Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Weight, fat mass, and central distribution of fat increase when women use  depot-medroxyprogesterone acetate for contraception

International Journal of Obesity volume 29, pages 1252–1258 (2005)Cite this article

Abstract

OBJECTIVE:

To compare longitudinal changes in weight, body fat, and ratio of central to peripheral fat mass among first-time depot-medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and to evaluate user characteristics associated with that change.

DESIGN:

Prospective longitudinal study.

SUBJECTS:

Healthy women, aged 18–35 y, using DMPA for contraception (n=178) and women using no hormonal contraception (n=145).

MEASUREMENTS:

Weight, body fat, and the central distribution of fat, measured at 3-month intervals for 30 months, by electronic scale and dual-energy X-ray absorptiometry (DEXA). The ratio of central to peripheral distribution of body fat was computed by dividing the body fat in the conventional DEXA trunk region of interest (ROI) by the ROI's that encompass the arms, hips and legs.

RESULTS:

Women using DMPA had a significantly greater increase in all measures of fatness than women using no hormonal method of contraception (P<0.03). The observed weight of DMPA users increased from a mean of 69.4 kg (s.d.=16.9) at baseline to 75.5 kg (s.d.=25.0) at 30 months; an increase of 6.1 kg (8.8.%). Fat mass increased from a mean of 25.3 kg (s.d.=12.6 kg) at baseline to 31.4 kg (s.d.=17.8); an increase of 6.1 kg (23.6%) in DMPA users. The ratio of central to peripheral fat mass in DMPA users changed from 0.95 (s.d.=0.155) at baseline to 1.01(s.d.=0.198) at 30 months. In contrast, weight, fat mass and the ratio of central to peripheral fat mass of control participants remained virtually unchanged over the same time period. Women with higher baseline physical activity levels had a smaller increase in body fat (P=0.003) and the fat ratio (P=0.03), but not weight (P=0.48). No other user characteristics including, smoking, past oral contraceptive use or previous pregnancies predicted change in level of fatness.

CONCLUSIONS:

This study has demonstrated a change in body composition toward greater fatness and toward a central redistribution of fat among DMPA users as compared to controls and provides important information to be used when counseling women regarding contraceptive methods. Given the potential long-term implication of these changes, further study is recommended to determine whether the gains in fatness are reversed following DMPA discontinuation and to examine the role of progestins in the development and maintenance of obesity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.

    Article  Google Scholar 

  2. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T . Do obese children become obese adults? A review of the literature. Prev Med 1993; 22: 167–177.

    Article  CAS  Google Scholar 

  3. Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ . Fertility, family planning and women's health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 23; 1997: 19:1–1114.

  4. Paul C, Skegg DC, Williams S . Depot medroxyprogesterone acetate: patterns of use and reasons for discontinuation. Contraception 1997; 56: 209–214.

    Article  CAS  Google Scholar 

  5. Colli E, Tong D, Penhallegon R, Parazzini F . Reasons for contraceptive discontinuation in women 20 –39 years old in New Zealand. Contraception 1999; 59: 227–231.

    Article  CAS  Google Scholar 

  6. Matson SC, Henderson KA, McGrath GJ . Physical findings and symptoms of depot medroxyprogesterone acetate use in adolescent females. J Pediatr Adolesc Gynecol 1997; 10: 18–23.

    Article  CAS  Google Scholar 

  7. Mainwaring R, Hales HA, Stevenson K, Hatasaka HH, Poulsen AM, Jones KP, Peterson CM . Metabolic parameter, bleeding, and weight changes in U.S. women using progestin only contraceptives. Contraception 1995; 51: 149–153.

    Article  CAS  Google Scholar 

  8. Moore LL, Valuck R, McDougall C, Fink W . A comparative study of one-year weight gain among users of medroxyprogesterone acetate, levonorgestrel implants, and oral contraceptives. Contraception 1995; 52: 215–219.

    Article  CAS  Google Scholar 

  9. Pelkman CL, Chow M, Heinbach RA, Rolls BJ . Short-term effects of a progestational contraceptive drug on food intake, resting energy expenditure, and body weight in young women. Am J Clin Nutr 2001; 73: 19–26.

    Article  CAS  Google Scholar 

  10. Taneepanichskul S, Reinprayoon D, Khaosaad P . Comparative study of weight change between long-term DMPA and IUD acceptors. Contraception 1998; 58: 149–151.

    Article  Google Scholar 

  11. Espey E, Steinhart J, Ogurn T, Quallis C . Depo-Provera associated with weight gain in Navajo women. Contraception 2000; 62: 55–58.

    Article  CAS  Google Scholar 

  12. Bahamondes L, Del Castillo S, Tabares G, Arce X, Perrotti M, Petta C . Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD up to 5 years. Contraception 2001; 64: 223–225.

    Article  CAS  Google Scholar 

  13. Danli S, Qingxiang S, Guowei S . A multicentered clinical trial of the long-acting injectable contraceptive Depo Provera in Chinese women. Contraception 2000; 62: 15–18.

    Article  CAS  Google Scholar 

  14. Schwallie PC, Assenzo JR . Contraceptive use-efficacy study utilizing medroxyprogesterone acetate administered as an intramuscular injection once every 90 days. Fertil Steril 1973; 24: 331–339.

    Article  CAS  Google Scholar 

  15. Clark MK, Sowers MF, Nichols S, Levy BT . Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate. Fertil Steril 2004; 82: 1580–1586.

    Article  CAS  Google Scholar 

  16. Treuth MS, Hunter GR, Kekes-Szabo T . Estimating intraabdominal adipose tissue in women by dual-energy X-ray absorptiometry. Am J Clin Nutr 1995; 62: 527–532.

    Article  CAS  Google Scholar 

  17. Park YW, Heymsfield SB, Gallagher D . Are dual-energy X-ray absorptiometry regional estimates associated with visceral adipose tissue mass? Int J Obes Relat Metab Disord 2002; 26: 978–983.

    Article  Google Scholar 

  18. Ainsworth B, Haskell WL, Leon AS, Jacobs Jr DR, Monotoye HJ, Sallis JF, Paffenbarger Jr RS . Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80.

    Article  CAS  Google Scholar 

  19. Diggle PJ, Liang K, Zenger SL . Analysis of longitudinal data. Oxford Science Publications: Oxford; 1994.

    Google Scholar 

  20. Westhoff C . Depot-medroxyprogesterone acetate injection (Depo-Provera): a highly effective contraceptive option with proven long-term safety. Contraception 2003; 68: 75–87.

    Article  CAS  Google Scholar 

  21. Faria AN, Ribeiro Filho FF, Gouveia Ferreira SR, Zanella MT . Impact of visceral fat on blood pressure and insulin sensitivity in hypertensive obese women. Obes Res 2002; 10: 1203–1206.

    Article  Google Scholar 

  22. Forouhi NG, Sattar N, McKeigue PM . Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord 2001; 25: 1327–1331.

    Article  CAS  Google Scholar 

  23. Giltay EJ, Elbers JM, Gooren LJ, Emis JJ, Kooistra T, Asscheman H, Stehouwer CD . Visceral fat accumulation is an important determinant of PAI-1 levels in young, nonobese men and women. Arterioscler Thromb Vasc Biol 1998; 18: 1716–1722.

    Article  CAS  Google Scholar 

  24. Sowers JR . Obesity as a cardiovascular risk factor. Am J Med 2003; 115 (Suppl 8A): 37S–41S.

    Article  CAS  Google Scholar 

  25. Sorensen MB, Collins P, Ong PJ, Webb CM, Hayward CS, Asbury EA, Gatehouse PD, Elkington AG, Yang GZ, Kubba A, Pennell DJ . Long-term use of contraceptive depot medroxyprogesterone acetate in young women impairs arterial endothelial function assessed by cardiovascular magnetic resonance. Circulation 2002; 106: 1646–1651.

    Article  Google Scholar 

  26. Clark MK, Sowers FM, Levy BT, Tenhundfeld P . Magnitude and variability of sequential estradiol and progesterone concentrations in women using depot medroxyprogesterone acetate for contraception. Fertil Steril 2001; 75: 871–876.

    Article  CAS  Google Scholar 

  27. Liang YQ, Akishita M, Kim S, Ako J, Hasimoto M, Iijima K, Ohike Y, Watanabe T, Sudoh N, Toba K, Yoshizumi M, Ouchi Y . Estrogen receptor beta is involved in the anorectic action of estrogen. Int J Obes Relat Metab Disord 2002; 26: 1103–1109.

    Article  CAS  Google Scholar 

  28. Misso ML, Murata Y, Boon WC, Jones ME, Britt KL, Simpson ER . Cellular and molecular characterization of the adipose phenotype of the aromatase-deficient mouse. Endocrinology 2003; 144: 1474–1480.

    Article  CAS  Google Scholar 

  29. Tommaselli GA, Di Carlo C, Nasti A, Giordano E, Pisano G, Pellicano M, Bifulco G, Nappi C . Effects of bilateral ovariectomy and postoperative hormonal replacement therapy with 17beta-estradiol or raloxifene on serum leptin levels. Menopause 2003; 10: 160–164.

    Article  Google Scholar 

  30. Douchi T, Yamamoto S, Yoshimitsu N, Andoh T, Matsuo T, Nagata Y . Relative contribution of aging and menopause to changes in lean and fat mass in segmental regions. Maturitas 2002; 42: 301–306.

    Article  Google Scholar 

  31. Kontula K, Paavonen T, Luukkainen T, Andersson LC . Binding of progestins to the glucocorticoid receptor. Biochem Pharmacol 1983; 32: 1511–1518.

    Article  CAS  Google Scholar 

  32. Harte C, Henry MT, Murphy KD, Mitchell TH . Progestogens and Cushing's syndrome. Irish J Med Sci 1995; 164: 274–275.

    Article  CAS  Google Scholar 

  33. Rockall AG, Sohaib SA, Evans D, Kaltsas G, Isidori AM, Monson JP, Besser GM, Grossman AB, Resnek RH . Computed tomography assessment of fat distribution in male and female patients with Cushings's syndrome. Eur J Endocrinol 2003; 149: 561–567.

    Article  CAS  Google Scholar 

  34. Grueso E, Rocha M, Puerta M . Plasma and cerebrospinal fluid leptin levels are maintained despite enhanced food intake in progesterone-treated rats. Eur J Endocrinol 2001; 144: 659–665.

    Article  CAS  Google Scholar 

  35. Owens S, Gutin B, Allison J, Riggs S, Ferguson M, Litaker M, Thompson W . Effect of physical training on total and visceral fat in obese children. Med Sci Sports Exerc 1999; 31: 143–148.

    Article  CAS  Google Scholar 

  36. Riechman SE, Schoen RE, Weissfeld JL, Thaete FL, Kriska AM . Association of physical activity and visceral adipose tissue in older women and men. Obes Res 2002; 10: 1065–1073.

    Article  Google Scholar 

Download references

Acknowledgements

This project was supported by NIH Grant NICHD R01 39100 and AG55741 and by the Office of Research and Development, Department of Veterans Administration. The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or the Department of Veterans Administration.

Author information

Authors and Affiliations

  1. College of Nursing, University of Iowa, Iowa City, IA, USA

    M K Clark & S Nichols

  2. Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa and Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA

    J S Dillon

  3. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    M Sowers

Authors
  1. M K Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J S Dillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Sowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Nichols
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M K Clark.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clark, M., Dillon, J., Sowers, M. et al. Weight, fat mass, and central distribution of fat increase when women use  depot-medroxyprogesterone acetate for contraception. Int J Obes 29, 1252–1258 (2005). https://doi.org/10.1038/sj.ijo.0803023

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0803023

Keywords

This article is cited by

Search

Advanced search

Quick links