Yaz is an Appropriate Contraceptive Choice for Weight Concerns
Yaz (drospirenone/ethinyl estradiol) is actually one of the better contraceptive options when weight gain is a concern, as combined oral contraceptives have not been reliably linked to weight gain, and drospirenone's unique antimineralocorticoid properties may help prevent fluid retention and maintain stable body weight. 1, 2
Why Yaz is Suitable for This Patient
Weight Neutrality of Combined Hormonal Contraceptives
Combined oral contraceptives (COCs) do not cause clinically significant weight gain according to American Academy of Pediatrics guidelines, which explicitly state that weight gain has not been reliably linked to combined hormonal contraception 1, 2, 3
Women with obesity are generally not more likely to gain weight with COCs compared to their normal-weight peers 1, 2
The typical weight fluctuation during COC use is approximately 3 kg over 6-24 months, which is comparable to age-related weight changes in the general population 4
Unique Advantages of Drospirenone
Drospirenone has antimineralocorticoid activity that prevents salt and water retention, which distinguishes it from other progestins and may actually help maintain stable body weight 5, 6
Studies comparing drospirenone-containing COCs to other formulations show more favorable effects on body weight, with mean body weight remaining at or below baseline for the majority of women 6
The antimineralocorticoid properties also reduce fluid retention-related symptoms like bloating, breast tenderness, and abdominal swelling 6, 7
Contraceptives to Avoid for Weight Concerns
DMPA (Depo-Provera) Should Be Avoided
DMPA is the only contraceptive method with strong evidence of weight gain, with users gaining an average of 6.2 kg compared to 2.3 kg in COC users over 4-5 years 8
The proportion of women gaining more than 3 kg per year is significantly higher with DMPA compared to other hormonal contraceptives 2, 4
Early weight gain at 6 months (>5% body weight increase) strongly predicts future excessive weight gain with continued DMPA use, with "early gainers" experiencing mean BMI increases of 7.6 versus 2.3 in non-early gainers over 18 months 1, 2
Prescribing Recommendations for This Patient
Starting Yaz
No pelvic examination is required before initiating COCs, though routine STI screening is recommended for sexually active patients 1
Yaz contains 20 mcg ethinyl estradiol with a 24/4 regimen (24 active pills, 4 placebo), which provides effective contraception with a low estrogen dose 5, 7
The 24/4 regimen with shortened hormone-free interval optimizes ovarian suppression and may improve contraceptive effectiveness, especially important for adolescents who may miss pills 1
Counseling Points
Reassure the patient that COCs do not cause weight gain and that fear of weight gain should not be a barrier to using this effective contraceptive method 2, 3
Explain that drospirenone's unique properties may actually help with fluid-related symptoms and weight stability 6, 7
Discuss noncontraceptive benefits including decreased menstrual cramping and blood loss, improvement in acne, and no negative effect on long-term fertility 1
Monitoring and Follow-Up
Assess blood pressure at baseline and monitor health status changes at follow-up visits 1
Frequent follow-up is important to maximize adherence and address any concerns 1
If the patient were to switch to DMPA in the future (not recommended given weight concerns), weight should be monitored at 6 months as a critical decision point 2
Alternative Weight-Neutral Options
If the patient strongly prefers non-hormonal contraception:
Copper IUD is completely weight-neutral with no hormonal effects whatsoever 3
Barrier methods are entirely weight-neutral 3
Long-acting reversible contraceptives (LARC) like the levonorgestrel IUD or etonogestrel implant should be considered first-line options for adolescents given their superior efficacy, and women with obesity are not more likely to gain weight with IUDs or implants than normal-weight peers 1, 2