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Contraceptive-Induced Weight Gain-Myth and Reality Review.

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Summary

Hormonal contraception perception versus reality: Combined hormonal contraceptives (CHCs) are generally weight-neutral, with perceived gain often due to fluid retention. Depot Medroxyprogesterone Acetate (DMPA) is linked to actual weight gain.

Keywords:
contraceptionendometriosisestrogenfathormonalpolycystic ovary syndromeprogesteroneweight-gain

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Area of Science:

  • Reproductive Health
  • Pharmacogenomics
  • Endocrinology

Background:

  • Patient perception of hormonal contraception causing weight gain is a significant barrier to family planning.
  • Distinguishing subjective experience from objective metabolic changes is crucial for informed decision-making.

Purpose of the Study:

  • To critically evaluate the evidence linking hormonal contraceptives to weight gain.
  • To differentiate between various hormonal contraceptive methods regarding their impact on body weight.
  • To explore potential biological mechanisms and genetic factors influencing weight changes.

Main Methods:

  • Narrative review of data from Cochrane systematic reviews.
  • Analysis of placebo-controlled trials.
  • Inclusion of recent pharmacogenomic studies.

Main Results:

  • Combined hormonal contraceptives (CHCs) show no consistent evidence of causing weight gain; placebo-controlled trials indicate they are weight-neutral on average.
  • Depot Medroxyprogesterone Acetate (DMPA) is associated with significant fat mass accumulation.
  • Etonogestrel implant is generally weight-neutral, but a specific Estrogen Receptor 1 (ESR1) gene variant may predispose some individuals to weight gain.

Conclusions:

  • Perceived weight gain with CHCs may be linked to fluid retention (RAAS), not fat accumulation.
  • The nocebo effect and misattribution of age-related weight changes contribute to the persistent concern.
  • DMPA poses a verified risk for weight gain, while CHCs and etonogestrel implants are largely weight-neutral, with potential genetic predispositions for the latter.