Early Weight Gain Predicting Later Weight Gain Among Depot Medroxyprogesterone Acetate Users

Abstract

Objective To examine if early weight gain in depot medroxyprogesterone acetate (DMPA) users predicts continued excessive weight gain and to identify risk factors of early weight gain in DMPA users. Methods DMPA users (N=240) were assessed prior to initiating contraception and every 3 months for 36 months. Early weight gain was defined as over 5% baseline weight gain within 6 months of DMPA use. Mean weight gain at 6-month intervals was estimated based on early weight gain status (at or below 5% gain vs. above 5% gain). Multiple logistic and mixed-model regression analyses were used. Results About one-fourth of DMPA users had early weight gain. The mean weight gain of the at or below 5% group and above 5% group was 0.63 kg and 8.04 kg, 1.48 kg and 10.86 kg, and 2.49 kg and 11.08 kg after 12, 24, and 36 months (P < 0.001 at all observations), respectively. Early weight gainers also had a much steeper slope of weight gain over time than the regular weight gainers (0.35 kg/month vs. 0.08 kg/month, P < 0.001). Risk factors for early weight gain were: BMI less than 30 (OR 4.00, 95% confidence interval (CI): 1.513 – 10.455), parity (OR 2.23, 95% CI: 1.040 – 4.761), and self-reported increased appetite after 6 months of DMPA use (OR 3.06, 95% CI: 1.505 – 6.214). Conclusion Most DMPA users who gain excessive weight experience more than a 5% weight increase within 6 months. These data help physicians predict who is at risk of excessive gain and counsel them appropriately.

Contraception for Adolescents

“…Over 18 months, those early gainers experienced an increase in mean BMI of 7.6 compared with 2.3 for non-early weight gainers. Similar findings in adult patients 104 suggest that weightgain status at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use but that weight gain on DMPA is not a uniform finding for all patients. 96,98 Because DMPA suppresses circulating estradiol concentrations, it causes lack of BMD accrual [105][106][107] and has an adverse effect on biochemical markers of bone formation and resorption.…”

Contraception for Adolescents

“…75,76 Other possible adverse effects include headache, mastalgia, hair loss, change in libido, and weight gain. Studies in both adolescents 77 and adults 78 suggest that weight gain status at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use, but that weight gain does not occur in all patients. 79,80 DMPA causes reductions in bone mineral density (BMD), [81][82][83] 91 no gynecologic examination is needed to determine eligibility for COC use.…”

Use of Depot Medroxyprogesterone Acetate in Current Gynecologic Practice

“…African-American women showed a nonsignificant increase in likelihood of excessive weight gain compared with Caucasian women. 14 Providers should be aware of this propensity when prescribing DMPA, record weights at each subsequent visit, and counsel patients appropriately if rapid weight gain is noted, especially early in use.…”