Elsevier

Contraception

Volume 58, Issue 6, December 1998, Pages 345-349
Contraception

Original Research Articles
Weight change with oral contraceptive use and during the menstrual cycle: Results of daily measurements

https://doi.org/10.1016/S0010-7824(98)00127-9Get rights and content

Abstract

Although weight gain is among the most common complaints of women using oral contraceptives (OC) and a frequent reason for discontinuation, studies demonstrate little basis for this perception. We explored this issue by analyzing the daily weights of 128 women during four cycles of triphasic OC use. The mean weight at the end of the fourth cycle of use was the same as baseline weight (average weight change, 0.0 pounds). The largest proportion of women, 52%, remained within 2 pounds (0.9 kg) of their starting weight, and 72% of women had either no weight change or a loss. Over each menstrual cycle, regular but minor weight shifts were observed, with the mean weight rising by one-half pound (0.2 kg) during the first weeks of each cycle and falling by the same amount during the last few days. These results emphasize the lack of association of OC use with weight gain but OC may be blamed at least in part, based on cyclic fluctuations. Counseling should emphasize weight gain as a misperception and stress the fact that a highly effective and safe form of contraception should not be ruled out or discontinued because of concern about weight.

Introduction

Weight gain is one of the most frequently cited reasons for not using oral contraceptives (OC), complaints among women who use OC, and reasons for discontinuation. A nationally representative sample of American women, for example, indicated that weight gain was the most common single reason for discontinuing OC.1 At 11%, this was a more frequent reason than nausea, headache, and menstrual abnormalities. A survey of 6676 women from several European countries similarly found that weight gain was among the most common complaints and was associated with a 40% increased likelihood of discontinuation.2 A separate analysis of the same European data indicates that weight gain is the most frequent reason for not initiating use of OC.3 Other studies and surveys consistently indicate that weight gain is among the most common reasons given for OC discontinuation.

Despite the strong influence of the weight gain perception on a woman’s initial and ongoing choice of contraception, relatively few studies have examined the relationship between weight gain and OC use. What information is available indicates little or no weight change.4, 5, 6 A large longitudinal study found a modest but significant weight gain of 0.1–1 kg after 1 year of use and 1.1–1.7 kg more after 2 years.7 However, this study was not controlled so could not differentiate between weight gain as a normal part of aging and that possibly resulting from the use of OC. A study comparing weight in women using different methods of contraception found a slight weight loss in the OC group and no significant differences between any of the contraceptive user groups.8 Finally, a controlled study found that weight change was similar in groups of women who were randomized to placebo and high-dose OC preparations.9 None of these studies measured daily weights, relying instead on periodic clinic visits.

If the common perception that OC result in weight gain is incorrect, it means that a highly reliable and safe contraceptive, which also has a number of important noncontraceptive benefits, will not be used as fully as it might. To help clarify this issue, we analyzed daily weight measurements among women enrolled in a clinical trial.

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Materials and methods

Subjects ranged in age from 18–35 years old, had not taken hormonal contraception for at least 2 months before enrollment in the study, and had completed two normal menstrual cycles before enrollment. Subjects received a triphasic oral contraceptive (Tri-Norinyl) with 35 μg of ethinyl estradiol (EE) on each pill day and a variable amount of norethindrone (NET): 50 μg on days 1–7, 100 μg on days 8–14, and 50 μg on days 15–21. Inert pills were provided for the remaining 7 days of each cycle. Of

Results

Study participants were primarily young, nulliparous, and white (Table 1). The mean weight change between study start and completion was 0.0 pounds (Figure 1). There was also no difference in mean weights over the four-cycle observation period if weights are examined on any given cycle day. For example, when day 7 of each cycle is examined, no differences in mean weight are apparent.

Consideration of weight change for individuals also indicates that the majority of women experienced little or

Discussion

Most women starting OC experienced no change in weight, and those who did were approximately equally distributed between gain and loss. These results did not differ when considered based on percentage change or between different groupings of age, race, and parity.

Our findings are consistent with those from other studies that find little or no weight change associated with OC use. Few of these, however, measured other factors that might have affected weight, such as diet and physical activity.

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