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Related Articles. Spotting and Bleeding With Depo-Provera. The Advantages and Disadvantages of Depo-Provera. The amount of weight gain was dependent on the length of time DMPA was used, as the rate of weight gain slowed over time.
The study, which appears in the March 4 issue of the American Journal of Obstetrics and Gynecology, is one of the most comprehensive studies of its kind. DMPA is an injected contraceptive administered to patients every three months. DMPA is relatively inexpensive compared to some other forms of birth control, has a low failure rate and doesn't need to be administered daily, which contributes to the contraceptive's popularity.
The study followed women in two age categories, to years-old, and to years-old, using DMPA, oral desogestrel or nonhormonal bilateral tubal ligation, condom or abstinence contraception for three years. DMPA users who discontinued this method and selected another form of birth control were followed for up to two additional years. Throughout the course of the study, researchers compared changes in body weight and composition and took into account the influence of age, race, caloric intake and exercise, among other factors.
Estrogen can also promote sodium salt and water retention, increasing blood volume which is important in pregnancy since it increases delivery of nutrients etc. But in a non-pregnant state it can result in weight gain. The weight gain is often temporary since the body eventually adjusts to shifts in fluid.
Haarbo and Associates reported that abdominal fat deposition is significantly lower in HRT users. Although all women in this Finnish study gained weight, the HRT users gained less weight and fat overall than non-users. Further, removal of the ovaries in mice, resulting in a lack of estrogen and progesterone similar to the hormonal situation in post-menopausal women, results in massive weight gain due, at least partially, to a greatly increased food intake.
Administration of estradiol results in a return of food intake to normal levels and a consequent weight loss. In women administration of GnRH agonists such as Lupron and other drugs which have the effect of shutting down the ovary are also notorious for causing weight gain, often a large amount more than can be explained by an increased appetite. The exact mechanism underlying this remains unclear, as does the mechanism underlying menopausal weight gain.
Having said that, we often see women whose weight gain was very closely associated with starting hormone therapy. One study showed no significant difference.
Of note, this weight gain was significant only for patients categorized as normal weight or overweight; women who were obese showed no significant weight gain on DMPA. One study involving the levonorgestrel-releasing intrauterine system Mirena found that women who used this method had an increase in body fat 2. Despite the small difference in body composition, no significant change in body weight was noted between the two groups.
Several studies compared women using the six-capsule levonorgestrel implant no longer available in the United States with those using other hormonal and nonhormonal contraceptives. A study of women 15 to 30 years of age using the levonorgestrel implant or DMPA showed no significant weight change between the two groups at one year. None of the studies in the review evaluated the newer etonogestrel implants Implanon, Nexplanon. Overall, there is little evidence that progestin-only contraceptives cause weight gain.
The mean weight gain was less than 2 kg for most studies up to 12 months. Multiyear studies showed more weight gain, but the gain was similar when comparing women who used progestin-only contraceptives and those who did not. This suggests that weight gain over time may occur regardless of contraceptive use.
The two studies looking at body mass showed that progestin-only contraceptive users had greater increases in body fat and decreases in lean mass than users of nonhormonal methods. This could be caused by a hormone-mediated increase in fat deposition. Having frank discussions with patients about the average weight gain that occurs with progestin-only contraceptive use may decrease discontinuation rates of this method.
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