Question

• Among teenagers on depot medroxyprogesterone acetate (DMPA), what is the risk of gaining weight and what factors impact this?

Clinical Bottom Lines

1. Caution and honesty should be used in prescribing DMPA to overweight young teenagers because they may gain weight.¹ If we dismiss this potential side effect, this could foster distrust of physicians and compromise the teenager's medical care.
2. Clinicians would like to use DMPA with teenagers because it does not require daily compliance and has a decreased risk for pregnancy (a typical one-year failure rate is between 0.0% to 0.7%).²

Summary of Key Evidence

1. 43 adolescents (ages 12-21) were enrolled on DMPA (26 black subjects, 15 white subjects, 2 mixed) in an urban Teen Health clinic.¹
2. This study's purpose was to identify risk factors for weight gain with DMPA by examining body constitution and eating behaviors.
3. Weight, BMI, total body fat and lean body mass were similar in the black and white groups. Black subjects were younger by 1.2 years (p=0.003) and had an increased initial appetite score (p=0.05).
4. At 6 months, black subjects had a 4.2% increase in weight (mean weight gain=2.9 kg, p=0.003) and a 12.5% increase in body fat. White subjects had a 1.2% increase in weight (mean weight gain=0.9 kg, p=0.32) with a 1.2% increase in body fat.
5. Baseline weight was related to a weight gain of 2.2 kg during the first three months. (AOR=1.2, CI: 1.03-1.3). Increased weight gain (2.2 kg) over the second three months was associated with black race (AOR=7.8, CI 1.5-66.2) and early menarche (AOR=0.6, CI 0.3-0.9). Predicting weight gain of 5 kg over 6 months was based on baseline weight (AOR=1.2, CI 1.1-1.3).
6. Predictors of weight gain for black subjects were higher baseline weight, younger chronological age, higher baseline dietary restraint and disinhibition, and current use of medications. The only predictor for weight gain for white subjects was baseline weight.

Additional Comments

• 54% of adolescents on DMPA may gain weight.¹
• 41% who discontinue DMPA will list weight gain as their primary reason.¹
• The Physician's Desk Reference describes, for a 136 pound female, an average weight gain of 5.4 pounds after 1 year, 8.1 pounds after 2 years, 13.8 pounds after 4 years, and 16.5 pounds after 6 years.³
• DMPA's weight gain was thought to be due to increased appetite, but both groups' appetite fell during the study. This weight gain was associated with increase in total body fat.¹

Citation

1. Bonny AE, Britto MT, Huang B, Succop P, Slap GB. Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA). J Pediatr Adolesc Gynecol 2004;17:109-15.
2. Margulies R, Miller L. Increased depot medroxyprogesterone acetate use increases family planning program pharmaceutical supply costs. Contraception 2001;63:147-9.
3. Physicians' Desk Reference 56th edition, 2002, 2798-2800. www.pdrhealth.com

CAT Author: Inas H. Thomas, MD

CAT Appraisers: John Frohna, MD

Date appraised: Jaunary 26, 2005