Everything You Need To Know About Oral Birth Control And Weight Gain

by Marixie Ann Obsioma, MT, undergrad MD on November 3, 2021
Last updated on January 15, 2022

What You Need To Know

Weight gain is a common concern among those considering hormonal birth control. Some people may be put off by stories of others gaining weight on hormonal birth control. But it isn’t. Contraception does not cause weight gain in most studies. Some do report gaining a few pounds in the weeks and months following their first dose. Temporary water retention causes temporary weight gain.

What the Study Says

Hormonal contraception used to use much higher hormone levels than today.

Progestins can increase appetite, while estrogen can cause fluid retention. Hormonal birth control and combination pill advancements have addressed this issue.

Most, if not all, pills do not contain enough estrogen to cause weight gain. The first birth control pill contained 150 mcg of estrogen mestranol.

A 2012 review found that today’s pills contain 20-50 mcg estrogen.

Numerous studies have examined the link between weight gain and popular hormonal contraception methods like the pill and the patch. The majority of these studies found no link between birth control pills and weight gain.

Water retention causes weight gain in the first few weeks or months of starting birth control. It’s not fat gain.

Using a progestin-only pill for 6 or 12 months resulted in an average weight gain of less than 4.4 pounds.

If you gain more than that after starting hormonal birth control, it’s probably due to something else.

Causes of Weight Gain

If you’ve gained weight without knowing why, it could be due to one of the following causes.

Routine shifts

If you recently changed jobs and spend most of your day sitting, you may notice a gradual weight gain. Sitting for long periods of time can cause weight gain, among other effects.

Diet changes

Are you eating out more? Gradual calorie increases can cause weight gain.

Track your daily calorie intake with a food tracking app. This can help you maintain your weight or lose weight if you want to.

Metabolic changes

Depending on your age, your metabolism may be affecting your weight and energy. Your metabolism can slow down as you age. Your body’s natural calorie-burning ability may be impaired.

If you have a health condition that may be affecting your body’s ability to burn calories, ask your doctor to check your physical and metabolic functions.

Gym changes

What kind of exercises do you do more? Increased muscle mass may explain the scale increase.

You’ll probably still feel big. Your jeans will fit as before or better, but your weight may increase. You’re gaining muscle.

Chance of Gaining Weight

No particular group is more prone to weight gain than another, according to research. Your starting weight shouldn’t matter either.

Study shows that obese girls under the age of 18 aren’t more likely to gain weight when taking the pill.

Managing Weight Gain

If you’ve gained weight since starting birth control, keep in mind these suggestions:

Give it time

You may gain a few pounds right away after starting birth control. This is usually due to water retention, not fat gain.

Almost always transitory. Water will evaporate and your weight should return to normal.

Move more

Regular exercise and a healthy diet can only help you. Getting more active may help you lose the weight you gain after starting birth control.

Switch birth control pills

Progestins can increase appetite and estrogen can cause water retention. A high dose of progestin or estrogen in your contraception may cause weight gain.

If you think your weight gain is due to your birth control, make an appointment with your doctor.

Your doctor may be able to find a birth control pill that has less estrogen and doesn’t affect your appetite or weight.

Consequences of Birth Control

Other side effects, besides water retention, may appear shortly after starting birth control.

Birth control side effects include:

Nausea

You may feel nauseated if your birth control dose is too high or you don’t take it with food. Consult your doctor about reducing nausea.

You can try taking the pill right after a meal or lowering the dosage. You could also take it before bed to help with nausea.

Dysmorphia

Birth control usually reduces acne breakouts. Using birth control may cause increased breakouts in some women. Hormone changes can cause this.

Headaches

Estrogen can cause headaches. If you suffer from migraines, adding estrogen to your system may exacerbate your symptoms.

Aura migraine is a contraindication to the combined birth control pill. Talk to your doctor if you have neurological or visual symptoms in addition to your headache.

Before starting birth control, tell your doctor about your headaches. Ask your doctor what can be done if headaches become more frequent.

Consult your doctor before avoiding hormonal birth control. The beauty of birth control today is the variety of options.

If you don’t like your doctor’s first suggestion, you can easily switch it up.

If you don’t like it, you can keep trying until you find something that you like, has no unpleasant side effects, and fits your lifestyle.

Birth Control and Weight Gain

Concerns about weight gain from birth control use are common and may deter some from using it.

Hormonal birth control may cause weight gain in some people.

The hormonal pill, patch, and ring do not appear to cause weight gain in most people, and neither does the hormonal IUD.

The implant and the shot may cause weight gain.

Obstetrics and Weight

Hormonal birth control is frequently misunderstood as causing weight gain. It’s possible to gain weight while using hormonal birth control, but it’s more likely that you’ll gain bloating or changes in body composition (the amount and distribution of body fat). Some people avoid hormonal birth control due to side effects like weight gain. Obesity increases the likelihood of discontinuing hormonal birth control (the pill or the shot).

It’s important to remember that ideal weight and body type are influenced by changing social and cultural beliefs.

In some cultures, there is a harmful pressure to conform to unrealistic standards. Even scientific measures like BMI can’t adequately classify who is healthy. Concerning birth control, some people fear weight gain, while others desire it.

Hormonal changes during puberty and menopause can alter body composition. Estrogen causes fat storage in the chest, thighs, hips, and butt. Increased body fat, particularly around the abdomen, occurs during and after menopause. Some women gain weight around menopause, but this is thought to be due to aging rather than hormonal changes. On the other hand, hormones may influence food intake. Dietary intake decreases during the follicular phase (first half of the cycle) until ovulation (ovarian egg release), then increases during the luteal phase (the second half of the cycle when progesterone is dominant).

What Your Doctor May Say

Combined hormonal contraceptives include most pills, the patch, the ring, and some shots. The implant, most IUDs, a shot, and some pills are progestin-only contraceptives.

Evidence suggests that combined hormonal contraceptives may cause weight gain, but the gain is likely to be minimal. Most studies show no increase in weight or body fat with progestin-only contraceptives, but some show a small increase. Some people gain weight on birth control, and some people gain weight more easily.

Hormonal contraceptives have many uses besides preventing unwanted pregnancy. Menstrual pain, heavy, irregular or painful periods, and anemia are also treated with them. Fear of gaining weight may prevent someone from using birth control, cause them to use it incorrectly or inconsistently, or stop using it altogether. This may leave someone without effective contraception or treatment for a condition. Talking to a doctor can help you weigh the risks and benefits of hormonal birth control.

Why It’s Difficult

Contrary to popular belief, birth control does not cause weight gain. Weight gain occurs over time, and it varies depending on when it is measured. From early adulthood to middle age, most people gain 0.52 kg (1.15 lbs) per year. Weight fluctuates daily, weekly, monthly, and seasonally. Two small studies found that people weigh less in the morning. In one study, weight increased from Friday to Monday and decreased from Monday to Friday. And Americans gain weight around the holidays.

A four-month study of pill users found that they gained 0.2 kg (0.44 lbs) during the first three weeks of a pill pack and lost the same amount during the placebo (withdrawal bleeding) week. Their weight remained stable throughout the four-month study.

Since copper IUDs (Paragard, Mona Lisa, T-safe) do not contain hormones, they cannot directly affect weight. Long-term copper IUD users gain weight, just like non-users gain weight with age. In one study, long-term copper IUD users gained 4.0 kg (8.8 lbs) over 7 years. Copper IUD users are frequently used as a control group in studies examining weight gain with hormonal birth control. One group uses hormonal birth control, while the other uses a copper IUD, and both groups gain weight over time.

Although using hormonal birth control may appear to cause weight gain, it may be no different than using a non-hormonal method (such as a copper IUD) or nothing at all.

Most adults gain weight and lose weight in a normal pattern, but fear of gaining weight prevents people from starting or stopping birth control. Weight gain and birth control are complex issues with often ambiguous or contradictory findings. Longer studies with more people may be required to fully understand hormonal birth control’s impact on weight.

Here’s What the Research Says About Each Birth Control Type

Progestin-only contraceptives and weight gain

The hormonal IUD, unlike the implant and the shot, is unlikely to cause weight gain.

The implant (e.g. Nexplanon) may contribute to weight gain. One study found that after a year of use, users gained 0.1 kg (0.22 lbs), similar to the copper IUD. The same study found no difference in body fat between implant users and copper IUD users after one year. Another study found that implant users gained 2.1 kg (4.6 lbs) more than copper IUD users after a year, but this difference was only seen when users of all races were compared. The researchers found no difference in weight gain between implant and copper IUD users when they separated participants by race (black implant users vs. white or other race).

More research is needed to determine if the implant causes weight gain.

HRT (Mirena, Liletta): The hormonal IUD does not appear to cause weight gain, but it may increase body fat. Precisely the same amount of weight was gained by hormonal IUD users as by copper IUD users after a year of use.

These studies included a 10-year hormonal IUD user’s weight change. After ten years of use, hormonal IUD users gained an average of 4.0 kg (8.8 lbs), which is similar to the weight gained by copper IUD users.

This is difficult to measure with hormonal IUDs. After a year of hormonal IUD use, one study found no increase in body fat, while another found an increase in body fat percentage.

However, weight changes with hormonal IUDs like Kyleena, Jaydess, or Skyla have not been well studied.

The shot (e.g. Depo-Provera): Some studies show weight gain from the shot, while others show no change. Users gained between 1.3 kg and 2.2 kg after a year of using the shot, which was more than users of the copper IUD gained in some studies, but similar in others.

Even studies that tracked weight changes in people who took the shot for a long time yielded mixed results. In one study, shot users gained 6.5 kg (14.3 lbs) after ten years, whereas copper IUD users gained 9.5 kg (20.9 lbs).

The shot increased overall body fat, especially around the abdomen, but another small study found no difference in body fat compared to copper IUD users after 12 months.

But averages can be misleading. When researchers divided study participants into two groups based on race, they found that the shot users gained more weight than copper IUD users on average (users of the shot who were black and users of the shot who were white or any other race). In this study, black women gained weight regardless of birth control method. In another study, despite similar average weight gains, 4 out of 10 shot users gained a lot of weight (4.6 kg or 10 lbs) and gained abdominal fat, whereas the copper IUD users did not.

Hormone-based contraceptives

The pill, patch, and ring appear to cause no weight gain in studies.

The pill (various brands): After six months on the pill, people gained 0.88 kg (1.94 lbs) less weight than people who didn’t use birth control. After six months or a year, pill users had no change in body fat. In one year, 10 out of 100 pill users gained over 7% of their body weight, while 5 out of 100 lost over 7%.

The patch (e.g. Xulane): After a year, people gained an average of 0.4 kg (0.88 lbs), similar to pill users.

The ring (e.g. Nuvaring): After a year, users gained 0.4 kg (0.88 lbs), the same as users of the pill. After a year, Nuvaring users had no difference in body fat. After a year, 8 out of 100 ring users gained over 7% of their body weight, while 7 out of 100 lost over 7%.

Remember that these are averages. People in these studies gain or lose weight, and the amount varies. Some people gain weight on birth control more easily than others.

More research is needed to fully understand how and why some forms of birth control cause weight gain while others do not.

A new birth control method, along with weight and other symptoms (like bloating), can help you track changes and determine if they are related to your birth control.

Takeaway

Many women fear the pill will make them fat. It hasn’t been proven, but it has been shown to alter body shape (and fat storage) in unexpected ways.

It’s blamed for polluting rivers, ruining marriages, and even killing sex drives. Patriarchy calls it a conspiracy. Awkward men are said to attract women. But one of the most disconcerting charges against the pill is that it makes us fat.

In fact, the most common type of combined pill, which contains both estrogen and progesterone, causes weight gain. That’s why drug companies put it on the label.

But after decades of research, there is still no conclusive proof that the effect exists. An analysis of 49 studies of the combined pill found “no large effect is evident,” but there wasn’t enough research to be sure. This holds true regardless of the progesterone type in the combined pill. Other studies on progesterone-only pills found no effect.

References

  1. https://www.healthline.com/health/how-to-lose-weight-on-birth-control
  2. https://helloclue.com/articles/sex/birth-control-and-weight-gain
  3. https://www.bbc.com/future/article/20181003-does-the-birth-control-pill-make-you-fat
  4. https://www.medicalnewstoday.com/articles/322448

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