Depo-medroxyprogesterone acetate, weight gain and amenorrhea among obese adolescent and adult women

Abstract

Purpose:The objective of the current study was to evaluate the correlation between obesity and the use of depo-medroxyprogesterone (DMPA) in regards to weight gain and changes in bleeding patterns. Materials and Methods:A retrospective chart review of women receiving 150mg DMPA via intramuscular injection at inpatient and outpatient clinics at the University of Mississippi Medical Center (UMMC) between June 1, 2012 to December 31, 2016 was conducted. Body mass indices (BMI) were assessed at baseline and at the time of final injection. Race, medical history, age at first DMPA injection, number and timing of injections, reported side effects, indication for DMPA use, and reason for discontinuation, if applicable were collected.Results: Of the 240 patients included in the study, 3.4% were underweight, 30.8% were normal weight, 23.3% were overweight, 15% were Class I obese, 9.6% were Class II obese, and 17.9% were Class III obese. 87.9% of the population were African American. Contraception was the most common indication for use. Women gained (2.40kg; 95% CI 1.34 -3.45) while they were on DMPA (p<0.01), which after adjusting for confounding variables was associated with age at initial injection (beta coefficient = −0.13; p=0.01). Amenorrhea was the most commonly reported change in bleeding pattern among these women. Conclusion:Women who started DMPA at an earlier age gained the most weight over time, independent of initial BMI. Similar rates of amenorrhea were found among all BMI categories.

Effect of Hormonal Contraception on Obesity in Women of Reproductive Age in Jakarta, Indonesia

“…The results showed that the use of DMPA for more than 3 years has a greater risk of developing obesity. Previous research also showed the same results, where the use of DMPA led to obesity [6], [10], [15], [22].…”

“…Contraceptive methods related to weight gain in several studies, namely Depo Medroxy Progesterone Acetate (DMPA) contraception [6], [25]- [27]. In line with this study, the use of DMPA hormonal contraception increases the incidence of obesity which is triggered by excessive weight gain.…”

Clinical approaches to minimize iatrogenic weight gain in children and adolescents

“…Depot medroxyprogesterone has the largest effect on increased weight, while other oral contraceptives have either neutral or only slight increase. 18,28 In a primarily African American sample (87.7%), adolescents had increased weight gain compared to adult women, with mean increases of 5.35 ± 1.4 kg vs 1.75 ± 0.56 kg, respectively (P = 0.01). 28 If long-acting contraception is a goal, the most weight neutral and effective are the progesterone-containing intrauterine devices.…”

“…18,28 In a primarily African American sample (87.7%), adolescents had increased weight gain compared to adult women, with mean increases of 5.35 ± 1.4 kg vs 1.75 ± 0.56 kg, respectively (P = 0.01). 28 If long-acting contraception is a goal, the most weight neutral and effective are the progesterone-containing intrauterine devices. 29 Further, combined oestrogen-progestin contraceptives carry some increased risk of venous thrombosis, 30 as well as impact on bone accrual, 31 making progestin-only a preferred means of birth control.…”

Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018

“…According to a systematic review and meta-analysis, progesterone-only pill and DMPA users had no change in BP, myocardial infarction, or stroke compared to nonusers [26]. One concern with DMPA, an injectable progesterone, is the potential increased risk in venous thromboembolism and weight gain, though studies reporting these associations have been mixed and observational only [26][27][28][29]. Progesterone-only pills and DMPA may be preferred for women with HTN who want to avoid an implantation procedure inevitable with long-acting reversible contraceptives.…”