Depot Medroxyprogesterone Acetate and Weight Gain

Abstract & Commentary

By Leon Speroff, MD, Editor, Professor of Obstetrics and Gynecology, Oregon Health and Science University, Portland, is Editor for OB/GYN Clinical Alert.

Synopsis: Depot medroxyprogesterone acetate causes obese adolescents to gain more weight.

Source: Bonny A, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med. 2006;160:40-45.

Bonny and colleagues report the effect of depot medroxyprogesterone on weight changes in obese and nonobese adolescent girls.1 This was a prospective study of 450 adolescents, aged 12 to 18 years. The objective was to compare body weight changes over 18 months in adolescents according to baseline body weight. Adolescent girls obese at the time of initiation of treatment with depot medroxyprogesterone acetate gained more weight (mean, 9.4 kg gain) compared to obese girls who started oral contraceptives (mean, 0.2 kg) or to a group not using hormonal contraception (mean, 3.1 kg). Weight in obese adolescents using depot medroxyprogesterone increased at a greater rate with increasing duration of use. Obese adolescents using depot medroxyprogesterone gained more weight than nonobese users. Among subjects who were not obese at baseline, there were no differences in weight gain according to methods of hormonal contraception. The authors conclude that depot medroxyprogesterone use may contribute to adolescent obesity.

Commentary

By now it is conventional wisdom that the use of depot medroxyprogesterone acetate for contraception causes weight gain. Indeed, many users of this method discontinue its use because of weight gain. However, it has been difficult to know whether the drug causes weight gain or whether the weight gain is simply the consequence of lifestyle and diet. Attempts to document a greater weight gain have had mixed results.

It is worth emphasizing the negative studies. A placebo-controlled experiment concluded that depot medroxyprogesterone had no effects on food intake, energy expenditure, or body weight.2 With the newer subcutaneous method, an average gain of only 1.5 kg occurred after one year.3 On the other hand, specific individuals or ethnic groups may be more susceptible to weight gain. For example, an excellent study in Navajo women documented significant weight gain.4

So where does that leave us? Is weight gain a general reaction to depot medroxyprogesterone acetate or does it occur only in vulnerable individuals? Answers to these questions are hindered by limitations in the available studies. The evidence is not derived from randomized trials (something that is probably impossible to do). Therefore, results can be influenced by those reasons for which subjects choose a certain method and responses that affect continuation with methods. The individuals who choose to use depot medroxyprogesterone differ in their socioeconomic status, contraceptive practices, and sexual histories; thus the difficulty in matching users and nonusers.

This problem also applies to another problem assigned by conventional wisdom to depot medroxyprogesterone users: mood changes and depression. When studied closely, it has been difficult to find an increase in depressive symptoms in depot medroxyprogesterone users.5,6

Because low-dose estrogen-progestin contraceptive methods do not cause weight gain, it would seem appropriate to promote the use of these methods in overweight individuals, especially obese adolescents. However, the small increase in failure rates reported with oral contraceptive use in obese women combined with lower continuation rates (and higher pregnancy rates) with oral contraceptives stand out in contrast to better compliance and efficacy rates with depot medroxyprogesterone acetate. Thus it is important to promote the consideration of the transdermal and vaginal ring methods for this population. Perhaps the most attractive choice will prove to be the new subcutaneous rod, Implanon, known to be highly effective even in heavy women.

References

  1. Bonny AE, et al. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med. 2006;160:40-45.
  2. Pelkman CL, et al. Short-term effects of a progestational contraceptive drug on food intake, resting energy expenditure, and body weight in young women. Am J Clin Nutr. 2001;73:19-26.
  3. Jain J, et al. Contraceptive efficacy and safety of DMPA-SC. Contraception. 2004;70:269-275.
  4. Espey E, et al. Depo-provera associated with weight gain in Navajo women. Contraception. 2000;62:55-58.
  5. Westhoff C, et al. Depressive symptoms and Depo-Provera. Contraception. 1998;57:237-240.
  6. Gupta N, et al. Mood changes in adolescents using depot-medroxyprogesterone acetate for contraception: a prospective study. J Pediatr Adolesc Gynecol. 2001;14:71-76.