Does low hormone birth control cause weight gain in the upper part of the body?

Low-Dose Hormonal Birth Control and Weight Gain

Low-dose hormonal birth control (combined oral contraceptives with ≤35 μg ethinyl estradiol) does not cause clinically significant weight gain or preferential upper body fat distribution in most women. 1

Evidence on Weight Changes with Low-Dose Combined Hormonal Contraceptives

The concern about "hormonal weight gain" is largely not supported by evidence for low-dose combined hormonal contraceptives:

• Mean weight changes are minimal: Studies show mean weight gain of less than 1 kg (approximately 0.5-0.9 kg) over 6-13 months of use with low-dose combined oral contraceptives 2
• Only 0.3% of users experience clinically significant weight change (defined as >10% of baseline body weight) 2
• Neither weight gain nor mood changes have been reliably linked to combined hormonal contraception according to American Academy of Pediatrics guidelines 3

Body Composition Changes (Not Overall Weight)

While total weight may not change substantially, there can be subtle shifts in body composition:

• When weight gain does occur with low-dose oral contraceptives, it is due to increased body fat percentage (not water retention), with one study showing fat accumulation from 22.5% to 25.6% in the subset of users who gained weight 4
• However, this fat accumulation is not preferentially distributed to the upper body - the waist-to-hip ratio remains unchanged, indicating no specific upper body or abdominal fat distribution pattern 4
• Approximately 30-35% of users gain weight (>0.5 kg), but a similar proportion of non-users also gain weight, suggesting age-related factors rather than contraceptive effects 4

Important Distinction: DMPA is Different

The evidence for depot medroxyprogesterone acetate (DMPA/Depo-Provera) is distinctly different from low-dose combined hormonal contraceptives:

• DMPA is associated with weight gain in a subset of users, with the proportion gaining >3 kg/year being higher compared to other hormonal contraceptives 3, 5
• Early weight gain at 6 months predicts future excessive weight gain: 21% of adolescent DMPA users gained >5% body weight at 6 months, and these "early gainers" experienced mean BMI increase of 7.6 versus 2.3 in non-early gainers over 18 months 1, 3
• DMPA users show increased body fat percentage and decreased lean body mass compared to non-hormonal method users 5

Clinical Counseling Approach

Measuring weight and calculating BMI at baseline is helpful for monitoring changes and counseling women concerned about weight change perceived to be associated with their contraceptive method 1

For women specifically concerned about weight:

• Copper IUDs, barrier methods, and surgical sterilization are the most weight-neutral options 6
• Low-dose combined oral contraceptives (≤35 μg ethinyl estradiol) should be first-line options as they show minimal to no weight effects 1, 3
• Avoid DMPA in adolescents with obesity, as they appear at higher risk for weight gain compared to normal-weight DMPA users and obese combined oral contraceptive users 6, 3

Common Pitfall to Avoid

Do not discontinue effective contraception based on weight misperceptions, as the risk of unintended pregnancy far outweighs minimal or nonexistent weight effects from most contraceptives 3. The perception of weight gain often exceeds actual measured changes, and appropriate counseling about typical weight fluctuations (approximately 3 kg over 6-24 months, similar to non-users) may help reduce discontinuation 7.