progestogen only injectable contraceptive (contraception) and obesity

Last edited 03/2020 and last reviewed 11/2020

Progestogen-only injectable

• available evidence suggests that effectiveness of depot medroxyprogesterone acetate (DMPA) is not affected by body weight or BMI
• from the limited evidence available it is not possible to confirm or exclude a causal association between DMPA use and venous thromboembolism (VTE)
• whilst obesity alone does not restrict the use of DMPA (UKMEC 1), DMPA use becomes a UKMEC 3 when obesity is one of multiple risk factors for cardiovascular disease (e.g. smoking, diabetes and hypertension)
• DMPA use appears to be associated with some weight gain, particularly in women under18 years of age with a BMI >= 30 kg/m2

FSRH state (1):

• For women with obesity:
• if using intramuscular DMPA or norethisterone enanthate injectable, consider use of a longer-length needle or deltoid administration to ensure the muscle layer is reached
• consider use of subcutaneous DMPA

Weight gain with DMPA

Overall, the available evidence indicates that use of DMPA isassociated with some weight gain.

BMI prior to DMPA use in adolescents (aged <18 years) may predict weight gainwith DMPA use, with higher initial BMI being predictive of increased weight gain,
but evidence is insufficient to draw definitive conclusions. Women who gained more than 5% of their baseline body weight inthe first 6 months of DMPA use were more likely to experience continued weight gain

Reference:

• FSRH (April 2019). Overweight, Obesity & Contraception