Which progestin is associated with less weight gain?

From the Guidelines

Drospirenone is the progestin associated with the least weight gain, making it a good choice for individuals concerned about this side effect. When considering hormonal contraception or hormone therapy, products containing drospirenone (such as Yaz, Yasmin, or Slynd) may be preferable for weight-sensitive patients. The typical dose for drospirenone in combined oral contraceptives is 3 mg daily, taken continuously for 24 days followed by 4 placebo days, or in some formulations, 3 mg daily for 21 days followed by 7 placebo days.

Key Points to Consider

• Drospirenone has mild diuretic properties that can help prevent fluid retention, which contributes to its weight-neutral profile, as noted in studies such as 1.
• This is because drospirenone is structurally related to spironolactone, which blocks aldosterone receptors.
• Individual responses to progestins vary significantly, and some patients may still experience weight changes regardless of which progestin is used.
• Other factors like estrogen content (in combined hormonal contraceptives) and individual metabolic factors also influence weight effects, as discussed in 1.
• It's also worth noting that other progestins, such as desogestrel and levonorgestrel, may have relatively lower weight gain potential, but the evidence is not as strong as it is for drospirenone, as seen in the comparison with other studies like 1.

Clinical Considerations

• When prescribing hormonal contraception or hormone therapy, clinicians should consider the potential impact on weight and choose products that minimize this risk.
• Barrier methods, copper intrauterine devices, and surgical sterilization are weight-neutral contraceptive options that can be utilized when appropriate, as mentioned in 1.
• The weight impact of hormonal intrauterine devices requires additional investigation.
• Clinicians should also be aware of the potential weight gain associated with other medications, such as oral glucocorticoids, and consider alternative classes of medications when possible, as discussed in 1.

From the Research

Progestin and Weight Gain

• Drospirenone is a progestin that has been shown to have a beneficial effect on body weight 2, 3, 4.
• Studies have demonstrated that drospirenone, in combination with ethinyl estradiol, leads to slight decreases in body weight compared to other oral contraceptives containing levonorgestrel 3.
• The antimineralocorticoid activity of drospirenone is thought to contribute to its effects on weight, by reducing salt and water retention 3, 5.
• Drospirenone has also been shown to have antiandrogenic activity, which may help to counteract the negative effects of androgens on body composition 4, 5.

Comparison to Other Progestins

• Drospirenone differs from other progestins in its derivation from spirolactone and its unique pharmacological profile 5.
• Unlike other progestins, drospirenone has antimineralocorticoid and antiandrogenic activity, which may contribute to its beneficial effects on weight and other symptoms 2, 3, 4, 5.
• The available evidence suggests that drospirenone may be associated with less weight gain compared to other progestins, although more research is needed to fully understand its effects 2, 3, 4.