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Do hormonal contraceptives lead to weight gain?
Author(s)
Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
EVIDENCE-BASED ANSWER:
It depends. Weight doesn’t appear to increase with combined oral contraception (OC) compared with nonhormonal contraception, but percent body fat may increase slightly. Depot-medroxyprogesterone acetate injection (DMPA) users experience weight gain compared with OC and nonhormonal contraception (NH) users (strength of recommendation: B, cohort studies).
DMPA users gain more weight and body fat than OC users
A 2008 prospective, nonrandomized, controlled study of 703 women compared changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio in 245 women using OC, 240 using DMPA, and 218 using NH methods of birth control.1 Over the 36-month follow-up period, 257 women were lost to follow-up, 137 discontinued participation because they wanted a different contraceptive method, and 123 didn’t complete the study for other reasons.
Compared to OC and NH users, DMPA users gained more actual weight (+5.1 kg) and body fat (+4.1 kg) and increased their percent body fat (+3.4%) and central-to-peripheral fat ratio (+0.1; P<.01 in all models). OC use wasn’t associated with weight gain compared with the NH group but did increase OC users’ percent body fat by 1.6% (P<.01) and decrease their total lean body mass by 0.36 (P<.026) (TABLE1).
DMPA users gain more weight in specific populations
For 18 months, researchers conducting a large prospective, nonrandomized study followed American adolescents ages 12 to 18 years who used DMPA and were classified as obese (defined as a baseline body mass index [BMI] >30 kg/m2) to determine how their weight gain compared with obese combined OC users and obese controls.2
Obese DMPA users gained significantly more weight (9.4 kg) than obese combined OC users (0.2 kg; P<.001) and obese controls (3.1 kg; P<.001). Of the 450 patients, 280 (62%) identified themselves as black and 170 (38%) identified themselves as nonblack.
In another retrospective cohort study of 379 adult women from a Brazilian public family planning clinic, current or past DMPA users were matched with copper T 30A intrauterine device users for age and baseline BMI and categorized into 3 groups: G1 (BMI <25 kg/m2), G2 (25-29.9 kg/m2), or G3 (≥30 kg/m2).3
Weight doesn’t appear to increase with combined oral contraception compared with nonhormonal contraception, but percent body fat may increase slightly.
At the end of the third year of use, the mean increase in weight for the normal weight group (G1) and the overweight group (G2) was greater in DMPA users than in DMPA nonusers (4.5 kg vs 1.2 kg in G1; P<.0107; 3.4 kg vs 0.2 kg in G2; P<.0001). In the obese group (G3), the difference in weight gain between DMPA users and DMPA nonusers was minimal (1.9 kg vs 0.6 kg; P=not significant).
One limitation of these 2 studies could be that the women under investigation were from defined populations—black urban adolescents and a public family planning service.
References
1. Berenson AB, Rahman M. Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. Am J Obstet Gynecol. 2009;200:329.e1-8.
2. Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch PediatrAdolesc Med. 2006;160:40-45.
3. Pantoja M, Medeiros T, Baccarin MC, et al. Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive. Contraception. 2010;81:107-111.
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Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
University of Illinois at Chicago, College of Medicine
EDITOR
Corey Lyon, DO
University of Colorado Family Medicine Residency, Denver
Issue
The Journal of Family Practice - 64(6)
Publications
The Journal of Family Practice
MDedge Family Medicine
Topics
Women's Health
Page Number
371-372
Legacy Keywords
Maria Albright, MD; Saira Rani, MD; Thomas Gavagan, MD, MPH; women's health; contraceptives; weight gain; DMPA; depot-medroxyprogesterone acetate injection
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Author(s)
Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
Author(s)
Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
Author and Disclosure Information
Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
University of Illinois at Chicago, College of Medicine
EDITOR
Corey Lyon, DO
University of Colorado Family Medicine Residency, Denver
Author and Disclosure Information
Maria Albright, MD
Saira Rani, MD
Thomas Gavagan, MD, MPH
University of Illinois at Chicago, College of Medicine
EDITOR
Corey Lyon, DO
University of Colorado Family Medicine Residency, Denver
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Article PDF
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EVIDENCE-BASED ANSWER:
It depends. Weight doesn’t appear to increase with combined oral contraception (OC) compared with nonhormonal contraception, but percent body fat may increase slightly. Depot-medroxyprogesterone acetate injection (DMPA) users experience weight gain compared with OC and nonhormonal contraception (NH) users (strength of recommendation: B, cohort studies).
DMPA users gain more weight and body fat than OC users
A 2008 prospective, nonrandomized, controlled study of 703 women compared changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio in 245 women using OC, 240 using DMPA, and 218 using NH methods of birth control.1 Over the 36-month follow-up period, 257 women were lost to follow-up, 137 discontinued participation because they wanted a different contraceptive method, and 123 didn’t complete the study for other reasons.
Compared to OC and NH users, DMPA users gained more actual weight (+5.1 kg) and body fat (+4.1 kg) and increased their percent body fat (+3.4%) and central-to-peripheral fat ratio (+0.1; P<.01 in all models). OC use wasn’t associated with weight gain compared with the NH group but did increase OC users’ percent body fat by 1.6% (P<.01) and decrease their total lean body mass by 0.36 (P<.026) (TABLE1).
DMPA users gain more weight in specific populations
For 18 months, researchers conducting a large prospective, nonrandomized study followed American adolescents ages 12 to 18 years who used DMPA and were classified as obese (defined as a baseline body mass index [BMI] >30 kg/m2) to determine how their weight gain compared with obese combined OC users and obese controls.2
Obese DMPA users gained significantly more weight (9.4 kg) than obese combined OC users (0.2 kg; P<.001) and obese controls (3.1 kg; P<.001). Of the 450 patients, 280 (62%) identified themselves as black and 170 (38%) identified themselves as nonblack.
In another retrospective cohort study of 379 adult women from a Brazilian public family planning clinic, current or past DMPA users were matched with copper T 30A intrauterine device users for age and baseline BMI and categorized into 3 groups: G1 (BMI <25 kg/m2), G2 (25-29.9 kg/m2), or G3 (≥30 kg/m2).3
Weight doesn’t appear to increase with combined oral contraception compared with nonhormonal contraception, but percent body fat may increase slightly.
At the end of the third year of use, the mean increase in weight for the normal weight group (G1) and the overweight group (G2) was greater in DMPA users than in DMPA nonusers (4.5 kg vs 1.2 kg in G1; P<.0107; 3.4 kg vs 0.2 kg in G2; P<.0001). In the obese group (G3), the difference in weight gain between DMPA users and DMPA nonusers was minimal (1.9 kg vs 0.6 kg; P=not significant).
One limitation of these 2 studies could be that the women under investigation were from defined populations—black urban adolescents and a public family planning service.
EVIDENCE-BASED ANSWER:
It depends. Weight doesn’t appear to increase with combined oral contraception (OC) compared with nonhormonal contraception, but percent body fat may increase slightly. Depot-medroxyprogesterone acetate injection (DMPA) users experience weight gain compared with OC and nonhormonal contraception (NH) users (strength of recommendation: B, cohort studies).
DMPA users gain more weight and body fat than OC users
A 2008 prospective, nonrandomized, controlled study of 703 women compared changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio in 245 women using OC, 240 using DMPA, and 218 using NH methods of birth control.1 Over the 36-month follow-up period, 257 women were lost to follow-up, 137 discontinued participation because they wanted a different contraceptive method, and 123 didn’t complete the study for other reasons.
Compared to OC and NH users, DMPA users gained more actual weight (+5.1 kg) and body fat (+4.1 kg) and increased their percent body fat (+3.4%) and central-to-peripheral fat ratio (+0.1; P<.01 in all models). OC use wasn’t associated with weight gain compared with the NH group but did increase OC users’ percent body fat by 1.6% (P<.01) and decrease their total lean body mass by 0.36 (P<.026) (TABLE1).
DMPA users gain more weight in specific populations
For 18 months, researchers conducting a large prospective, nonrandomized study followed American adolescents ages 12 to 18 years who used DMPA and were classified as obese (defined as a baseline body mass index [BMI] >30 kg/m2) to determine how their weight gain compared with obese combined OC users and obese controls.2
Obese DMPA users gained significantly more weight (9.4 kg) than obese combined OC users (0.2 kg; P<.001) and obese controls (3.1 kg; P<.001). Of the 450 patients, 280 (62%) identified themselves as black and 170 (38%) identified themselves as nonblack.
In another retrospective cohort study of 379 adult women from a Brazilian public family planning clinic, current or past DMPA users were matched with copper T 30A intrauterine device users for age and baseline BMI and categorized into 3 groups: G1 (BMI <25 kg/m2), G2 (25-29.9 kg/m2), or G3 (≥30 kg/m2).3
Weight doesn’t appear to increase with combined oral contraception compared with nonhormonal contraception, but percent body fat may increase slightly.
At the end of the third year of use, the mean increase in weight for the normal weight group (G1) and the overweight group (G2) was greater in DMPA users than in DMPA nonusers (4.5 kg vs 1.2 kg in G1; P<.0107; 3.4 kg vs 0.2 kg in G2; P<.0001). In the obese group (G3), the difference in weight gain between DMPA users and DMPA nonusers was minimal (1.9 kg vs 0.6 kg; P=not significant).
One limitation of these 2 studies could be that the women under investigation were from defined populations—black urban adolescents and a public family planning service.
References
1. Berenson AB, Rahman M. Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. Am J Obstet Gynecol. 2009;200:329.e1-8.
2. Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch PediatrAdolesc Med. 2006;160:40-45.
3. Pantoja M, Medeiros T, Baccarin MC, et al. Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive. Contraception. 2010;81:107-111.
References
1. Berenson AB, Rahman M. Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. Am J Obstet Gynecol. 2009;200:329.e1-8.
2. Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch PediatrAdolesc Med. 2006;160:40-45.
3. Pantoja M, Medeiros T, Baccarin MC, et al. Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive. Contraception. 2010;81:107-111.
Issue
The Journal of Family Practice - 64(6)
Issue
The Journal of Family Practice - 64(6)
Page Number
371-372
Page Number
371-372
Publications
The Journal of Family Practice
MDedge Family Medicine
Publications
The Journal of Family Practice
MDedge Family Medicine
Topics
Women's Health
Article Type
Article
Display Headline
Do hormonal contraceptives lead to weight gain?
Display Headline
Do hormonal contraceptives lead to weight gain?
Legacy Keywords
Maria Albright, MD; Saira Rani, MD; Thomas Gavagan, MD, MPH; women's health; contraceptives; weight gain; DMPA; depot-medroxyprogesterone acetate injection
Legacy Keywords
Maria Albright, MD; Saira Rani, MD; Thomas Gavagan, MD, MPH; women's health; contraceptives; weight gain; DMPA; depot-medroxyprogesterone acetate injection
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