Gynecologist and fat shaming

I have an appointment to get my nexplanon reinserted sometime in April and I'm nervous.

I've gained weight due to covid and the last time I went into this office near this weight the doctor did not want to place it. He said I'd be much happier if I lost weight and he said nexplanon would not be as effective.

I'm worried that I'll have to deal with this. There are no solid studies about it being ineffective in fat people. I'm seeing more studies showing they need to study birth control and overweight people more before making a decision.

So I'm nervous. This is the only BC that works for me and it's what I want. If it happens to be less effective my husband and I are willing to take that risk

How do I deal with this and advocate for myself and my medical needs?

[Mallika]

Hello!

Thank you for sharing this with us. While I have not used contraceptives before, I'll try to help.

Recently I listened to a podcast whereby a gynaecologist was almost forcing an expecting couple to do a procedure they clearly did not want to do. They managed to stand their ground confidently after meeting a genetic counsellor who rooted for them instead of the gynaecologist, and subsequently had their way. Unfortunately, the physician-patient relationship can sometimes get pretty paternalistic - the doctor/gynae can be quite insistent on you doing something even if you might not be fully comfortable with it. I suggest you might be able to do two things:

1) Openly share your viewpoint and the reading you've done about it.

Since this form of birth control has previously worked for you, you can honestly tell the doctor that you and your husband are comfortable using a previously tried-and-tested contraceptive and would rather not go for something new. You had described that you and your husband are willing to take the risk even if it's not as effective - you can tell that to the doctor as well, just so they know how firmly you feel about this. You've done some research on how there is currently no convincing evidence that this form of contraceptive does not work for larger sized individuals. You might want to share that you've done your reading of scientific literature regarding this matter too.

It can be quite difficult to challenge a professional who is an expert in that field, however, you have your autonomy and understand your needs best. If you prefer using one form of treatment that has helped you in the past, you have the right to express that openly. As patients, I guess the best we can do is assert ourselves as politely yet firmly so our point gets across.

2) Get a second opinion/go to another gynae

If you've been seeing this doctor for a long time, then it might be a little challenging to go elsewhere and get familiarised with a new doctor. But if you feel your voice might be heard more well elsewhere, or that you might meet another gynaecologist/doctor who would be more open to administering this BC, then perhaps that might be a good option. After all, this doctor did not administer the BC the previous time you visited - you can of course try to get your point across this time, but if they are still not up for it, then perhaps switching to another doctor might be worth thinking about.

When I was younger, I had to get a knee surgery. Though the surgeon I first visited was really good and well-known for his capabilities, my parents insisted on getting a second opinion, and I'm glad they did. While the first surgeon presented the surgery as "optional", the second doctor was very firm that getting a surgery was necessary or else my knee would worsen. Medical experts do differ in their viewpoints, so if you feel that another gynaecologist might be able to understand you better, then go for it.

At the end of the day, the physician-patient relationship is dependent on human interaction - how well we can get along with the doctor and how well they understand our needs plays a key role our treatment journey.

I wish you the very best with this!!

Thank you!


I am in the process of seeing a new gynecologist but I do have to see this one for the time being. I will be seeing a new one in June or July but I need to try and get my BC replaced by April.


The one I am seeing is supposed to be really good so I am hoping for the best.


It is kind of ironic because I advocate for people as part of my job but I struggle with it a bit when it comes to me especially when it has to do with weight related stuff. That probably has to do with insecurities and the fact that weight issues tie in to my eating disorder and I do not feel comfortable explaining that to doctors who do not seem supportive.


I wish I was comfortable enough to ask one of my friends to go with me to my gynecologist because I think that'd help me to advocate.

[Mallika]

Hello!

It's great that you work in a job that helps people advocate for themselves. It is very understandable why you are feeling this way regarding advocating for yourself, given the circumstances about weight issues or ED.

If not a friend then, would there by any other individual with whom you and your husband be more comfortable visiting the gynaecologist with? Perhaps a parent, or a cousin? These matters are no doubt awkward to be discussed with friends, but if a closer relative like a family member might be able to understand where you are coming from and advocate for you, that might go a long way, especially if it will ultimately benefit you in terms of seeking the form of treatment you prefer best.

Originally Posted by Mallika

Hello!

It's great that you work in a job that helps people advocate for themselves. It is very understandable why you are feeling this way regarding advocating for yourself, given the circumstances about weight issues or ED.

If not a friend then, would there by any other individual with whom you and your husband be more comfortable visiting the gynaecologist with? Perhaps a parent, or a cousin? These matters are no doubt awkward to be discussed with friends, but if a closer relative like a family member might be able to understand where you are coming from and advocate for you, that might go a long way, especially if it will ultimately benefit you in terms of seeking the form of treatment you prefer best.

I asked my dad to go but I think he is uncomfortable with the idea.


I have friends I could ask who are female/have dealt with female issues but I haven't been friends with them long and am nervous about asking.


My biggest concern is that I worry the doctor will take my weight and refuse to place it like they did one other time...and then I'll walk out of there without the appropriate birth control. I need the birth control cause I cannot afford to get pregnant and my husband and I do enjoy having sex. The other issue is that if they refuse to place it, I have to get the current one out because the gynecologist I am set to see in June or July...will not remove someone else's insertion. I know that theoretically the doctor cannot deny me the birth control and if they try I might have to get bitchy and that is the problem. I do not like having to get bitchy because then I feel like crap about myself for ages...even if it is justified.

[hocus pocus]

A previous gyn of mine was looking into birth control options with me and said "well, given what you weigh, we don't want to use this one. You can't afford to gain more weight." Gyns seem to have a thing for fat shaming, or at least several of the ones I've met do.

I wish I lived closer because I'd definitely go with you. Is your husband going/able to come with you? It might be comforting if he comes along. You can ask to have a nurse in, but I do think most of the time they have someone else come along for the appointment.

You could write some notes down in terms of what you'd want to say if something arises. You can also be stern, but still polite if that makes sense. You could say something like "I appreciate your concern for my weight, but that is not why I am here today." Even though there's no solid studies, to appease your doctor you could also express that you're aware your bc might not be as effective: you understand that and you still want the nexaplanon regardless.

Another thing I've heard people doing is starting the appointment with an opener about their weight like "yes, I am aware and respect your opinion but please know I am not here about my weight. I am here for gynecology."

Specialist appointments tend to zap the life out of me, so sometimes it helps to have something either fun (to look forward to) afterwards, or clear the day (or a few hours) if possible so I can take a nap or do some self-care. Do you know what your other plans/obligations are on that day? Something to consider.