in the family planning isle of most major pharmacy chains.  Progestin-only EC is legally available on the shelf without age restrictions and can be purchased by both women and men of all ages.    EC is sold on many Internet sites, including Amazon. Ella requires a prescription; but obtaining an online prescription is possible.

EC is definitely something that all sexually active women should have on hand.  Think of the “emergency” products in your bathroom cabinet: that miracle acne cream, your migraine pills or ointment for a nasty cold sore.  You always make sure you always have enough stock right?   EC should be on the shelf.  A zit will eventually go away, an unintended pregnancy will not.  Yeah, this is serious business.  Because there is a 120 hour effectiveness window, you don’t have a lot of time to mess around getting to a pharmacy.

How does weight change things?:  This is an excellent question and a relevant one since over 35% of  American adults are obese.  In addition, women with comorbidities such as diabetes or heart disease are at higher risk of pregnancy-related complications, therefore avoidance of unintended pregnancy is especially important.

Here’s the not so good news:  EC appears to be less effective the more you weigh, and decline steadily in effectiveness with increased BMI.   These findings have come out only recently as more EC products are introduced on the market and more women of varying weight are included in clinical trails.   More studies are in the works, but for now this is what I recommend: Calculate your BMI.  If your BMI is 26 or greater, you should talk to your doctor about which EC is right for you.  Your doctor may prescribe ella which appears to have less of a weight factor.

Take care.