Which Types of Birth Control Cause Weight Gain?

Hormonal birth control can negatively affect metabolic health and contribute to weight gain. Some types are more likely to do so than others, depending on the type of progestin.

But before we get to the question of “which progestin,” I’ll just point out that the biggest problem with hormonal birth control is that it (usually) switches off hormones.

Birth control replaces natural hormones with “hormone-like” medications

Most types of hormonal birth control switch off ovarian estradiol and progesterone, and replace them with synthetic substitutes. (Case in point: A blood test for estradiol while on the pill would show menopausal levels.) And while estradiol and progesterone are highly beneficial for female metabolic health, their replacements are not.

Here’s a little more detail:

• On combined estrogen methods of birth control (pills, patches, rings), the ovaries produce almost no estradiol or progesterone. Those beneficial hormones are replaced by ethinylestradiol (a synthetic estrogen) and a progestin.

💡 Tip: Keep reading for the metabolic effects of ethinylestradiol and progestins.

• On the Depo-Provera injection, the ovaries produce no estradiol or progesterone. They’re replaced by the progestin medroxyprogesterone, which can have very negative effects (see below).
• Progestin-only methods (implants, mini-pills) allow the ovaries to produce some estradiol but no progesterone. Progesterone is replaced by a progestin such as norethindrone, levonorgestrel, etonogestrel, or drospirenone. Check the label to see which one you’re taking.
• Hormonal IUDs (levonorgestrel-releasing IUDs) allow the ovaries to make both estradiol and progesterone (which is good!). However, levonorgestrel can directly cause weight gain because it’s androgenic.

💡 Tip: Androgenic progestins like levonorgestrel can increase visceral fat and reduce insulin sensitivity.

Metabolic effects of synthetic estrogen and progestins

Ethinylestradiol (synthetic estrogen)

While ovarian estradiol benefits metabolic health, its synthetic replacement (ethinylestradiol) can have negative effects, such as reducing muscle mass and impairing insulin sensitivity. On the plus side (for metabolic health), ethinylestradiol lowers androgens, which can offset the visceral fat-promoting effects of high androgens in women.

Progestins and their effect on metabolic health and weight

The impact of progestins on metabolism depends on how androgenic (testosterone-like) they are:

Non-androgenic or anti-androgenic progestins (drospirenone, cyproterone acetate) can improve insulin sensitivity and reduce visceral fat. However, stopping them can promote insulin resistance and weight gain. And of course, anti-androgenic progestins can have other side effects, like anxiety and depression.

Androgenic progestins (levonorgestrel, norethindrone, etonogestrel, desogestrel, norgestrel, norgestimate, and medroxyprogesterone) impair insulin sensitivity and promote visceral fat. That’s because in women, androgen or testosterone excess can cause or drive insulin resistance. And insulin resistance can cause weight gain.

💡 Tip: According to some research, medroxyprogesterone (Depo-Provera injection) can cause “unstoppable weight gain,” which is weight gain that doesn’t plateau or level out.

💡 Tip: Androgenic progestins are more likely to promote weight gain (and other androgen side effects) if they’re taken on their own (without synthetic estrogen), such as a progestin-only pill, implant, injection, or IUD.

For more, read:

• Metabolism Repair for Women
• How testosterone can cause weight gain in women

What has been your experience with hormonal birth control and weight? Share your experience.