The first study to compare the effectiveness of the birth control pill in women with marked weight differences has found that the pill works equally well in women with obesity and thinner women. This new finding by physician-scientists at NewYork-Presbyterian Hospital/Columbia University Medical Center refutes a long-held conviction among many doctors that the pill may not reliably prevent pregnancy in women who are overweight or obese. With obesity a significant health issue in the United States -- the U.S. government estimates that nearly 65 percent of adult women ages 20 and older are overweight or obese -- the reliability of the birth control pill in this population is critical, especially since pregnancy itself is riskier among women with obesity.

In the study, published in the August issue of the journal Obstetrics & Gynecology, principal investigator Dr. Carolyn Westhoff, and her colleagues did not rely, as previous studies had, on women's recollections of how much they may have weighed at a time when the pill had failed and they became pregnant."We wanted to study what was actually happening in the ovaries of women and not depend on memory, which is notoriously faulty," Dr. Westhoff says.

Dr. Westhoff and her colleagues designed a prospective study where 226 women of normal weight or who were overweight, and between the ages of 18 and 35, were randomly assigned to take either a lower- or higher-dose version of the pill. The researchers purposely used the different dose levels to assess whether heavier women required higher dosing, as has been previously believed.  After three or four months of using the oral contraceptives -- the time it usually takes for a woman's body to acclimate to the pill -- the women had multiple ultrasounds and blood tests to determine if ovulation was being suppressed. The goal of oral contraception is to suppress ovulation.

Of the 150 women who used the pill consistently, three of the 96 women with normal weight ovulated, as did one of the 54 women with obesity. The researchers also found that when women were not taking the pill regularly, they ovulated with greater frequency."Our findings strengthen the message to patients that the pill will only work if it is taken every day. Weight does not seem to have an impact on suppression of ovulation, but consistency of pill-taking does," Dr. Westhoff says.

Importantly, the lower-dose pill seemed to be as effective as the higher-dose pill in suppressing ovulation in women with obesity. This is a crucial finding because women with obesity are at greater risk for developing blood clots from taking either type of pill, although the overall risk is small. "For a woman to fear relying on her oral contraceptive to prevent an unwanted pregnancy is a huge burden. This study should put those fears to rest," Dr. Westhoff says.

Source:   New York Presbyterian Hospital/Columbia University Medical Center

Click here to see full press release.

Note from the Institute for Women's Health Research:   Expect debate on this issue until the findings are replicated by other researchers and further analyzed.   The Institute will continue to track this issue and put updates on this blog site.

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Comments

The studies conducted and described in the article are of course interesting, but I have some reservations about the low numbers of women sampled. I'm not being critical but would just wonder how the stats would look with bigger numbers.

I've been working with several thousand people over the last 12 years and acting as a health coach. What I've noticed is that those who are obese, or heading that way, are likely to struggle with self esteem and personal discipline. It would not surprise me if some of the women in the obese group did not take every contraceptive pill but may have hidden it to the trial team. I've not seen the trial protocol but it may have taken that into account - would be interested to learn more about the longer term outcomes too.

I think Paul made a good point when he pointed out that women who are obese struggle with self esteem and personal discipline. I think that would be the reason why this study was done in the first place. It seems that the doctors must have thought that the pill was not working as well on obese women. The answer might not have been in the dosage of the pill itself, but the character of the women taking the pill. Research is so tricky. I have heard that obese women have a harder time getting pregnant. Hum.

I would not have guessed that there was much debate about whether weight would affect contraceptive medications. Your weight should not impact body chemistry so drastically that medications would lose significant validity. Perhaps, if there is concern, it is time to stand up and make the male use contraceptives. Often, the importance of self confidence and self esteem are overlooked. I cannot recall how many times I’ve spoken with someone who seemed to accept their own low self confidence or low self esteem. It is as if many people believe that it is physical or mental defect that cannot be helped. They fail to realize that they are in control to change it and improve their lives whenever they are ready to make the effort.

Quote: "“For a woman to fear relying on her oral contraceptive to prevent an unwanted pregnancy is a huge burden. This study should put those fears to rest,” Dr. Westhoff says." It seems a shame that woman have to carry the burden of contraception, at all. Why can't the man take more responsibility, and get sniped, for instance? I did for the sake of my partner.

I agree that the state of mind of the person taking the birth control pill would more likely be a factor in the effectiveness of it than their weight. People under stress do funny things and their body chemistry is certainly mixed up. Maybe there should be a study on how effective the pill is in people who are stressed, be interesting to see how much difference it would make.

it doesnt matter if the woman is fat or not. it matters on how the contraceptives are effective and potent.

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