Weight Change and Hormonal Contraception: Fact and Fiction

Mags E Beksinska; Jenni A Smit; Franco Guidozzi

Disclosures

Expert Rev of Obstet Gynecol. 2011;6(1):45-56. 

In This Article

Abstract and Introduction

Abstract

Weight gain is commonly cited as a side effect of hormonal contraception, and may lead to discontinuation or reluctance to initiate. This view is widely held among clients and providers. Combination contraceptives are not associated with weight gain, although among users of depot-medroxyprogesterone acetate weight gain may occur, which may be limited to adolescent users who are overweight or obese at initiation of depot-medroxyprogesterone acetate. Users who rapidly gain weight initially may also be at higher risk of greater weight increase. There is limited information on other progestin-only methods. Women who request contraceptive methods need reassurance and advice from providers to allay their fears of weight gain. The providers, in turn, need to be aware of the available evidence.

Introduction

Weight change can occur through gains and losses in fat deposition and body fluids. These changes can be caused by alterations in dietary habits, physical activity, illness, psychological factors, aging and lifestyle factors. Hormonal contraception use has been implicated in weight changes, particularly in weight gain. Weight gain is commonly cited as a side effect of hormonal contraceptives by clients and providers, and is one of the frequent reasons given for method discontinuation.[1–11] The role of progestins and estrogens in hormonal contraception, and the possible mechanisms through which weight change could occur, are complex.[12,13] However, a recent Cochrane systematic review found that there was insufficient evidence to determine the effect of combination contraceptives on weight.[14] The data on progestogen-only contraceptives have produced conflicting results, with many studies reporting weight gain in depot-medroxyprogesterone acetate (DMPA) users,[15–28] while fewer have found no significant weight gains compared with other hormonal method users, or nonuser controls.[29–32] The main body of literature on weight and hormonal contraception is concentrated on combined oral contraceptives (COCs) and DMPA, with patchy data on other hormonal methods.

This article summarizes the evidence of the effect of hormonal contraceptive use and weight change for each hormonal contraceptive method available. This article also highlights gaps and limitations in research, and considers how perceptions of weight gain may have developed over time and have affected continuation of hormonal methods.

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