Average Weight Gain Associated with Different Contraceptive Methods
Depot medroxyprogesterone acetate (DMPA) is associated with the most significant weight gain among contraceptive methods, with users gaining approximately 6.2 kg over 4-5 years compared to 2-3 kg in non-users and users of other methods. 1
Hormonal Contraceptive Methods
Injectable Contraceptives
- DMPA (Depo-Provera) shows consistent evidence of weight gain, with users gaining an average of 6.2 kg over 4-5 years 1
- DMPA users gain significantly more weight than users of other contraceptive methods or non-users 1, 2
- In one study, DMPA users gained 2.28 kg more than non-hormonal IUD users in the first year, with the difference increasing to 3.17 kg by the third year 2
- DMPA not only increases weight but also affects body composition, with adolescent users showing an 11% greater increase in body fat percentage and a 4% greater decrease in lean body mass compared to non-hormonal method users 2
Combined Oral Contraceptives (COCs)
- COC users typically gain about 2.3 kg over 4-5 years, which is similar to weight gain in non-users of hormonal contraception (2.8 kg) 1
- Most studies show no substantial difference in weight between COC users and placebo or non-hormonal method users 3
- Daily weight measurements in one study showed no net weight change after four cycles of triphasic oral contraceptive use, with 72% of women experiencing either no weight change or weight loss 4
- Minor cyclic fluctuations occur during COC use, with weight typically increasing by about 0.2 kg during the first weeks of each cycle and decreasing by the same amount during the last few days 4
Progestin-Only Pills
- Limited evidence suggests minimal weight gain with progestin-only pills, generally less than 2 kg over 12 months 2
- Weight changes with progestin-only pills generally do not differ significantly from comparison groups using other contraceptive methods 2
Contraceptive Implants
- Implant users show greater weight gain compared to users of non-hormonal IUDs (0.47-1.10 kg more) 2
- In one study, implant users gained 0.74 kg more than those using barrier methods or no contraception 2
Hormonal IUDs
- Limited evidence suggests that levonorgestrel-releasing intrauterine systems (LNG-IUS) may affect body composition, with one study showing a 2.5% increase in body fat mass and a 1.4% decrease in lean body mass compared to non-hormonal IUD users 2
- Whether hormonal IUDs are truly weight-neutral requires additional investigation 5
Non-Hormonal Contraceptive Methods
Copper IUDs
- Copper IUDs are considered weight-neutral 5
- However, one study suggested that users of non-hormonal IUDs experienced approximately twice the weight gain of the average female population (about 0.6 kg/year versus 0.3 kg/year) 6
Barrier Methods
- Barrier methods (condoms, diaphragms) are considered weight-neutral 5
Surgical Sterilization
- Surgical sterilization methods (tubal ligation, hysteroscopic sterilization) are weight-neutral 5
Clinical Considerations
- Weight gain concerns are among the most common reasons for contraceptive discontinuation, yet evidence suggests the effect is often overestimated 3, 4
- Age-associated weight gain is approximately 0.3 kg per year in the general female population, which may be incorrectly attributed to contraceptive use 6
- Individual responses to hormonal contraceptives vary considerably, and some women may be more susceptible to weight changes than others 5
- For women concerned about weight gain, copper IUDs, barrier methods, and surgical sterilization are the most weight-neutral options 5
Special Populations
- Adolescents with obesity who use DMPA appear to be at higher risk for weight gain compared to normal-weight DMPA users, normal-weight non-users, and obese COC users 5
- Women with obesity are generally not more likely to gain weight with COCs, vaginal rings, IUDs, or implants than their normal-weight peers 5
- Women who have undergone bariatric surgery may experience decreased effectiveness of oral contraceptives due to malabsorption issues, but weight effects should be similar 5