Earlier this week I faced a young lady across the table wanting to change her method of contraception as the Mini Pill she was currently using had made her gain weight

As she saw it, she had been doing everything right (but piling on the pounds regardless), since she’d started this pill and so it seemed the obvious cause of her problem.

Looking objectively at her medical 'facts', it was difficult to disagree with her.

Of course, only she can provide the actual evidence of whether she is following an appropriate diet and lifestyle that is supportive of NOT adding weight.

However, when taken at her word the only possible reason for her weight gain must be the daily consumption of Progesterone which constitutes the Mini Pill as we know it today.

When you look at the evidence available for how Progesterone affects the body weight, it shows: The Mini Pill does not directly cause changes in weight*.

From reliable studies women have reported weight changes including weight gain and weight loss while taking the Mini Pill but there isn't enough proof that this change is due directly to taking it.

From the same reports, it seems that where such observations are made with regards to weight gain it is usually not more than about 2 kg in a 12-month period.

So, what did I do with my patient? We rationalised the above information and agreed to change her pill.

She accepted that it was unlikely the current pill was contributing anything more than a small fraction of her weight gain and would focus her energies more on healthy eating and increased activity to achieve her weight loss goals.

Given her dissatisfaction with the old pill, we agreed to continue the Mini-Pill while opting for a change to the type. After 3 months, we would review her experience.

The solution was a lot simpler with my next contraception consultation: A lady who was very near the expiration period for her uterine coil arrived to say she could no longer feel her threads.

Usually women are advised to regularly check the Intra-Uterine Device (IUD) (commonly called 'coil') threads (after each menstruation or regularly at alternate months). The implication of not feeling the threads is either:

1. that the coil has been ‘expelled’ or fallen out of the womb through the vagina; or
2. that the coil may have perforated the womb**

In either case once the coil threads have been confirmed to be absent by physical examination by a clinician, the advice will be to use alternate contraception – pills, condom etc. – until an ultrasound scan (and other tests like X-rays if necessary) can be arranged to locate the coil.

And that's what we did.

Let me know what you think.

References:
*Progestogen-only Pills Clinical Effectiveness Unit March 2015 (Updated January 2016) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
**Intrauterine Contraception Clinical Effectiveness Unit April 2015 (Updated October 2015) - Faculty of Sexual and Reproductive Health Clinical Guidance UK

Well they say contraceptives makes a woman to gain weight.

I think before you make choice(s), you should consult a Doctor and with his advise, I do not think there would be challenges.

drsperm wey no fertilise your egg must fertilise some thing now

ToriBlue:
Well they say contraceptives makes a woman to gain weight.

Hi!

Thanks for reading and commenting.

Broadly speaking it’s not strictly true that all contraceptives cause weight gain.

That’s because there are so many of them (15 different types are available under the UK NHS system, for example!!), and they work differently.

Outside of natural methods (abstinence, lactation/breastfeeding, safe periods etc.), contraceptives include:

1. Tablet: Pill - Combined and Mini (Progesterone Only)
2. Contraceptive ring and patch - contains same as combined pill
3. Injection
4. Implant - usually inserted under the skin of the arm
5. Mirena Coil - IUCD – inserted in the womb
6. Copper Coil – inserted in the womb
7. Condoms
8. Other barriers like the caps/diaphragm
9. Sterilisation - male and female

Let’s quickly dispense with #6-9. These will not cause weight gain.

We know from studies that contraceptive #3 is most likely to cause weight gain.

But the issue I believe you address is with the contraceptive tablets (#1).

Weight gain has been known to happen when a woman is on the pill but the evidence we have says that the weight gain is small and not directly related to the pill.

I know that may sound confusing.

Practically – as with the patient discussed - it is difficult to say to her it’s not the pill making her gain weight since she is gaining weight despite doing her best not to.

Therefore, despite knowing the evidence, I agreed to change her pill.

The evidence from studies for weight gain with the tablets is not as strong as that with the injections (#3).

The same risk of weight gain will apply to the #2 as with the tablets; and this may apply to women who use the implant and the mini-pill.

Choice is best made after a discussion of pros and cons of the available methods (which they all have) to help the right decision.

Do you think this clarification would make a woman choose differently?

Cheers!

LLSAINT:
I think before you make choice(s), you should consult a Doctor and with his advise, I do not think there would be challenges.

Thanks for that comment!

Yes - speak to a doctor, and do some research online about the different methods before you arrive at a final choice.

However, these methods all have some challenge/disadvantage or the other.

Take a few examples:

Condoms can split - no matter how careful one is.

The pill in some people can cause migraine/headaches.

The copper coil in some women can cause heavy bleeding...and so on.

None of them is free of a side effect, but some will be safer and more appropriate for a particular woman than others; and (most important) most women do not suffer the side effects.

Cheers