OCs and weight gain: It’s time to banish the myths
OCs and weight gain: It’s time to banish the myths
When reviewing birth control options with a teen-age female patient, she tells you that she doesn’t want to use the Pill because it will make her gain weight. What do you tell her?
Share the following scientific findings from a new long-term study: Oral contraceptive (OC) use during adolescence is not associated with weight gain or increased body fat.1
Until now, most of the major research on the effects of pill use have looked at women ages 20 and older, says Tom Lloyd, PhD, professor of health evaluation sciences at the Penn State College of Medicine in Hershey, PA, and lead author of the research paper. The study provides new information about the effects of oral contraceptive use on adolescents and young women.
Why are the study results so important?
The No. 1 reason for women of all ages discontinuing OC use is the perception that they are gaining weight or getting fatter, notes Lloyd. (Four out of 10 women in a 2001 survey said weight gain is a reason to stop taking or avoid the Pill. See "Women and weight gain: OCs are not the culprit," Contraceptive Technology Update, May 2002, p. 53.)
"The operative word is perception," observes Lloyd. "In adult women, other works have shown that they do not gain weight or get fatter,2-5 but this had not been illustrated and defined in teen women."
Look at the results
The research paper is the latest work drawn from the Penn State Young Women’s Health Study, an ongoing observational study begun in 1990 with the enrollment of 112 healthy Caucasian female adolescents. The Penn State researchers continue to follow the natural progression of cardiovascular, reproductive, and bone health in this study population.
The OC study involved 66 females, 39 who used pills for a minimum of six months, were still users at age 21, and had used oral contraceptives for an average of 28 months. The 27 nonusers had never used OCs.
From ages 16-21, researchers took blood samples from the participants once a year to measure cardiolipoprotein levels. From ages 12.5-21, they took body composition measurements with dual energy X-ray absorptiometry. Participants filled out questionnaires with information about physical activity so that researchers could adjust results for body mass index and level of activity.
Results revealed that height, weight, body mass index, body fat, and most cardiovascular disease risk factors were similar for OC users and nonusers. Low-density lipoproteins, total cholesterol, and triglycerides were slightly higher in users than in nonusers, although still within the normal range.
No weight-loss OC
While no OC promotes weight gain, it is important to note that no OC promotes weight loss. Some providers report that women are requesting a particular pill, Yasmin, due to word-of-mouth reports that the OC will help them lose weight, or at least prevent them from gaining weight.
Yasmin, a monophasic birth control pill from Berlex Laboratories of Montville, NJ, is the first OC is the first to use the progestin drospirenone. Each package contains 21 active tablets with 3 mg of drospirenone and 0.030 mg of ethinyl estradiol and seven inert tablets. The pill gained Food and Drug Administration approval in May 2001. (See "Oral contraceptive with unique progestin receives FDA approval," in CTU, July 2001, p. 73, for news of the regulatory approval, and the Contraceptive Technology Reports, "Evaluation of a new oral contraceptive progestogen, drospirenone with ethinyl estradiol," inserted in the September 2001 issue, for a clinical review of the drug.)
In two European studies, Yasmin had a more favorable effect on body weight than a comparable OC, with mean body weight remaining lower in the Yasmin group.6 In one study, there was a distinct weight decrease in Yasmin users over the whole treatment phase, with a less distinct decrease in the comparative group.7 In the other study, the mean body weight per cycle in the Yasmin group was slightly below the baseline value throughout the study, with an increase in the comparison group from cycle 5 onward.8
The ethinyl estradiol in oral contraceptives can cause fluid retention, leading to weight increase in women sensitive to estrogen.9 Theoretically, the mild antimineralocorticoid properties of drospirenone help to counteract this effect and decrease the likelihood of weight gain.
Berlex Laboratories has no plans to market the drug for weight capabilities; the only studies now ongoing revolve around the drug’s potential use for treatment of premenstrual symptoms, says Kim Schillace, the company’s manager of public relations for female health care. (Read about this research in "Researchers eye Yasmin for treatment of PMS," December 2001 CTU, p. 141.)
"We have never marketed Yasmin as any kind of weight-loss method," says Schillace. "In fact, we are very concerned; we want people to know that it is not a weight-loss method."
References
1. Lloyd T, Lin HM, Matthews AE, et al. Oral contraceptive use by teenage women does not affect body composition. Obstet Gynecol 2002; 100:235-259.
2. Rosenberg M. Weight change with oral contraceptive use and during the menstrual cycle: Results of daily measurements. Contraception 1998; 58:345-349.
3. Reubinoff BE, Grubstein A, Meirow D, et al. Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women. Fertil Steril 1995; 63:516-521.
4. Endrikat J, Müller U, Düsterberg B. A 12-month comparative clinical investigation of two low-dose oral contraceptives containing 20 mg ethinyl estradiol/75 mg gestodene and 30 mg ethinyl estradiol/75 mg gestodene, with respect to efficacy, cycle control, and tolerance. Contraception 1997; 55:131-137.
5. Redmond G, Godwin AJ, Olson W, et al. Use of placebo controls in an oral contraceptive trial: Methodological issues and adverse event incidence. Contraception 1999; 60:81-85.
6. Foidart JM. The contraceptive profile of a new oral contraceptive with antimineralocorticoid and antiandrogenic effects. Eur J Contracept Reprod Health Care 2000; 5 Suppl 3:25-33.
7. Huber J, Foidart JM, Wuttke W, et al. Efficacy and tolerability of a monophasic oral contraceptive containing ethinyl estradiol and drospirenone. Eur J Contracept Reprod Health Care 2000; 5:25-34.
8. Foidart JM, Wuttke W, Bouw GM, et al. A comparative investigation of contraceptive reliability, cycle control, and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. Eur J Contracept Reprod Health Care 2000; 5:124-134.
9. Krattenmacher R. Drospirenone: Pharmacology and pharmacokinetics of a unique progestogen. Contraception 2000; 62:29-38.
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