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. Progestins like drospirenone (found in birth control pills like Yaz and Yasmin) may even help with weight management due to their anti-androgenic and anti-mineralocorticoid properties, which can reduce water retention 1. Other progestins with relatively minimal weight effects include desogestrel and norgestimate. In contrast, progestins like medroxyprogesterone acetate (found in Depo-Provera) and levonorgestrel (in some IUDs and emergency contraceptives) are more commonly associated with weight gain. The mechanism behind progestin-related weight changes involves effects on appetite, fluid retention, and metabolic processes. Individual responses to different progestins vary significantly, so what works best depends on your personal health history, other medications, and specific concerns. If weight gain is a significant concern, discuss with your healthcare provider about trying a formulation containing drospirenone or other newer-generation progestins.
Some key points to consider when choosing a progestin include:
- The anti-mineralocorticoid effects of drospirenone, which can help mitigate weight gain and reduce blood pressure 1
- The potential for medroxyprogesterone acetate to negatively impact cardiovascular risk and lipid profiles 1
- The favorable profile of natural micronized progesterone in terms of minimizing hormonal-related cardiovascular risks and having a neutral or beneficial effect on blood pressure 1
- The importance of individualized treatment and consideration of personal health history, other medications, and specific concerns when selecting a progestin.
It's essential to consult with a healthcare provider to determine the best progestin for your specific needs and health status. They can help you weigh the potential benefits and risks of different progestins and make an informed decision about which one to use.
From the Research
Progestin and Weight Gain
- The progestin hormone associated with less weight gain is drospirenone, as it has antimineralocorticoid and antialdosterone effects that help reduce water retention and blood pressure 2, 3, 4, 5, 6.
- Drospirenone's unique pharmacological profile, which is closer to progesterone than other synthetic progestogens, allows it to counteract the estrogen-induced stimulation of the renin-angiotensin-aldosterone system and block testosterone from binding to androgen receptors 3, 4, 5, 6.
- Studies have shown that drospirenone, in combination with ethinyl estradiol, is effective as a combined oral contraceptive and has positive effects on weight and lipid levels, with a decrease in body weight compared to conventional oral contraceptives 2, 3, 4, 6.
- The antimineralocorticoid activity of drospirenone causes decreased salt and water retention, leading to a lowering of blood pressure, which may also contribute to the reduction in weight gain 2, 3, 5, 6.
Comparison to Other Progestins
- Unlike other synthetic progestogens, drospirenone has a high affinity for the mineralocorticoid receptor, making it an antagonist of aldosterone, which is not only important in the renin-angiotensin-aldosterone system but also acts directly on the cardiovascular system 3, 5, 6.
- Drospirenone's antiandrogenic activity may also counteract the negative effects of androgens on hair growth, lipid changes, insulin, and possibly body composition in postmenopausal women 3, 5, 6.
- The pharmacodynamic properties of drospirenone are very similar to those of progesterone, making it a viable alternative to currently available progestogens 4, 5.