What is the effect of progesterone on body weight?

From the Guidelines

Progesterone is associated with weight gain, as evidenced by a recent Cochrane review of progestin-only contraceptives demonstrating weight gain associated with medroxyprogesterone acetate 1. The effect of progesterone on body weight is complex and can vary depending on the individual and the specific formulation of the hormone.

• Different progestins have variable androgenic/anti-androgenic profiles, which can influence their impact on weight.
• Estrogen doses also vary considerably in hormonal contraceptives, making it difficult to categorize their weight impact as a whole.
• A study published in Gastroenterology in 2017 noted that the quality of studies assessing the weight impact of hormonal contraceptives is limited, frequently due to lack of randomization or absence of a placebo group 1. Some individuals may experience weight gain due to increased fluid retention, appetite, and slowed metabolism caused by progesterone.
• This weight gain is often temporary and concentrated in the lower abdomen, breasts, and hips.
• To manage progesterone-related weight changes, it is recommended to maintain consistent physical activity, focus on a balanced diet rich in fruits, vegetables, and lean proteins, limit sodium intake to reduce fluid retention, and stay well-hydrated.
• If weight gain becomes significant or concerning while on progesterone-containing medications, it is advised to consult with a healthcare provider, as dosage adjustments or alternative treatments may be appropriate 1.

From the Research

Effect of Progesterone on Body Weight

• The relationship between progesterone and body weight is complex, with various studies showing different results 2, 3, 4, 5, 6.
• A study on progestin-only contraceptives found that most studies showed a mean weight gain of less than 2 kg up to 12 months, and weight change for the progestin-only contraceptive group generally did not differ significantly from that of the comparison group using another contraceptive 2.
• Another study on hormone replacement therapy found no statistically significant difference in mean weight gain between those using unopposed oestrogen or combined oestrogen and progestogen therapy and non-hormone replacement therapy users 3.
• A systematic review on the impact of micronized progesterone on body weight, body mass index, and glucose metabolism found that estrogens combined with micronized progesterone either do not change or reduce body weight in normal weight postmenopausal women, and do not change body mass index in normal and overweight postmenopausal women 4.
• A retrospective cohort study found a strong negative correlation between serum progesterone level and both body mass index and weight, with body mass index accounting for 27% and weight accounting for 29% of the variance in progesterone level 5.
• A secondary analysis of data from a randomized controlled trial found no evidence of weight gain from short-term use of a progestin contraceptive implant, despite differences in perceived weight gain between the implant and control arms 6.

Key Findings

• Progesterone may not be the primary cause of weight gain in women using hormonal contraceptives or hormone replacement therapy 2, 3, 4.
• Body weight and body mass index may affect serum progesterone levels, with higher body weight and body mass index associated with lower serum progesterone levels 5.
• The perception of weight gain may be influenced by the nocebo effect, where women who are counseled to expect possible weight gain from initiating hormonal contraceptive use may perceive weight gain even in its absence 6.