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. 2011 Apr 13:(4):CD008815.
doi: 10.1002/14651858.CD008815.pub2.

Progestin-only contraceptives: effects on weight

Laureen M Lopez  1 , Alison Edelman, Mario Chen-Mok, James Trussell, Frans M Helmerhorst
Affiliations

Progestin-only contraceptives: effects on weight

Laureen M Lopez et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users.

Objectives: The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight.

Search strategy: We searched MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, ClinicalTrials.gov, and ICTRP, and contacted investigators to identify other trials.

Selection criteria: All comparative studies were eligible that examined a POC versus another method or no contraceptive. The primary outcome was mean change in body weight or body composition.

Data collection and analysis: Two authors extracted the data. We computed the mean difference with 95% confidence interval (CI) for continuous variables and odds ratio with 95% CI for dichotomous variables.

Main results: We did not conduct meta-analysis due to the various contraceptive methods and weight change measures. Fifteen studies examined progestin-only pills (N=1), Norplant (N=4), and depot medroxyprogesterone acetate (DMPA) (N=10). Comparison groups were similar for weight change in 11 studies. Four studies showed differences in weight or body composition change for POCs compared to no hormonal method. Adolescents using DMPA had a greater increase in body fat (%) versus a group using no hormonal method (mean difference 11.00; 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (mean difference -4.00; 95% CI -6.93 to -1.07). In another study, weight gain (kg) was greater for the DMPA group than an IUD group (mean difference 2.28, 2.71, 3.17, respectively). The differences were notable within the normal weight and overweight subgroups. One study showed the Norplant (six-capsule) group had greater weight gain (kg) than a non-hormonal IUD group (mean difference 0.47 (95% CI 0.29 to 0.65) and a group using non-hormonal or no method (mean difference 0.74; 95% CI 0.52 to 0.96). Another study also showed a Norplant group also had greater weight gain (kg) than an IUD group (mean difference 1.10; 95% CI 0.36 to 1.84).

Authors' conclusions: We found little evidence of weight gain when using POCs. Mean gain was less than 2 kg for most studies up to 12 months, and usually similar for the comparison group using another contraceptive. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.

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Conflict of interest statement

DECLARATIONS OF INTEREST

The authors do not have any conflicts of interest to declare regarding this review.

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 Norethisterone 350 μg versus levonorgestrel 30 μg, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 2.1
Analysis 2.1
Comparison 2 DMPA 150 mg/mL + placebo versus DMPA 150 mg/mL + E2C, Outcome 1 Mean change in total body fat (%) at 6 months.
Analysis 2.2
Analysis 2.2
Comparison 2 DMPA 150 mg/mL + placebo versus DMPA 150 mg/mL + E2C, Outcome 2 Mean change in lean body mass (%) at 6 months.
Analysis 3.1
Analysis 3.1
Comparison 3 DMPA 150 mg/mL versus control (no hormonal method), Outcome 1 Mean change in total body fat (%) at 6 months.
Analysis 3.2
Analysis 3.2
Comparison 3 DMPA 150 mg/mL versus control (no hormonal method), Outcome 2 Mean change in lean body mass (%) at 6 months.
Analysis 4.1
Analysis 4.1
Comparison 4 DMPA 150 mg/mL versus MPA + E2C, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 4.2
Analysis 4.2
Comparison 4 DMPA 150 mg/mL versus MPA + E2C, Outcome 2 Mean weight change (kg) at 12 months.
Analysis 4.3
Analysis 4.3
Comparison 4 DMPA 150 mg/mL versus MPA + E2C, Outcome 3 Mean percentage weight change at 6 months.
Analysis 4.4
Analysis 4.4
Comparison 4 DMPA 150 mg/mL versus MPA + E2C, Outcome 4 Mean percentage weight change at 12 months.
Analysis 5.1
Analysis 5.1
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 5.2
Analysis 5.2
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 2 Mean weight change (kg) at 12 months.
Analysis 5.3
Analysis 5.3
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 3 Mean percentage weight change at 6 months.
Analysis 5.4
Analysis 5.4
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 4 Mean percentage weight change at 12 months.
Analysis 5.5
Analysis 5.5
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 5 Weight gain >= 1 kg at month 6.
Analysis 5.6
Analysis 5.6
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 6 Weight gain >= 1 kg at month 12.
Analysis 5.7
Analysis 5.7
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 7 Weight loss >= 1 kg at month 6.
Analysis 5.8
Analysis 5.8
Comparison 5 DMPA 150 mg/mL versus COC, Outcome 8 Weight loss >= 1 kg at month 12.
Analysis 6.1
Analysis 6.1
Comparison 6 DMPA 150 mg/mL versus DMPA 450 mg/mL, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 7.1
Analysis 7.1
Comparison 7 DMPA 150 mg/mL initiation after pregnancy: interval (>=20 weeks) versus postpartum (5 to 8 weeks), Outcome 1 Mean weight gain (lbs) at 1 year.
Analysis 7.2
Analysis 7.2
Comparison 7 DMPA 150 mg/mL initiation after pregnancy: interval (>=20 weeks) versus postpartum (5 to 8 weeks), Outcome 2 Mean weight gain (lbs) at 2 years.
Analysis 8.1
Analysis 8.1
Comparison 8 DMPA-IM 150 mg versus DMPA-SC 104 mg, Outcome 1 Mean weight change (kg) at 36 months.
Analysis 9.1
Analysis 9.1
Comparison 9 DMPA 150 mg/mL versus NET-EN 200 mg (60-day intervals), Outcome 1 Mean weight change (kg) at 12 months.
Analysis 9.2
Analysis 9.2
Comparison 9 DMPA 150 mg/mL versus NET-EN 200 mg (60-day intervals), Outcome 2 Mean weight change (kg) at 24 months.
Analysis 9.3
Analysis 9.3
Comparison 9 DMPA 150 mg/mL versus NET-EN 200 mg (60-day intervals), Outcome 3 Mean weight change at 1 year.
Analysis 10.1
Analysis 10.1
Comparison 10 NET-EN 200 mg: 60-day intervals versus 3 intervals of 60 days then 84-day intervals, Outcome 1 Mean weight change (kg) at 12 months.
Analysis 10.2
Analysis 10.2
Comparison 10 NET-EN 200 mg: 60-day intervals versus 3 intervals of 60 days then 84-day intervals, Outcome 2 Mean weight change (kg) at 24 months.
Analysis 11.1
Analysis 11.1
Comparison 11 DMPA 150 mg/mL versus IUD, Outcome 1 Mean weight change (kg) at 120 months.
Analysis 11.2
Analysis 11.2
Comparison 11 DMPA 150 mg/mL versus IUD, Outcome 2 Mean weight change (kg) at 1 year by baseline BMI.
Analysis 11.3
Analysis 11.3
Comparison 11 DMPA 150 mg/mL versus IUD, Outcome 3 Mean weight change (kg) at 2 years by baseline BMI.
Analysis 11.4
Analysis 11.4
Comparison 11 DMPA 150 mg/mL versus IUD, Outcome 4 Mean weight change (kg) at 3 years by baseline BMI.
Analysis 12.1
Analysis 12.1
Comparison 12 Norplant versus DMPA 150 mg/mL, Outcome 1 Mean weight change (kg) at 1 year.
Analysis 13.1
Analysis 13.1
Comparison 13 Norplant versus IUD, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 13.2
Analysis 13.2
Comparison 13 Norplant versus IUD, Outcome 2 Mean weight change (kg) at 1 year.
Analysis 13.3
Analysis 13.3
Comparison 13 Norplant versus IUD, Outcome 3 Mean weight change (kg) at 3 years.
Analysis 14.1
Analysis 14.1
Comparison 14 Norplant versus barrier, ‘local’, or no contraceptive method, Outcome 1 Mean weight change (kg) at 6 months.
Analysis 15.1
Analysis 15.1
Comparison 15 Norplant versus 2-rod LNG, Outcome 1 Mean weight change (kg) at 1 year.
Analysis 15.2
Analysis 15.2
Comparison 15 Norplant versus 2-rod LNG, Outcome 2 Mean weight change (kg) at 3 years.
Analysis 15.3
Analysis 15.3
Comparison 15 Norplant versus 2-rod LNG, Outcome 3 Mean weight change (kg) at 5 years.
Analysis 16.1
Analysis 16.1
Comparison 16 Norplant versus COC, Outcome 1 Mean weight change (kg) at 1 year.
Analysis 16.2
Analysis 16.2
Comparison 16 Norplant versus COC, Outcome 2 Mean weight change (kg) at 3 years.
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References

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