Does Slynd Cause Weight Gain?
Slynd (drospirenone 4mg progestin-only pill) does not cause weight gain and may actually lead to modest weight decreases, particularly in women with elevated baseline blood pressure.
Evidence for Drospirenone's Effect on Weight
Drospirenone has unique antimineralocorticoid properties that prevent the fluid retention and weight gain typically associated with other hormonal contraceptives. 1 This distinguishes it from conventional progestins that lack this protective effect. 2, 3
Progestin-Only Drospirenone (Slynd)
Drospirenone 4mg as a progestin-only pill is associated with decreases in systolic blood pressure of 8 mmHg and diastolic blood pressure of 5 mmHg among individuals with baseline SBP ≥130 and DBP ≥85, while maintaining stable blood pressures in normotensive individuals. 1
Among normotensive women, drospirenone 4mg maintains stable body weight without causing weight gain. 1
The antimineralocorticoid activity of drospirenone prevents salt and water retention, thereby maintaining stable body weight. 4, 5
Mechanism of Action
Drospirenone acts as an aldosterone antagonist at the mineralocorticoid receptor, similar to natural progesterone, preventing sodium retention that other progestins cannot counteract. 2, 3
This natriuretic effect leads to mild sodium loss followed by compensatory activation of the renin-aldosterone system, comparable to a low-sodium diet. 2
The relationship between drospirenone's progestogenic and antimineralocorticoid potency is almost identical to that of natural progesterone. 3
Comparison to Other Contraceptives
Combined Oral Contraceptives
Combined oral contraceptives (COCs) generally do not cause clinically significant weight gain, according to American Academy of Pediatrics guidelines. 6
Women with obesity are generally not more likely to gain weight with COCs compared to their normal-weight peers. 6
DMPA (Depot Medroxyprogesterone Acetate)
DMPA is the notable exception among contraceptives, with documented weight gain in a subset of users. 6
The proportion of women gaining more than 3 kg per year is higher with DMPA compared to other hormonal contraceptives. 6
Weight gain at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use. 6
Clinical Context
Normal Weight Gain in Reproductive-Aged Women
Reproductive-aged women gain weight more rapidly than other age groups, with an average weight gain of 6.3 kg over 10 years, independent of contraceptive use. 7
This baseline weight gain trajectory is important context when counseling patients about contraceptive-related weight concerns. 7
Weight-Neutral Options
- For women specifically concerned about weight gain, copper IUDs, barrier methods, and surgical sterilization are the most weight-neutral options. 6, 7
Clinical Recommendations
Counsel patients that Slynd is unlikely to cause weight gain and may offer advantages over other hormonal contraceptives due to its antimineralocorticoid properties. 1, 8
Baseline weight measurement may be useful for subsequent monitoring, though it is not required for determining medical eligibility. 6
Emphasize that fear of weight gain should not be a barrier to using effective contraception, as the risk of unintended pregnancy far outweighs minimal or nonexistent weight effects from most contraceptives. 6
For women with mild hypertension or fluid retention concerns, drospirenone-containing contraceptives may offer additional benefits beyond contraception. 1, 5, 8