What birth control methods have minimal weight gain as a side effect?

Birth Control Methods with Minimal Weight Gain Side Effects

The copper intrauterine device (Cu-IUD), barrier methods, and surgical sterilization are the birth control options least likely to cause weight gain as they do not contain hormones that could affect metabolism. 1, 2

Non-Hormonal Options (Best for Avoiding Weight Gain)

• Copper IUD (Paragard) - completely hormone-free and has no systemic metabolic effects that could lead to weight gain 1
• Barrier methods (condoms, diaphragms) - contain no hormones and have no effect on weight 1
• Surgical sterilization (tubal ligation, hysteroscopic sterilization) - permanent options without hormonal side effects 1

Hormonal Options with Lower Risk of Weight Gain

Combined Hormonal Contraceptives

• Lower estrogen content pills (20 μg ethinyl estradiol) may be associated with less fluid retention than higher-dose formulations 1, 3
• Drospirenone-containing pills (like Yasmin or Yasminelle) have antimineralocorticoid properties that may help prevent water retention and weight gain 3
• Some studies have shown weight loss that stabilized after 6 months of treatment with drospirenone/ethinyl estradiol combinations 3

Progestin-Only Methods

• Progestin-only pills ("mini-pills") generally have fewer systemic effects than combined hormonal methods 1
• Hormonal IUDs (like Mirena) primarily work locally in the uterus with minimal systemic absorption 2

Methods to Approach with Caution

• Depot medroxyprogesterone acetate (DMPA) injections have been associated with weight gain in studies 1
• Research shows that approximately 21% of adolescents using DMPA experience "early weight gain" (>5% increase in weight at 6 months) 1
• These "early gainers" experienced an increase in mean BMI of 7.6 compared with 2.3 for non-early gainers over 18 months 1

Special Considerations

• The transdermal patch has slightly higher pregnancy rates in women weighing more than 198 pounds (0.9% vs 0.3% in first 12 months of perfect use) 1, 2
• For emergency contraception specifically, ulipristal acetate may be more effective than levonorgestrel in women who weigh more than 165 pounds 1, 2
• Women with higher BMIs may benefit from formulations with lower estrogen doses (20 μg) combined with drospirenone 3

Clinical Approach

1. Consider non-hormonal methods first if weight gain is a significant concern
2. If hormonal methods are preferred or required, consider:
   • Lower dose estrogen formulations (20 μg ethinyl estradiol) 3, 4
   • Progestins with antimineralocorticoid properties like drospirenone 3
   • Local hormone delivery systems (hormonal IUD) over systemic ones 2
3. Avoid depot medroxyprogesterone acetate (DMPA) injections if weight gain is a major concern 1

Remember that individual responses to hormonal contraceptives vary considerably, and what causes weight gain in one person may not affect another in the same way 1.