Can I use progestin-only pills (POPs) with a body mass index (BMI) of 36?

Progestin-Only Pills Are Safe for Women with BMI 36

Yes, you can safely use progestin-only pills (POPs) with a BMI of 36. POPs have no weight restrictions and are classified as U.S. MEC Category 1 (no restrictions) for women with obesity 1.

Safety Profile of POPs for Women with Obesity

Progestin-only pills work primarily by thickening cervical mucus and are an excellent contraceptive option for women with higher BMIs for several reasons:

• Unlike combined hormonal contraceptives, POPs do not contain estrogen, which eliminates concerns about estrogen-related cardiovascular risks that can be elevated in obesity 1
• The U.S. Medical Eligibility Criteria for Contraceptive Use specifically categorizes POPs as Category 1 (no restrictions) for women with obesity, regardless of BMI 1
• Weight measurements are not needed to determine medical eligibility for POPs, as they can be safely used by women with obesity 1

Effectiveness Considerations

While POPs are highly safe for women with higher BMIs, it's important to understand effectiveness considerations:

• Traditional POPs (containing norethindrone or norgestrel) have typical use failure rates of approximately 9% in the first year 1
• For maximum effectiveness with traditional POPs:
  • Take pills at the same time each day
  • If starting POPs more than 5 days after your period began, use backup contraception (like condoms) for the first 2 days 1
  • If you miss a pill by more than 3 hours, use backup contraception for the next 2 days

Side Effects and Monitoring

The most common side effect of POPs is irregular bleeding patterns, which may include:

• Spotting
• Amenorrhea (no bleeding)
• Unpredictable bleeding

Unlike combined hormonal methods, research shows limited evidence of significant weight gain with POPs. Most studies show mean weight gain of less than 2 kg over 12 months, which is generally not significantly different from non-hormonal methods 2.

Advantages of POPs for Women with Higher BMIs

POPs offer several advantages for women with BMI ≥30:

1. No increased risk of venous thromboembolism (unlike estrogen-containing methods)
2. No need for blood pressure monitoring specifically for the contraceptive method
3. Very low prevalence of contraindications (only 1.6% of reproductive-aged women have any contraindication to POPs) 3
4. Can be safely used by women with well-controlled hypertension 4

When to Consider Alternative Methods

While POPs are safe with BMI 36, you might consider other options if:

• You have difficulty remembering to take pills at the same time daily
• You have a history of ectopic pregnancy
• You're taking medications that interact with POPs (certain anticonvulsants, rifampin, or rifabutin) 1

In these cases, long-acting reversible contraceptives like IUDs or implants might provide higher effectiveness while maintaining safety for women with higher BMIs.

Starting POPs

You can start POPs at any time if it's reasonably certain you're not pregnant. If starting within the first 5 days of your menstrual period, no backup contraception is needed. If starting later, use backup contraception for the first 2 days 1.