Does Birth Control Cause Weight Gain?

Many people wonder if using hormonal birth control can lead to impaired metabolic health or weight gain. This is a valid concern, and it's important to understand how hormonal birth control affects the body.

The majority of hormonal birth control works by suppressing ovulation, which means that they also turn off the production of estradiol and progesterone. These are natural hormones that help to enhance metabolism. Therefore, it's possible that using any type of hormonal birth control could potentially impair metabolic health, as they turn off the metabolic benefits of these hormones. As for which types are the worst, more research is needed to answer this question definitively.

Birth control turns off hormones

When it comes to hormonal birth control, the production of estradiol is significantly reduced, and in most cases, progesterone is not produced at all. Furthermore, birth control doesn't contain either estradiol or progesterone. Although a few combined contraceptive methods use body-identical estradiol, none of them use body-identical progesterone.

Specifically:

If you are using a combined oestrogen-progestin method such as the pill, patch, or ring, your body will produce very little estradiol or progesterone. Instead, these methods contain contraceptive drugs like ethinylestradiol (a synthetic oestrogen) and one of several progestins. Below are the metabolic effects of ethinylestradiol and different progestins.

On the other hand, if you are using the Depo-Provera injection, your body will not produce any estradiol or progesterone, but instead, it will contain the drug medroxyprogesterone.

On a progestin-only method such as an implant or pill, estradiol is produced but no progesterone. Instead of progesterone, you’ll have a progestin like norethindrone (norethisterone), levonorgestrel, etonogestrel, or drospirenone. Check the label to see which progestin you’re taking.

It's worth noting that even if you're using a hormonal IUD, which releases the progestin levonorgestrel directly into your uterus, you may still ovulate and produce your own estradiol and progesterone. It's also important to keep in mind that you will have a low level of levonorgestrel present throughout your body, including in your brain.

How do different contraceptive drugs affect metabolic health?

Ethinylestradiol may cause fluid retention, reduce muscle, and impair insulin sensitivity. In contrast, natural oestrogen (estradiol) improves insulin sensitivity.

The metabolic effects of progestins vary with the individual progestin and how androgenic or testosterone-like it is.

Non-androgenic or anti-androgenic progestins like drospirenone and cyproterone acetate generally improve insulin sensitivity and reduce visceral fat, but coming off them can cause rebound insulin resistance and weight gain.

Androgenic (testosterone-like) progestins like levonorgestrel, norethindrone (norethisterone), etonogestrel, desogestrel, norgestrel, norgestimate, and medroxyprogesterone impair insulin sensitivity and potentially increase visceral fat (also called abdominal or android fat). That’s because, in women, androgen or testosterone excess can cause or drive insulin resistance.

Medroxyprogesterone (from the DepoProvera injection) is interesting in that it’s only slightly androgenic at the androgen receptor, but in women, that’s enough to cause androgen side effects like acne, facial hair, and weight gain. In men, on the other hand, a high dose of medroxyprogesterone can be used to shut down testicular function and act as a strong anti-androgen.

Depo-ProveraⓇ may cause weight gain through two mechanisms. Firstly, it may interact with cortisol receptors, leading to cortisol-induced insulin resistance. This insulin resistance may, in some women, result in "unstoppable weight gain," or weight gain that does not plateau or level out.

It is important to note that even synthetic oestrogen has anti-androgen properties, which means that all combined oestrogen birth control methods have an anti-androgen effect, regardless of whether or not they contain an androgenic progestin. When taken alone in progestin-only methods like implants, IUDs, or progestin-only pills, androgenic progestins are more likely to cause weight gain (and other androgen side effects).

The Dutch Hormone test is a comprehensive hormone panel that we use to assess hormone imbalance in our clients in all stages of reproduction from pre-menopause to postmenopause. It allows us to be targeted with treatments because it shows us adequate and reliable results that we can use to help reduce our clients’ symptoms and balance their hormones properly and effectively.

For more information take a look at the Dutch Packages we offer.