Talking about birth control can feel super weird and vulnerable. It might bring up memories of really bad experiences (like the time I spent all day curled in a ball watching Lifestyles of the Rich and Famous while on the verge of puking after I took emergency contraception. It might also force us to examine things like how (and when, and with whom, and how many times) we get down, which can feel overwhelming. If you grew up religious like I did, thinking about this stuff might also make you feel guilty and ashamed (though nowadays I don’t feel shame or guilt about my sex life, and it turns out that really helps me make better decisions).
When you’re a plus-size woman, there are often extra dimensions to this discussion: like the fact that we often have really negative experiences at the doctor because of fatphobia and the fact that we can’t rely on every medication to work equally well for us if we’re above a certain weight.
I spoke to four plus-size women—Chaya, Sarah, Liz, and Monica—and asked them to be as honest as possible about their experiences with birth control, including what has worked for them and what hasn’t. They talked about the stuff that surrounds the birth control convo that we almost never hear about. Here’s what they had to say:
(Responses are lightly edited for clarity.)
“It’s so freeing to not have to deal with maintaining this method. You get it implanted and basically forget about it. Taking the pill every day was a hassle.”
“I need to share that I’ve tried almost every birth control out there and at 17 settled on what worked best for controlling my PCOS, the Nexplanon. Trust me when I say I was skeptical of getting an implant in my arm, but nothing worked well until then. So, I figured it couldn’t hurt to try. The Nexplanon was inserted quickly with virtually no side effects at all. When my 3 years were up, I got another one. Several months ago, I was supposed to get my third, but my doctor suggested an estrogen-based pill instead. After suffering severe depression as a side effect, I’ll be getting my third Nexplanon next week.
It’s so freeing to not have to deal with maintaining this method. You get it implanted and basically forget about it. Taking the pill every day was a hassle even before the side effects became clear. When I tried the NuvaRing years back it wouldn’t stay in place. I even got the IUD only to spend an entire day vomiting and in treacherous pain. By the end of day one I got it removed in the ER for immediate relief.
As a plus size femme, it’s important to me to have options available that will work with my weight especially when I learned that the morning-after pill isn’t proven to be as effective over 165lbs.* While the main reason for my usage of birth control has nothing to do with pregnancy prevention, I love having the peace of mind that if my main form (condoms) fail this is a backup.”
(*Note: Levonorgestrel-based emergency contraception, like Plan B One-Step, Next Choice One Dose, and others, may not be as effective in women who weigh 165 pounds or more. Ella is equally effective in women between 165 and 194 pounds as in women under 165 pounds. The only option that’s proven equally effective in women 195 pounds or over is the copper IUD. Read more about this here.)
—Chaya Milchtein, 24, Milwaukee, WI
“As someone who engages in casual sex regularly, a birth control method I love is important to me.”
“As someone who engages in casual sex regularly, having a birth control method I love is important to me. I knew taking the pill would never work because I would forget to take it regularly. User error would for sure happen and ya girl has no desire for a pregnancy. I initially tried the copper IUD because I was anxious about introducing hormones into my body, especially as someone living with depression. That IUD did not stay put and came with more cramps and bleeding.
Now I have the Mirena. I absolutely LOVE not having my period. I love that I can’t feel it, my partners cannot feel it, I don’t have to remember to do anything, etc. As a fat woman, my birth control liberates me. I can participate in pleasure without worry. Through pleasure I have learned to love and cherish my body which is a beautiful act of defiance and self-love as a fat woman of color.”
—Sarah, 25, Boise, ID
“I have high blood pressure, so I am unable to use many of the hormonal birth control options unless they are progestin only like the mini-pill or non-hormonal like the copper IUD.”
“I am 26, a size 26/24, and have been with my partner for almost 8 years. Most of that time I used the Nexplanon implant. I had two in a row that I was really happy with for the most part. The Nexplanon stopped my periods altogether, which was great in many ways, but also led me to having feelings of anxiety that if my birth control failed for any reason I wouldn’t know that I was pregnant. I was worried I wouldn’t know because my fat body wouldn’t show signs of pregnancy as soon as smaller/straight-size women, and I would miss my window to make an informed decision about whether I wanted to keep the pregnancy.
It wasn’t until a year ago that I had to have my third implant removed after it broke in my arm, and I have been using ‘family planning’ [fertility awareness] since. I track my ovulation via an app that tracks my periods and fertile window. I avoid having vaginal intercourse when the app says that I am ovulating and fertile. During those times we participate in mutual masturbation and oral sex. My partner and I also use the pull out method when we do have vaginal intercourse. I have high blood pressure, so I am unable to use many of the hormonal birth control options unless they are progestin only like the mini-pill or non-hormonal like the copper IUD.”
—Liz, 26, Tustin, CA
“I appreciate the bliss of not having to remember to take the pill, refill a prescription, and travel with it in tow at all times.”
“My favorite birth control method is definitely the Mirena. It takes 1 appointment with your gyno for insertion, and you’re set for up to 5* years! That is important to me because I’ve never been able to take the pill consistently enough for it to be effective. I got pregnant in high school while taking the pill and now with one kid, I absolutely need birth control that’s less dependent on my memory.
I have considered other options like the NuvaRing and the kind that gets implanted into your arm, but overall the Mirena is the best choice for my lifestyle and who I am. I appreciate the bliss of not having to remember to take the pill, refill a prescription, and travel with it in tow at all times. Having birth control as a plus-size woman is super important, just as it is to any other sexually active person who doesn’t wish to get pregnant!”
(*Note: The Mirena and LILETTA are both FDA-approved for up to 5 years, but they’ve been found to be effective for up to 7 years.)
—Monica, 27, Omaha, NE
I loved how Chaya talked openly about her experience with depression and PCOS and the fact that she uses Nexplanon for more than just pregnancy prevention. It’s a good idea to take note about how our birth control affects us to make sure we’ve got the right one. It’s so important to be as honest about our needs around birth control as Sarah is. She knew she wasn’t going to remember to take a pill daily. So she picked something that did work for her, which is exactly how we should approach our care plan.
Liz brought up the fact that part of taking care of her high blood pressure meant choosing a non-hormonal or progestin-only method. And Monica noted that plus-size women deserve, want, and need the same access to effective birth control as anyone else, which is so important to speak out loud as we deal with finally putting fatphobia where it belongs—in the grave.
Finding the right birth control for you is about making intentional choices about a super important part of our lives, but as these women showed me, it’s also about prioritizing self-care, pleasure, mental health, and freedom—no matter what size you are.