Depot medroxyprogesterone results in increased weight gain compared to oral contraceptives

Article Outline

• Bonny AE, Ziegler J, Harvey R, Debanne SM, Secic M, Cromer BA. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006;160:40-5
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Bonny AE, Ziegler J, Harvey R, Debanne SM, Secic M, Cromer BA. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006;160:40-5 

Question Does the initiation of depot medroxyprogesterone acetate (DMPA) result in significant weight gain in obese and nonobese adolescent girls, when compared with an oral contraceptive (OC), or no hormonal contraceptive method (control)?

Design Non-randomized, prospective study.

Setting Four urban health clinics.

Participants 450 adolescent girls, aged 12 to 18 years.

Intervention The adolescents were treated with DMPA, OC, or control, based on their preferences.

Outcomes Weight was assessed at 6, 12, and 18 months and also as a mean change over 18 months.

Results Adolescent girls who were obese at initiation of DMPA gained significantly more weight than did obese girls starting OC or control (P<.001 for both). At 18 months, mean weight gain was 9.4, 0.2, and 3.1 kg for obese girls receiving DMPA, receiving OC, and control, respectively. Weight gain in obese girls receiving DMPA was also greater than weight gain in all nonobese categories (4.0 kg, DMPA; 2.8 kg, OC; 3.5 kg, control; P<.001). A significant interaction (P=.006) between length of time receiving DMPA and weight gain was evident for obese subjects.

Conclusions Over 18 months, DMPA use was associated with increasing rates of weight gain in obese subjects. The potential contribution to severe obesity in this population is concerning.

Comment This is another interesting study that shows an increase in weight gain in adolescents using hormonal contraception. The investigators used data that had been collected from a 2-year prospective cohort study evaluating hormonal contraception and bone mineral density changes in adolescents. The participants were followed for 18 months, which is longer than most studies in the field. Unfortunately, the baseline characteristics of the cohorts have significant differences. The control group had a younger age, lower baseline weight, and decreased rate of sexual activity when compared to both treatment groups. The DMPA cohort had a higher rate of prior pregnancy than the OC group (5.1% vs 2.9%). The attrition rate was high for all groups; consistent with other studies evaluating contraception in adolescents, however it was particularly high for the OC group (46.3% OC, 37.4% DMPA, 25% controls). This is a well-designed study, but the baseline differences do raise some caution. For example, the effect of prior pregnancy on the decision to continue DMPA despite weight gain is unknown. Also, the higher dropout rate in the OC group may have been secondary to perceived weight gain. Ultimately, it is unclear what impact the baseline differences have had on final data interpretation. The excess weight gain seen in these obese adolescents using DMPA is concerning. However, this concern must be balanced with the social and medical complications of unplanned teen pregnancy. Further study with well-matched cohorts will be of great benefit.