Mild Adverse effects of Hormonal contraception

Adverse effects represent the main factors in determining acceptability and compliance with any contraceptive method. Most frequent symptoms are: weight gain, nausea, breast tenderness and menstrual disorders⁽¹⁾. Mild and transitory disturbances are common in the first cycles of hormonal contraception and usually disappear after this period without any problem. Women often stop hormonal contraception because of perceived weight changes⁽²⁾. This suggestion affects particularly, adolescents and young women preoccuped with body image.

However, it is important to remember that breast tenderness, headache, nausea and oedema also occur in the general population and during use of placebo^(3,4). Is there a real evidence of weight gain? Several studies are carried out with the aim to clarify if weight increase with hormonal contraceptives is real or only a common misperception.

The combination ethinylestradiolEE) 20mcg/ levonorgestrel(LNG) 100mcg seems to have no significant impact on body weight and body composition(fat mass, fat-free mass, total body water, intracellular water, extracellular water)⁽⁵⁾. A multicenter comparative study between norgestimate (NGM) 180/215/250 mcg/EE 25mcg versus norethindrone acetate 1mg/EE 20 mcg showed that only the 0.3% of users, in both groups, experienced a 10% increase in weight ⁽⁶⁾.

A recent randomized, prospective study evaluating the incidence of side-effects in women using EE 20 mcg/LNG 100 mcg or EE 15 mcg/ gestodene 60 mcg or vaginal ring (EE 15mcg/etonogestrel-ENG 120mcg) reported no significant weight gain into three groups. Particularly, over 1 year of treatment, the maximum weight gain from baseline was 2,8 kg in the first group 1,6 kg in the second group and 0,8 in the thirt group⁽⁷⁾.

Another study which compared the formulations EE 30mcg/chlormadinone acetate 2mg and EE 30 mcg/Drospirenone 3 mg showed no significant increase in body weight in both groups of adolescents considered as demonstrated in other trials ^(8,9,10,11). Injectable contraceptive methods are safe, reliable and worldwide used. Depot-medroxyprogesterone acetate(DMPA) is the most commonly used injectable in the United States; but during its use irregular bleeding, breast tension, weight gain and impact on bone mineral density should be taken into account⁽¹²⁾.

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However, no differences in mean bone mineral density of distal forearm between DMPA and IUD users were showed; even though DMPA induces estrogen deficiency as demonstrated with measures performed 5 days after cessation of menstruation⁽¹³⁾. So, the relationship between DMPA and changes in bone density remains controversial despite a substantial number of studies evaluating this potential association⁽¹⁴⁾.