Episode #92: Weight Management and Contraception For PCOS Women

So perhaps when you saw your doctor at one point in time, you asked about the concern of gaining weight if you went on certain birth control. So in today’s episode, we are going to be reviewing some of the more recent research on PCOS contraceptives for hormones and weight gain. We’re going to be reviewing an article called weight changes among women using intramuscular Depo Medroxyprogesterone Acetate, a copper intrauterine device, or a Levonorgestrel Implant for contraceptive use. Findings from a randomized, multicenter, open-label control trial and of course, I will include the link to this research article in the show notes below. So let’s get started.

You’re listening to the PCOS repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally, with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re going to be diving into the topic of birth control and weight gain. So one of the questions that women often have when deciding to go on birth control, especially when they don’t need the birth control, but they’re thinking about incorporating it to help them alleviate PCOS symptoms. A question that I know when I was working in clinic, this would come up a lot and I know this is a question that I hear the women I work with asking a lot as well and that is, does birth control cause weight gain? I mean, this is like an old, old question, hearing this debate among women, even when I was a child, does birth control cause weight gain? So the research was limited on this, and the doctor’s response was, no, birth control does not cause weight gain. So in this research article that’s more recent, we are going to look at some of the findings of what happened when women with PCOS were given birth control that is progesterone only. So the Depo shot was one of the forms that was studied in this research and then also the implant, the depo shot, pretty straightforward, is a shot, you take it every three months and the implant, I think there’s a couple on the market, I could be wrong, I know there was a new one coming out right about the time that I transitioned out of primary care and women’s health and so I don’t remember exactly how many were on the market. They have varying lengths of time, but basically a little tablet is inserted under the skin, very simple procedure and then to remove it, it’s almost like popping a pimple, like a little tiny slit, and you just kind of pop out the implant once it’s done being used, and then put a new one in, in the close proximity of where that one was placed and it just kind of lives under the skin and slowly releases hormone. So these two were studied against the copper IUD. So the copper IUD is a non-hormone contraceptive. Okay? So that’s important to recognize and then these were, interestingly, these were actually PCOS women that were being studied in this research and so that’s also very pertinent to the podcast here and why I want to review this.

Okay, so the other thing I think that’s really important to just clarify before we dive into this particular research article is that progesterone only contraceptive is something that’s a little bit newer. So we’ve had the pill for a long time, and then there’s other estrogen based options. So estrogen based birth control, or combination birth control that contains estrogen in it can come with a whole risk of side effects. So women that smoke, women that are prone to clotting, these are all things that can be a contraindication to prescribing those forms of birth control and so, unfortunately, women with PCOS oftentimes have some of these things that give us a little bit of concern for giving them estrogen and so because of that, we jump to progesterone only and so ones that are really high dose progesterone, such as the shot and the implant, is what is being studied here. In this article, I do also want to note that there is the progesterone based IUD, which is not the one that they’re studying here in this article. In this article, they’re talking about the copper, which has no hormones, the progesterone based IUD, such as the Skyla or the Mirena IUD, they tend to release a lot lower dose of progesterone and I have seen and personally been on those ones. I had two different rounds of being on the Mirena IUD. I have worked with a lot of women who have been on those and who have had the shot and have experienced what we’re going to be talking about in this research article, but did okay on the Mirena, so I do want to start this off by saying this is not at all saying that contraceptives are bad. There is a time and place. If I hadn’t had contraceptives, I may have had a very difficult time getting through grad school, and so there’s a time and place for things. Okay. However, it’s important to be really well informed. To me, I think that women really deserve to be well informed about what they are choosing when it comes to contraceptives, especially when we have PCOS, our body is just more sensitive to our environment to begin with, and contraceptives are a fairly big player in our environment if we choose to go on them, so we want to choose them wisely.

Okay, so on to the research article. So progestin only hormonal contraceptives, which in this article are referred to as POCs, not to be confused with PCOS, but POCs, progestin only contraceptives have become a cornerstone of family planning, offering various formulations such as injectables, implants, and intrauterine, IUD. So these are the Skyla and the Mirena like we talked about, as well as oral contraceptives, which you may have heard referred to as the mini pill, which is often given to women. Historically, it was really reserved for women who were nursing. So right after you had a baby, if you wanted to make sure you weren’t going to get pregnant right away again, you could take the mini pill, because the progestin only pill in a low dose didn’t affect the milk supply as birth control would. Interestingly though, that has started to become something that is used for women regardless of if they just had a baby or not, if they’re having certain symptoms of breakthrough bleeding or different kinds of period symptoms. There are reasons why doctors are prescribing the mini pill other than to postpartum women.

However, there have been many concerns regarding potential weight gain, and although this question has historically been met with the answer of no birth control does not cause weight gain, this question has lingered especially in regions where POCs, so again, progesterone only contraceptives, notably the injectables and the implants, have been prevalent and so what we’re seeing is that although the response of no birth control doesn’t cause weight gain, we’ve seen this to be incorrect in women that are receiving these types of birth control. Understanding the impact of these contraceptive methods on weight is crucial for the informed decision making of the patient. This study delves into the intricate relationship presenting nuanced analysis between the expansive evidence of contraceptives options and the findings that we have for women, especially those with PCOS.

So, as we dive into this research article, I do want to give a little background and a little bit of limitations of this research. The landscape of evidence surrounding the effects of POCs on weight has been characterized by gaps and uncertainties. The previous Cochrane systematic reviews acknowledges that the insufficiency of data to determine the influence of POCs on weight conclusively. The challenge here is that previous studies have not necessarily had an absence of hormonal comparison group and so it’s difficult to compare large enough groups of women who are on progestin only hormones versus those who aren’t taking any hormones, because when we’re looking at who’s taking medications, oftentimes we’re just looking at side effects of the medication and the efficacy of the medication, not comparing it to a group who’s not taking the medication, lack of randomization. So when it comes to choices of birth control in the medical world, we tend to choose it based on demographic, and so we tend to use these long acting, progesterone based birth control options for people that are going to have a hard time constantly taking a pill or using more frequently dosed forms of birth control, women who maybe are of lower socioeconomic status, women who are younger, women who have reason that they shouldn’t be on estrogen. So there’s specific groupings that we are recommending these type of birth control to as a medical community and so it’s difficult to have a randomization of are we seeing these results only because we are giving this medication primarily to this group of people, or is this medication, this contraceptive, the reason why we’re seeing these results? So that’s where the lack of randomization comes in.

And then the third limitation of these studies is the suboptimal continuation rates. We are working with human beings, and we’re not going to force someone to continue with something that they don’t feel like is working for them. So when a woman feels like she’s starting to gain weight on a contraceptive, chances are she’s not going to continue with it and so our ability to get statistically significant evidence can be difficult and it leaves that critical question of whether or not the contraceptive is the problem, whether or not this is a long term issue, or whether women gain a few pounds and then it levels out is a little bit difficult to analyze and this question has been a bit left unanswered. So, recognizing these limitations that this study adopts a rigorous approach to provide a more comprehensive understanding of weight dynamics associated with different contraceptive methods.

So the methods used in this study to unravel this question about weight and specific contraceptives was that they randomly assigned participants to one of three categories and this is really important because, again, like we mentioned before, one of the limitations was there wasn’t any randomization that certain groups tend to be prescribed certain types of contraceptives more frequently than other groups, because there’s reasons why we have a go to in the medical community for why this one’s being a good fit for an individual and so in this study, we randomized everybody and we assigned participant pins to either one of these three groups.

One group was given every three months, the depo shot. Okay. The next group was given the progesterone implant, and the next group was given the copper IUD. So those three groups were the three groups that people were randomly assigned to, which provided us a unique opportunity for a comparative analysis and the study design was to have follow up extending out to at least 18 months, which also allowed for exploration of weight changes over time, because a lot of times women will change their birth control choices or their contraceptive choices, or they’ll not come back for follow up and so if something’s working for someone, a lot of times we lose that continuity of care and we don’t get the insight into what’s going on for the individual in several months and so this study gave us the unique opportunity to both compare these three different types of contraceptives, as well as to see the comparison over time.

Alright, so what did this study find in the weight disparities between these different forms of birth control? So, first of all, it’s important to acknowledge that all three groups, the depo shot, the implant, as well as the non hormonal IUD, the copper IUD, they all exhibited a mean weight increase, but the magnitude varied significantly. So this is important because all women’s weight goes up and down, right? So it’s important to realize that just because we gained weight, there’s so many factors that lead to weight gain, it’s not just contraceptives. So we needed to rule out that piece of the population overall is probably going to gain some weight. So we can take that non hormonal based IUD group and use their weight increase as kind of a way to level the playing field of what amount of uptick in weight would be normal to consider in a regular population, where contraceptives is not part of the equation. So the three month depo shot users faced the highest weight gain, which may not be surprising to you if you know anyone who has taken the depo shot or if you yourself have taken the depo shot. So they faced the highest weight gain, whereas women that were using the implant versus the copper IUD experienced comparatively much lower increase in weight, but the other finding that this study wants to emphasize is that not all women in any one of the group had the same results. So it is really important for women to have very personalized counseling and decision making and being informed with the research about these type of side effects that come with each type of birth control, because there is lifestyle considerations, there are so many different things to consider, that it doesn’t make one of these necessarily wrong or bad but it is worth noting, especially for women with PCOS, where weight can be a significant factor in root cause health, which we talked about in previous episodes, but that maybe the depo shot and the risk of gaining weight on it, although not all participants gained weight on this particular method, may be a consideration to choose others or be ready to quit it if you’re noticing that your weight is rising. So, of note, not all responses were the same amongst all women in each group, but we did see a significantly statistical increase of weight in the women that had the depo shot.

So, in conclusion, the research really stands as a significant contribution to the understanding of weight dynamics associated with different contraceptive methods. I think that it’s fair to say, as we’ve all suspected, as women, that birth control can definitely have an effect on our weight. What each type of birth control’s effect will be and how it will affect each individual unique person definitely has a ton of variability and so it’s not across the board that it will make you gain weight, for some women, they do great while they’re on birth control, other women do not but I think that it needs to be understood that it’s not correct to say that birth control will not make you gain weight. It’s definitely been shown in research now that there is a potential for certain types to definitely have an increased chance of weight gain and so by navigating this complex landscape of progesterone only hormonal birth control and their impact on weight, this study provides valuable insights for both healthcare providers and for women and that’s why I wanted to share it with you here on the PCOS repair podcast, because this newfound knowledge facilitates informed decision making in reproductive health, allowing women to weigh in on the benefits and potential side effects as they make a decision on what contraceptives and if they want to include contraceptives in their family planning methods and the more information we have, the better.

So there you have it. I think that it’s really important to understand that what we have long suspected has been shown in research that certain birth control methods definitely can lead to increased weight and I would love to hear in my Insta messages this week over on Instagram, you can find me @Nourishedtohealthy. I would love to hear if you have had an experience or know somebody that has had an experience with, you know, we hear research, and I think that it’s kind of, in some ways frustrating, in some ways interesting and amusing but I think when it comes to weight, nothing’s really amusing about this but I think it’s a little bit interesting how women have been experiencing this for a long time and reporting this back to their physicians who have continually said, oh, no, birth control does not cause weight gain and then here we finally have a study that proves the opposite and so I wanted to share this with you, I think it’s very validating for women who have had this experience to not feel like they were crazy or doing anything wrong but indeed, certain birth control does give us a higher tendency, a higher risk of weight gain and so if you have had this experience, I’d love to hear about it in my instant messages this week so that you can feel seen and heard and share your story because it’s through hearing what’s going on with other women that we finally see the places in which we may need to do further research and exploration in the medical community.

So with that, I hope you enjoyed this research review. I think they’re very helpful for us to keep aware of what’s going on in the research world. More and more studies about PCOS are becoming available, and I think that that is just amazing, because when I was going through school, there was very few resources and very few studies about PCOS beyond just the very basics of diagnosis and some very limited management of the disorder. So with that, I will sign off for now and until next week. Bye for now.