What birth control methods are associated with the lowest weight gain?

Birth Control Methods with Lowest Weight Gain

Copper IUDs, barrier methods, and combined oral contraceptive pills (COCs) are associated with the lowest weight gain, while depot medroxyprogesterone acetate (DMPA) should be avoided if weight gain is a primary concern. 1

Weight-Neutral Contraceptive Options

Non-Hormonal Methods (No Weight Gain)

• Copper IUD (Cu-IUD): The most weight-neutral option available, with no hormonal exposure and no association with weight gain 1
• Barrier methods (condoms, diaphragms): No hormonal effects on weight 1
• Surgical sterilization: Including tubal ligation and hysteroscopic sterilization, completely eliminates hormonal exposure 1

Combined Hormonal Contraceptives (Minimal to No Weight Gain)

• Combined oral contraceptive pills (COCs): No clear evidence of weight change associated with combination estrogen-progestin pills, though individual responses vary 1
• Neither weight gain nor mood changes have been reliably linked to combined hormonal contraception 1
• Low-dose pills (≤35 μg ethinyl estradiol) are first-line options and show minimal weight effects 1
• Mean weight gain at 6-12 months is typically less than 2 kg (4.4 lb) for most hormonal methods 2

Progestin-Only Methods with Variable Evidence

• Levonorgestrel IUD (LNG-IUD): Requires additional investigation to confirm weight neutrality, though evidence suggests minimal systemic effects 1
• Contraceptive implants: Limited evidence of significant weight change in most studies 2
• Progestin-only pills (POPs): Generally show minimal weight change, though data quality is limited 2

Methods to AVOID for Weight-Conscious Patients

Depot Medroxyprogesterone Acetate (DMPA/Depo-Provera)

DMPA is consistently associated with the greatest weight gain among contraceptive methods and should be avoided when weight is a concern 1, 2:

• Year 1: Mean weight gain of 2.28 kg more than Cu-IUD users 2
• Year 2: Mean weight gain of 2.71 kg more than Cu-IUD users 2
• Year 3: Mean weight gain of 3.17 kg more than Cu-IUD users 2
• Year 10: Mean weight gain of 6.6 kg versus 4.9 kg for Cu-IUD users 2

Additional concerns with DMPA:

• Greater increase in body fat percentage (11% increase) compared to non-hormonal methods 2
• Greater decrease in lean body mass (-4%) compared to non-hormonal methods 2
• A Cochrane review specifically demonstrated evidence of weight gain with medroxyprogesterone acetate 1

Clinical Recommendations Algorithm

Step 1: Assess patient priorities

• If weight gain is the primary concern → Recommend copper IUD or barrier methods 1
• If hormonal contraception preferred → Recommend COCs with ≤35 μg ethinyl estradiol 1

Step 2: Avoid DMPA

• Do not prescribe depot medroxyprogesterone acetate for weight-conscious patients 1, 2

Step 3: Counsel on realistic expectations

• CDC guidelines recommend assessing weight changes and counseling women concerned about perceived weight changes with their contraceptive method 1
• Most hormonal methods show mean weight gain <2 kg at one year 2
• Weight changes at 2-4 years are approximately twice those at one year, but study groups generally do not differ significantly 2

Step 4: Consider formulations with drospirenone for specific populations

• Drospirenone-containing COCs have antimineralcorticoid activity that opposes sodium retention and may help prevent water retention and weight gain 3
• Studies show weight loss that stabilizes after 6 months with drospirenone/ethinyl estradiol formulations 3

Important Caveats

• Quality of evidence: Most weight-related contraceptive studies are of low quality due to lack of randomization and high loss to follow-up 2
• Individual variation: While combination pills show no clear evidence of weight change at the population level, individual responses vary 1
• Counseling importance: Appropriate counseling about typical weight patterns may reduce discontinuation due to perceptions of weight gain 2
• The vaginal ring (NuvaRing) lists weight gain as an adverse event reported by 5-14% of users, though causality is not established 4