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Four out of 10 women in a just-released survey say weight gain is a reason to stop taking or avoid the Pill, and increased weight is the primary concern voiced by patients when inquiring about the Pill’s side effects.1
The survey, conducted on behalf of the Washing-ton, DC-based National Association of Nurse Practitioners in Women’s Health (NPWH), found that women seeking to avoid weight gain may choose a less-effective method of birth control than oral contraceptives (OCs) or no method, which may result in unintended pregnancies. (Review highlights of the report at the organization’s web site: www.npwh.org.)
"There’s a paradox, because oral contraceptives are one of the best, most effective methods that we have, and in fact women aren’t using it because they think they are going to gain weight," says Susan Wysocki, RNC, NP, NPWH president and CEO.
NPWH is encouraging providers to do a better job of educating women about oral contraceptives. With studies showing that today’s low-dose pills do not cause weight gain, clinicians need to provide adequate information to women who are seeking to preserve healthy weight, self-image, and reproductive wellness.
The myths persist
Why do the myths persists when it comes to it OCs and weight gain? Michael Rosenberg, MD, MPH, clinical professor of obstetrics and gynecology at the School of Medicine and adjunct professor of epidemiology at the School of Public Health, both at the University of North Carolina at Chapel Hill, and president of Health Decisions, a Chapel Hill-based private research firm specializing in reproductive health, offers the following observations:
• OCs are an easy target. "With other things going on, they are the first thing many women think of," comments Rosenberg.
• The largest group of OC users tends to be young women, a common age for weight gain.
• Although some women lose weight while using OCs, providers do not hear complaints to that effect. The absence of such reports creates the impression that weight gain, but not loss, is associated with OC use, explains Rosenberg.
Rosenberg explored the weight/OC issue in a study analyzing the daily weights of 128 women during four cycles of triphasic OC use.2 The mean weight at the end of the fourth cycle of use was the same as baseline weight. The largest proportion of women, 52%, remained within two pounds (0.9 kg) of their starting weight, and 72% of women had either no weight change or a loss. Over each menstrual cycle, regular but minor weight shifts were observed, with the mean weight rising by one-half pound (0.2 kg) during the first weeks of each cycle and falling by the same amount during the last few days. These results emphasize the lack of association of OC use with weight gain, but OC may be blamed at least in part, based on cyclic fluctuations, he concludes.
Although weight gain is often named as the reason for nonuse or discontinued use of OCs, studies fail to associate use of low-dose OCs
with significant weight gain.3,4
Studies that have examined the Pill against placebo for use in other indications outside of contraception also show no association with increased weight. One such study, conducted for use of Ortho Tri-Cyclen (marketed by Ortho-McNeil Pharmaceuticals of Raritan, NJ) for treatment of acne, showed no difference in weight gain vs. placebo; in fact, more women taking placebo discontinued prematurely due to weight gain.5
Discuss ways to manage weight goals
Women who avoid OCs and other hormonal contraception due to their fear of gaining weight should be brought up to date on the current status of weight changes in the U.S. population.6 More than half of women over age 20 are overweight (defined as a body mass index: kg/m2 of 25.0 to 29.9) or obese (defined as a body mass index:kg/m2 of 30 or more.)6
Talk with patients about their weight concerns, and identify steps for managing weight goals.
Prospective information and reassurance about weight issues are important, especially when it comes to keeping up physical activities, notes Rosenberg. Over two-thirds of women do not participate in regular and sustained physical activity, and almost one-third are physically inactive.6 Counsel women on healthy eating habits and exercise to address weight concerns.
"I do think that with the literature pretty consistently and clearly indicating a lack of problem associated with OCs, we’re back to efforts to educate," Rosenberg observes. "Weight gain is a powerful issue."
1. National Association of Nurse Practitioners in Women’s Health. Weight, Sexuality, and Women’s Birth Control Decisions. Washington, DC; January 2001. Web: www.npwh.org.
2. Rosenberg M. Weight change with oral contraceptive use and during the menstrual cycle: Results of daily measurements. Contraception 1998; 58:345-349.
3. Reubinoff BE, Grubstein A, Meirow D, et al. Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women. Fertil Steril 1995; 63:516-521.
4. Endrikat J, Müller U, Düsterberg B. A 12-month comparative clinical investigation of two low-dose oral contraceptives containing 20 mg ethinylestradiol/75 mg gestodene and 30 mg ethinylestradiol/75 mg gestodene, with respect to efficacy, cycle control, and tolerance. Contraception 1997; 55:131-137.
5. Redmond G, Godwin AJ, Olson W, et al. Use of placebo controls in an oral contraceptive trial: Methodological issues and adverse event incidence. Contraception 1999; 60:81-85.
6. Kushner R, Westhoff CL. Hormonal contraception and weight issues. Dialogues in Contraception 2000; 6:5-6.
For more information on weight gain and oral contraceptives, contact:
• Susan Wysocki, RNC, NP, National Association of Nurse Practitioners in Women’s Health, 503 Capitol Court N.E., Suite 300, Washington, DC 20002.
• Michael Rosenberg, MD, MPH, Health Decisions, 1512 E. Franklin St., Suite 200, Chapel Hill, NC 27514.