Contraceptive Pearl: Hormonal Birth Control & Weight Gain

Written by Monica Agarwal, MD

Do hormonal contraceptives cause weight gain? One survey of American women indicated that concern about weight gain was the most common single reason for discontinuing combined OCPs.

Current evidence suggests that estrogens should not be considered weight-positive medications. A recent Cochrane review that included 49 trials showed that combined hormonal contraceptives (pill, patch, ring) are not associated with weight gain, even amongst different doses of estrogen. 

Progestin-only contraceptives (pill, injection, hormonal IUD, implant), however, may cause weight gain. Another recent Cochrane review that included 22 studies showed modest weight gain of about 4.4 lb (2 kg) over 6 to 12 months with progestin-only contraceptives. It is not clear whether weight gain on progestins is dose-dependent, but one study did show comparatively more weight gain of 13.7 lb (6.2 kg) over five years with injectable progestins, which involve higher doses than progestin-only pills or LARCs.

Accurate counseling about weight gain with hormonal contraceptives may help patients know what to expect. 


Your Birth Control Choices Fact Sheet

Your Birth Control Choices Poster

Progestin-Only Birth Control Sheet


Pratt, W. F., & Bachrach, C. A. (1987). What Do Women Use When They Stop Using the Pill? Family Planning Perspectives, 19(6), 257–266.

Gallo MF, Lopez LM, Grimes DA, Carayon F, Schulz KF, Helmerhorst FM. Combination contraceptives: effects on weight. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD003987. DOI: 10.1002/14651858.CD003987.pub5. Accessed 08 March 2022.

Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, Helmerhorst FM. Progestin‐only contraceptives: effects on weight. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD008815. DOI: 10.1002/14651858.CD008815.pub4. Accessed 08 March 2022.

Beksinska ME, Smit JA, Kleinschmidt I, Milford C, Farley TM. Prospective study of weight change in new adolescent users of DMPA, NET-EN, COCs, nonusers and discontinuers of hormonal contraception. Contraception. 2010;81(1):30-34. doi:10.1016/j.contraception.2009.07.007


The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.