Is medroxyprogesterone (MPA) associated with an increased risk of obesity?

Medroxyprogesterone and Obesity Risk

Yes, medroxyprogesterone acetate (MPA) is associated with an increased risk of obesity, particularly in adolescents and those who are already overweight at initiation of therapy. 1

Evidence on Weight Gain with Medroxyprogesterone

Population-Specific Effects

• Adolescents: Evidence shows that adolescent DMPA users who are already overweight or obese may gain significantly more weight than normal-weight users or non-users 1, 2

  • In one study, obese adolescents gained an average of 9.4 kg over 18 months on DMPA, compared to only 3.1 kg in controls 2
  • The weight gain in obese adolescents using DMPA was also greater than in all non-obese categories (4.0 kg for non-obese DMPA users) 2

• Adults: The relationship between baseline weight and DMPA-associated weight gain appears less pronounced in adult women 3

  • Evidence from five studies suggests that among adult women, baseline weight or BMI is not associated with weight gain among DMPA users 3

Time Course and Risk Factors

• Weight gain with DMPA appears to be progressive and related to duration of use 1, 2
• A significant interaction exists between length of time receiving DMPA and weight gain, particularly in obese subjects 2
• Initial BMI is a significant predictor of weight gain with DMPA after adjusting for age, race, and contraceptive method 4

Comparison with Other Contraceptive Methods

• DMPA users gained significantly more weight (8.9 lbs) compared to oral contraceptive pill users (4.79 lbs) over one year 4
• The change in BMI from baseline was greater among DMPA users (1.51 ± 1.94) than OCP users (0.75 ± 1.65) 4
• Weight-neutral contraceptive options that minimize hormonal exposure include:
  • Barrier methods
  • Copper intrauterine devices
  • Surgical sterilization 1

Clinical Implications and Recommendations

Risk Assessment Before Initiating DMPA

1. Baseline BMI assessment is crucial before starting DMPA
2. Identify high-risk patients:
   • Adolescents
   • Patients who are already overweight or obese
   • Patients with other risk factors for obesity

Alternative Options for High-Risk Patients

For patients at high risk of weight gain:

• Consider weight-neutral contraceptive options:
  • Copper IUD
  • Barrier methods
  • Combined oral contraceptives (which show no clear evidence of weight change) 1
  • Levonorgestrel IUD (may have less systemic effect) 5

Monitoring Recommendations

For patients using DMPA:

• Regular weight monitoring, especially during the first year of use
• Consider discontinuation if significant weight gain occurs (>5% of baseline weight) 1
• Be particularly vigilant with adolescent patients who are already overweight

Conclusion

The evidence clearly shows that medroxyprogesterone acetate, particularly in the form of DMPA, is associated with weight gain. This effect is most pronounced in adolescents and those who are already overweight or obese at initiation. Healthcare providers should consider this risk when prescribing contraceptives, especially for vulnerable populations, and should monitor weight changes closely in patients using DMPA.