Birth Control Methods That Do Not Cause Weight Gain
Non-hormonal contraceptive methods such as copper IUDs, barrier methods, and surgical sterilization are the most weight-neutral birth control options and do not cause weight gain. 1
Non-Hormonal Methods (Weight-Neutral Options)
- Copper intrauterine devices (IUDs) are considered weight-neutral, with users experiencing approximately the same weight gain as the average female population (about 300g/year) 1, 2
- Barrier methods such as condoms and diaphragms do not affect weight 1
- Surgical sterilization methods, including tubal ligation and hysteroscopic sterilization, have no effect on weight 1
Hormonal Methods and Weight Effects
Combined Hormonal Contraceptives
- Combined oral contraceptives (COCs) do not show substantial evidence of causing weight gain in most women 3
- Most studies show mean weight gain of less than 2 kg (4.4 lbs) at 12 months, which is similar to non-hormonal method users 3
- In a study of adolescents and young adults, there was no significant difference in weight gain between oral contraceptive users and those using non-hormonal methods 4
- Daily weight measurements of women using triphasic oral contraceptives showed no overall weight change after four cycles, with 72% of women experiencing either no weight change or weight loss 5
Progestin-Only Methods
- Levonorgestrel-releasing IUDs (hormonal IUDs) may affect body composition, with a 2.5% increase in body fat mass and a 1.4% decrease in lean body mass compared to non-hormonal IUD users 1
- Depot medroxyprogesterone acetate (DMPA) injections show the strongest association with weight gain among all contraceptive methods 6
- DMPA users showed greater weight gain compared to copper IUD users over three years (3.17 kg more on average) 6
- Progestin-only pills have limited evidence regarding weight effects but are generally not associated with significant weight gain 7
Considerations for Special Populations
- Adolescents with obesity who use DMPA appear to be at higher risk for weight gain compared to normal-weight DMPA users 1
- Women with obesity are generally not more likely to gain weight with COCs, vaginal rings, or IUDs than their normal-weight peers 1
- Women who have undergone bariatric surgery involving malabsorptive procedures may experience decreased effectiveness of oral contraceptives but weight effects should be similar 7, 1
Clinical Recommendations
- For women concerned about weight gain, recommend copper IUDs, barrier methods, or surgical sterilization as the most weight-neutral options 1
- When counseling patients about hormonal methods, emphasize that perceived weight gain is often not supported by evidence and may be due to normal age-related weight changes (approximately 300g/year) 2, 5
- If hormonal methods are preferred, combined hormonal contraceptives (pills, patch, ring) generally show minimal impact on weight 3
- Avoid DMPA injections in patients who are particularly concerned about weight gain, as this method shows the strongest association with weight changes 6
- Consider monitoring weight and body composition changes in patients using hormonal methods who express concerns about weight gain 1
By understanding the evidence-based weight effects of different contraceptive methods, providers can help patients make informed decisions that balance contraceptive effectiveness with concerns about potential side effects.