University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• A 15 year old female presents to a clinic for counseling regarding birth control. She has narrowed her decision to either Norplant, Depo-Provera, or Oral Contraceptive Pills (OCPs). Concerned about self image she asks you about weight gain while using any of these methods. The question is: In adolescent females does Depo-Provera and Norplant compared to OCPs cause more or less weight gain?

Clinical Bottom Lines

1. According to the drug inserts, weight gain maybe a side effect of Norplant, Depo-Provera, and OCPs.
2. Weak comparative studies have found that there is no weight gain difference between Norplant, Depo-Provera, and OCPs.(1,2)

Summary of Key Evidence

Study #1

1. In a rural Arizona clinic, a retrospective chart review identified 150 women on either Norplant, Depo-Provera, or OCP.(1)
2. 50 women in each contraceptive group were identified who met all the study criteria. (15-30 years old, no prior contraception, height between 62 -70 inches, weight between 100-180 lbs., no diabetes, no thyroid disease, and greater than 12 months postpartum)
3. Body weight was compared initially and at 12 months. Age, height, and parity were also evaluated. The Depo-Provera group had lower baseline weights. OCP group was older and had few pregnancies.
4. Results: Mean 1 year weight gain for subjects in each of the 3 treatment groups was: -0.93 kg (95% CI= -1.3 to 0.5) in the OCP group, -0.81 kg (95% CI= - 1.6 to 0.1 kg) in the Norplant group, and + 0.06 kg (95% CI= -0.4 to 0.6 kg) in the Depo-Provera group.
5. They suggest that concerns regarding weight gain during Depo-Provera, Norplant, and OCP therapy, specifically, among patients their clinic may be unfounded.

Study #2

1. In an Ohio adolescent clinic, a prospective study examined clinical profiles among adolescents who chose Norplant (58 adolescents), Depo-Provera (66 adolescents), and Ortho-cept (75 adolescents).(2)
2. At baseline, at 3 months, and at 6 months, patients were interviewed regarding gynecologic history, side effects, and satisfaction. A physical exam and weight (Body Mass Index = weight-kg/ height (m2)) was also measured.
3. The average subject was 15.5 years (range 11-20 years); 66% were African-American and 34% Caucasian.
4. Results: The mean BMI at baseline for all the treatment groups was 24.2 +/- 5.5; the overall mean at the first follow-up visit was 24.4 +/- 5.9 and the mean at the second follow-up visit was 25.9 +/- 5.8.
5. They concluded that there were no differences found in body mass index among the different treatment groups at any visit or within any group between baseline and either follow-up.

Additional Comments

• Both studies failed to make comparisons with women using non-hormonal methods of birth control (i.e., condoms, diaphragm, or IUD).
• The studies did not mention other possible confounding issues: dieting, stress level, or anorexia/ bulimia.
• There are a large number of preparations and variations in dosages and active ingredients in oral contraceptive pills. In the retrospective study the same OCP is not used. Only Ortho-cept was used in the prospective study. It is a combined pill with ethinyl estradiol and desogestren.
• The prospective study had a very poor 6 months follow-up of only 40 adolescents out of 199 adolescents.

Citation

1. Moore L, et al, A Comparative Study of One-Year Weight Gain Among Users of Medroxyprogesterone Acetate, Levonorgestrel Implants, and Oral Contraceptives, Contraception 1995; 52: 215-220.
2. Cromer B, etal, A Prospective Study of Adolescents Who Choose Among Levonorgestrel Implant (Norplant), Medroxyprogesterone Acetate (Depo-Provera), or the Combined Oral Contraceptive Pill as Contraception, Pediatrics 1994; 94(5): 687-694.

CAT Author: Sue Lin, MD

CAT Appraisers: Robert Schumacher , MD

Date appraised: February 19, 2001