• People Gain Weight On Birth Control Implant
• People Gain Weight On Birth Control Pills

Today’s Pills Are Different. Estrogen in high doses can cause weight gain due to increased appetite and fluid retention. So, 50 years ago they may indeed have caused weight gain in some women. Current birth control pills have much lower amounts of hormones. So weight gain is not likely to be a problem. Switch from a hormonal IUD to a copper IUD, or vice versa. If you gain weight with one type of IUD, there’s a chance you may not gain weight with another. Switch to a different birth control method altogether. Instead of trying another IUD, you could try another form of contraception.

Birth control implants release a synthetic form of the hormone progesterone called progestin. This hormone prevents ovulation or the release of an egg. It also thickens the mucus of the cervix, making it hard for the sperm to reach an egg if the body does ovulate.

The hormone progesterone increases during pregnancy, so the implant works by making the body think it is already pregnant and has no need to release another egg.

Research is mixed on whether the implant causes weight gain or if the weight gain is due to other factors.

• Women have long complained of weight gain when using hormonal birth control.
• A 2014 Cochrane Review found no significant effects on weight.
• Changes in hormones can affect many processes within the body.
• Women should report any side effects they experience to their doctor promptly.

Theories on the implant and weight gain

The research on weight gain related to birth control is mixed. If birth control implants do cause weight gain, it is not clear why this might happen.

One theory is that the hormone progestin may increase body fat. A 2015 study found a 2 percent increase in body fat among women who used the implant for 12 months.

Another possibility is that progestin causes water retention, making women feel bloated and slightly heavier, without changing their body fat percentage.

Some doctors argue that women do not gain weight on birth control, but if they believe birth control causes weight gain, then they gain weight, and later they attribute this to the birth control rather than to anything else.

From young adulthood into middle age, Americans gain an average of 1 to 2 pounds per year. These are women's prime childbearing years, too, and the time when they are most likely to use birth control implants and other hormonal contraceptives. So, gaining wait through age coincides with birth control use.

Does birth control cause weight gain?

The 2014 Cochrane study quoted earlier in this article did not directly evaluate implants, but it did look at pills and patches, containing the same hormones as birth control implants. It strongly suggests that women are unlikely to gain weight from using birth control implants.

A study published in 2017 looked at weight loss in overweight and obese women after giving birth. One group received a birth control implant, and the other group used birth control that did not use hormones. Slightly fewer implant users had lost weight 6 months into the study. However, the difference in weight loss between the two groups was no statistically significant. This is evidence that hormonal implants probably do not cause weight gain. Even if they do, the gain is minimal.

However, other studies contradict the findings of these two studies.

The 2015 study mentioned early compared 75 users of the implant to 75 users of a non-hormonal IUD. Implant users had modest increases in body size and a 2 percent increase in body fat.

A 2016 study found that the hormonal birth control implant did not directly cause weight gain. However, women who were told that the implant might cause weight gain were more likely to think they had gained weight. In some cases, this caused them to stop using the implant.

A 2015 study arrived at a similar result to this last example. It concluded that teens who used hormonal birth control, including the implant, were likely to perceive weight gain.

In summary, this research means that most women should not notice weight gain when they use the implant, and if they do gain weight, the weight is likely to be minimal.

However, women who think they will gain weight may believe they have gained weight. They may even attribute weight gain due to changes in lifestyle to the implant. This could be a barrier to them making healthy lifestyle changes.

Other implant side effects

Side effects vary from woman to woman and can change based on lifestyle and overall health. Some other side effects of birth control implants include:

• issues with milk supply when breastfeeding
• breast pain
• bleeding between periods, for the first few months of use
• nausea
• pain where the implant was fitted
• an infection where the implant was fitted
• depression or mood swings

Birth control implants are safe, but some women should avoid them. Women should talk to a doctor about alternatives to the implant if:

• they have a history of blood clots
• they are pregnant or think they might be
• they are allergic to any of the ingredients
• they have progesterone-sensitive cancer, such as breast cancer
• they have liver disease or a liver tumor
• they have a history of unexplained vaginal bleeding

Women with the following health issues will still be able to use the implant safely:

• high cholesterol
• depression
• kidney disease
• other chronic health conditions

Certain lifestyle factors, such as smoking or being overweight, may exacerbate some risks of the implant. Women should be honest about their lifestyle and health history and should ask their doctors about the risks and benefits of each birth control option.

When to see a doctor

Seek emergency medical care for signs of a blood clot, such as swelling in the leg or unexplained leg pain accompanied by a rapid heart rate. Women who suddenly gain significant weight or retain water should talk immediately to their doctors.

Takeaway

For most women, weight gain is a fact of life, particularly without an aggressive exercise routine and careful management of diet. It is normal to gain a few pounds with each passing year, and weight gain that appears related to birth control implants might be part of normal weight gain that comes with age. Increasing activity can counteract weight gain that accompanies aging.

Women should discuss with their doctors whether their weight gain is healthy and normal, as well as how they can minimize problematic weight gain. For most implant users, weight gain is unlikely. Even if it occurs, it may only be a few pounds.

Related coverage

Article last reviewed by Sat 18 November 2017.
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Birth control implants. (n.d.). Retrieved from https://www.plannedparenthood.org/learn/birth-control/birth-control-implant-implanon

Gallo, M. F., Legardy-Williams, J., Hylton-Kong, T., Rattray, C., Kourtis, A. P., Jamieson, D. J., … Steiner, M. J. (2016, March). Association of progestin contraceptive implant and weight gain [Abstract]. Obstetrics & Gynecology, 127(3), 573–576. Retrieved from http://journals.lww.com/greenjournal/Abstract/2016/03000/Association_of_Progestin_Contraceptive_Implant_and.21.aspx

Griffin, L., Hammond, C., Liu, D., Rademaker, A. W., & Kiley, J. (2017, June). Postpartum weight loss in overweight and obese women using the etonogestrel subdermal implant: A pilot study [Abstract]. Contraception, 95(6), 564–570. Retrieved from http://www.sciencedirect.com/science/article/pii/S0010782417300604

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Perez, M. J., Squires, K. J., Parks, L., & Peipert, J. F. (2015, April). Perceived weight gain among adolescents using contraception [Abstract]. Journal of Pediatric and Adolescent Gynecology, 28(2), e70. Retrieved from http://www.jpagonline.org/article/S1083-3188(15)00127-8/abstract

Risks and side effects of NEXPLANON. (n.d.). Retrieved from https://www.nexplanon.com/side-effects/

Stuebe, A. M., Bryant, A. G., Lewis, R., & Muddana, A. (2016, May 4). Association of etonogestrel-releasing contraceptive implant with reduced weight gain in an exclusively breastfed infant: Report and literature review. Breastfeeding Medicine, 11(4), 203–206. Retrieved from http://online.liebertpub.com/doi/abs/10.1089/bfm.2016.0017

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Recommended related news

Nearly half of all unintended pregnancies occur in women who report contraceptive use during the month they conceive. Research has shown a relationship between birth control pills and weight — that a woman’s weight could contribute to oral contraceptive failure. Unplanned pregnancy and obesity represent overlapping epidemics in the United States. Women should understand that obesity and weight might decrease birth control pill effectiveness. Although birth control pills tend to be one of the most popular methods of preventing pregnancy, their effectiveness may be compromised in heavier women.

Current Status

Obesity rates have increased over the past 25 years. In fact, according to the National Center for Health Statistics, obesity continues to be a public health concern in the United States and throughout the world. In 2005 to 2006, more than one-third of U.S. adults (over 72 million people) were classified as being obese. This study also revealed that 35.3% of women suffer from obesity. Along the same notion, about 34% of the U.S. adult population (27.4% of females) would be considered overweight. Obesity is defined as a body mass index (BMI) of 30 or greater whereas an overweight person has a BMI of 25 to 29.9. BMI is calculated from a person’s weight and height and provides a reasonable indicator of body fatness and weight categories that may lead to health problems.

Background

Prior to the Holt et al. study, it was believed that body weight had no effect on birth control pill effectiveness. This conclusion was primarily based on the Oxford Family Planning Association cohort study published in 2001. These researchers found no association between body weight and oral contraceptive failure rates (after adjusting for age and parity). However, 75% of the women in this study were using birth control pills that contained greater than or equal to 50 mcg of estrogen. The results from this study may not be applicable to current day oral contraceptive use because (with the exception of a handful of pill brands), the majority of combination birth control pills contain 30 to 35 mcg of estrogen, and several low-estrogen (20 mcg) varieties are also available.

Recent Research

Holt et al. conducted the largest case-control study thus far, examining the link between weight and oral contraceptive failure. They concluded that for women who use birth control pills (as compared to women of lower weight), those who are overweight are 60% more likely to get pregnant while those who are obese are 70% more likely to experience contraception failure. Specifically, the connection between extra pounds and pill failure first surfaced among overweight women whose BMI was 27.3 or higher (this would be equivalent to a 5-foot, 4-inch woman who weighs 160 pounds or more). Thus, women who consistently use oral contraceptives and whose BMI was greater than 27.3 had 1.58 times the risk of becoming pregnant as compared with consistent users whose BMI was less than 27.3. Also, an overweight woman is more likely to experience contraception failure if she misses her daily pill. It is important to note, however, factors including height, weight, adherence to a birth control schedule, and frequency of sexual intercourse was self-reported in this study.

This means that result inaccuracies may be possible due to faulty reporting.

A 2007 research study by Brunner, Huber, and Toth reveals a weak, although not statistically significant, relationship between obesity and birth control pill failure. The results did indicate that obese women (BMI ≥ 30) had a higher risk for pregnancy. Yet, after the researchers adjusted for the age, race/ethnicity, and parity of the women, they concluded that there was no association between weight and oral contraceptive failure. The researchers did advise that their study could have yielded faulty results because rather than weighing and measuring the research participates, the results were based on the women’s self-report of their height and weight. Given that women tend to over-report their height and under-report their weight by a few pounds, the BMI may have been inaccurate. Finally, the researchers did not have information on the frequency of sexual intercourse or whether or not the women were consistently taking their pills; the lack of inclusion of these factors could significantly bias the results of this study, and the researchers even concluded that larger, more comprehensive studies are needed to have a more definite answer as to whether obesity plays relevant role in oral contraceptive effectiveness.

Why the Pill Is Less Effective

Unfortunately, the exact reason as to why overweight and/or obese women are at greater risk of oral contraceptive failure is not completely known. However, several proposed theories point to biological factors that may account for increased risk:

• Hormone Levels: Modern-day birth control pills contain relatively low hormone levels (as compared to those first introduced decades ago). Oral contraceptive manufacturers have decreased hormone levels in an attempt to minimize unwanted side effects, such as risk of blood clots, weight gain, and headaches. In order to be effective, the hormones in the pill need to circulate through a woman's bloodstream. If a woman has a larger body mass, it could be more difficult for adequate circulation to happen, especially given lower level of hormones found in most of today’s pills.
• Metabolism: Typically, heavier women have a higher metabolism, so the pill hormones may be metabolized faster. So, the more a woman weighs, the higher her basal metabolic rate; this can shorten the duration of the pill’s effectiveness.
• Liver Enzymes: Overweight women may experience an up-regulation of liver metabolism; these higher levels of enzymes may help break down the hormones in oral contraceptives. Heavier women tend to have a greater circulating blood volume and body mass. Given that there is more tissue through which blood must circulate and the likelihood that the enzymes will break down the hormones faster, the levels of circulating hormones may be decreased.

• Hormone Storage: The hormones, estrogen and progestin, found in birth control pills are stored in body fat. Thus, the more fat cells a woman has, the greater her chances of the pill hormones becoming trapped in the fat instead of flowing through her bloodstream.

What Does This All Mean?

Should we interpret the research to mean that obese women should avoid the use of birth control pills? This may not necessarily be the answer. In fact, the effectiveness of the use or oral contraceptives (even in severely overweight women) would still remain fairly high. Among 100 women taking oral contraceptives for one year, Holt et al.’s (2005) study suggests that an additional two to four women will get pregnant due to being overweight or obese. However, this increased risk of pregnancy could also equate to a higher number of obesity-related complications of pregnancy, which can include gestational diabetes, high blood pressure, and Cesarean delivery.

Where It Stands

People Gain Weight On Birth Control Implant

Many healthcare providers are choosing to counteract the decrease in pill effectiveness by putting overweight and obese women on a slightly higher-dose birth control pill rather than a low-dose brand to help ensure that there are enough hormones to block ovulation.

If you find yourself in this situation, it is important to discuss all of your options and risk factors with your doctor. Since overweight women may be more likely to have cardiovascular disease risk factors than normal-weight women, the higher-dose of oral contraception could increase these cardiovascular risks even more. For example, research has shown there to be an increased risk of venous thromboembolism (blood clots) among obese women who use birth control pills. Therefore, a doctor may wish to keep an overweight woman on a regular-dose birth control pill with the instructions to use a backup method of birth control to help maximize pregnancy protection. In this case, barrier methods like male or female condoms, the sponge, or spermicide may be used in conjunction with the pill. Finally, if an overweight woman has decided that she no longer wishes to have any more children, a permanent form of contraception such as a tubal ligation or hysteroscopic (no-surgical) sterilization, like Essure.

The Bottom Line

Given that there is a slight connection between higher weight and birth control pill effectiveness, it is important to discuss this with your healthcare provider. Also, since first being prescribed the pill, if you notice that your weight has noticeably gone up (maybe, perhaps at least two dress sizes), make sure to inform your healthcare provider to make sure that this method is still the most effective and safest contraceptive option for you.

People Gain Weight On Birth Control Pills

• Brunner Huber, LR & Toth, JL (2007). Obesity and Oral Contraceptive Failure: Findings From the 2002 National Survey of Family Growth. American Journal of Epidemiology, 166(11), 1306-1311.
• Holt et al. (2005). Body Mass Index, Weight, and Oral Contraceptive Failure Risk. Obstetricians and Gynecology, 105(1), 46–52.
• Ogden, C.L, Carroll, MD, McDowell, MA, & Flegal, KM (2007). Obesity Among Adults in the United States -- No Statistically Significant Change Since 2003-2004.
• Vessey, M (2001). Oral Contraceptive Failures and Body Weight: Findings in a Large Cohort Study. Journal of Family Planning and Reproductive Health Care, 27(2), 90-91.