Does Depo-Provera Cause Weight Gain?

Despite its effectiveness, the birth control shot raises concern

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Depo-Provera (depot medroxyprogesterone acetate, or DMPA) is an effective and relatively easy form of birth control. It does appear to cause weight gain for many women, though. Weight gain is often cited as the reason women stop using the shots.

DMPA can change body composition and increase fat mass. This compares with birth control pills that can affect body weight, mostly because of fluid retention. Not all women gain weight with DMPA. Some factors increase the chances and influence who may be more likely to gain more weight.

This article looks at what the studies show about average weight gain and who is most likely to experience it. It also offers ideas on what you can do to help control your weight if you choose DMPA for birth control.

A woman weighing herself during the day
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Depo-Provera and Weight Gain

Since 2009, studies have largely confirmed that DMPA can cause women to gain weight. The degree of weight gain, however, can vary widely. Some women add a few pounds while others might add a few clothing sizes. It's helpful to begin with a look at the research on Depo-Provera and weight gain.

Changes in Weight and Body Composition

One comprehensive study looked at weight changes in women using DMPA. The changes were compared with weight gain in people who used either the pill or another contraception method, like a diaphragm, that is not hormone-based. The study tracked 703 White, Black, and Hispanic women over a 36-month period. It did not find significant differences between these groups.

In this study, the weight gain that occurred for people using DMPA was due to an increase in body fat mass. There was no weight gain among users of the birth control pill.

The study found that, across 36 months, the women who used Depo-Provera experienced average gains in:

  • Weight (11.25 pounds)
  • Body fat (9 pounds)
  • Body fat percentage (3.4%)

The degree of weight gain appeared directly associated with the amount of DMPA used.

Women in this study seemed to gain more weight while taking DMPA if they were not obese before they started. Some 50% of these women were likely to become obese after three years.

When they stopped taking Depo-Provera, any further weight gain depended on what birth control method they used next. People who used the pill gained weight within the next six months, on average about a pound each. People who used a diaphragm or other birth control without hormones lost about a pound each.

Several studies have found similar results when studying Depo-Provera and weight gain. For example, a 2014 study of 52 people compared the effects of DMPA use to those of the intrauterine device (IUD). Across 12 months, weight remained stable for those with an IUD. The increase seen in women using DMPA during the same time was 4.2 pounds, most of it as fat mass.

Recap

Depo-Provera, or DMPA, is widely used for birth control. Women who use the method often stop their shots because of weight gain. Several studies suggest that DMPA does, in fact, cause more weight gain than other birth control methods such as the pill or an IUD. Most of the weight gained while using DMPA appears to be from additional fat mass.

Causes of Weight Gain

Studies to date don't show a clear reason why weight gain occurs, or how these gains are linked to diet and activity levels. It's not known if DMPA stimulates an increase in appetite, though the women in one study who tended to gain more weight did report an increase in hunger.

Researchers point to two effects that DMPA may have that could lead to weight gain. One is DMPA treatment reduces estrogen levels.

The other is that DMPA has glucocorticoid effects. The human body makes steroids such as cortisol in response to stress and other signals. Weight gain is common when people are given similar glucocorticoids such as prednisone. This is often the case for people with asthma, chronic obstructive pulmonary disease, or autoimmune disorders.

Effect of Weight Gain on Health

There are many health risks related to obesity and young women are no less at risk than older people. A 2019 study noted that the rates of some obesity-related cancers are rising steeply in young people. The rates of insulin resistance, and the diabetes it may lead to, also are rising sharply.

A 2017 study suggested that health effects of weight gain should be carefully balanced against the benefits of Depo-Provera use. In this study of 37 people, researchers looked at both weight gain and certain inflammatory markers in the blood that are linked with health conditions including diabetes. The study found that women who gained more than 6.6 pounds were more likely to develop signs of insulin resistance.

Predicting Who Will Gain Weight

One of the earlier studies noted above found that lean women were more likely to gain weight. But how can you know if you will gain a few pounds, or see even bigger weight gains?

A 36-month study found that early weight gain was a predictor of significant weight gain. This was defined as a weight gain of 5% of body weight or more during the first six months on the shots. (This would mean a weight gain of 5 pounds in a 100-pound woman or 10 pounds in a 200-pound woman). About 25% of the 240 people in the study met this definition.

Those who had early weight gain were more likely to gain even more weight. On average, their weights rose steeply with longer use of DMPA. With early weight gain, the average increase was 0.78 pounds per month going forward. For those without early weight gains, it was only 0.18 pounds per month.

Recap

Researchers aren't sure why some people who take Depo-Provera are more likely to gain weight. It may be because of hormonal shifts or steroid effects during DMPA use. It may be due to increased appetite. Some people gain weight quickly after starting DMPA and these people appear likely to gain more weight overall. Those who are obese before beginning DMPA are less likely to gain weight.

Lifestyle Changes and Weight Gain

Many healthcare providers who recommend Depo-Provera also suggest lifestyle changes to compensate for the weight gain. However, this doesn't always work.

A European study looked at whether counseling on healthy lifestyle habits could help offset the weight gain. Despite the counseling, the women still experienced an average weight gain of 4.4 pounds over 12 months, with a 2.2% increase in body fat.

A 2015 study of 45 young teens and women, ages 12 to 21, went into greater detail on eating habits. It recorded both their intake of calories and the specific nutrients they ate. It found that despite their weight gain, the amount of food they were eating didn't change much. But eating less of certain healthy nutrients like fiber was linked to more weight gain.

For those who choose to use DMPA but wish to avoid the weight gain, eating a balanced diet seems to be more important than counting calories.

Summary

Depo-Provera (DMPA) is an effective and widely used form of birth control. But most studies confirm that weight gain is common among people who use it. DMPA is likely to cause more weight gain than other birth control methods like the pill or an IUD.

There are a number of possible reasons why DMPA may lead to weight gain. It may have to do with changes in hormone levels. People who gain weight early after starting their shots may add the most pounds. Those who are leaner before taking DMPA also appear to gain more weight.

There also may be a greater risk of developing insulin resistance and diabetes in people who gain weight while taking DMPA. Be sure to talk to your healthcare provider if you have concerns about DMPA, weight gain, and any associated health risks.

A Word From Verywell

Choosing your method of contraception is a highly personal decision. For some women, the benefits of convenience may far outweigh any possible side effects. In the end, there is no right or wrong answer, though women who are at risk for diabetes may want to consider other methods instead of DMPA.

Not everyone gains weight on Depo-Provera. It's possible to reduce the chance that you do by eating a quality diet and staying fit through regular exercise. Talk to your healthcare provider about how to best keep your weight down while taking DMPA.

Frequently Asked Questions

  • Does Depo-Provera cause weight gain?

    Study results vary, but most suggest that Depo-Provera is associated with weight gain that can increase over time. A 2020 study in the European Journal of Contraception & Reproductive Health Care found that women on Depo-Provera gained an average of 5.3 pounds after 42 months.

  • How does Depo-Provera cause weight gain?

    Weight gain with Depo-Provera is due mainly to increases in visceral (inner abdominal) fat.

  • Does everyone on Depo-Provera gain weight?

    No. Some women even lose weight on Depo-Provera. Generally, women who start Depo-Provera at an earlier age are more likely to gain weight. The same applies to those who gain weight within the first six months of starting Depo-Provera.

  • Can I prevent weight gain from Depo-Provera?

    Diet and exercise can help, but they are not always enough to prevent the weight gain caused by Depo-Provera. A healthy diet of between 1,800 to 2,000 calories per day for a moderately active woman, and doing exercise for at least 150 minutes per week, can certainly help.

  • Will stopping Depo-Provera reverse weight gain?

    Switching from Depo-Provera to a non-hormonal form of birth control may partially reverse weight gains in some women. But once visceral fat has already built up, it will likely take healthy diet and exercise changes to return you to your pre-treatment weight.

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