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Do hormonal contraceptives lead to weight gain?

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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).

Evidence-based answers from the Family Physicians Inquiries Network

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