Does hormonal birth control harm metabolic health or cause weight gain? If so, which types are the worst?
First of all, most types of hormonal birth control prevent ovulation and, therefore, kill estradiol and progesterone. That is, most types of hormonal birth control kill the metabolism enhancing benefits of those natural hormones. In that sense, any type of hormonal birth control can harm metabolic health.
Birth control kills hormones
With most types of hormonal birth control, you will produce very little (or no) estradiol and almost always no progesterone. And, of course, no estradiol or progesterone in Excess birth control. (Some combined birth control methods use estradiol to match the body, but none use progesterone to match the body.)
Specifically:
- In a combined method of estrogen-progestin such as pill, patch, or ring, you have almost no estradiol or progesterone. In their place, you will have contraceptive drugs such as ethinylestradiol (synthetic estrogen) plus one of several progestins. See below for the metabolic effects of ethinylestradiol and various progestins.
- In Depo-ProveraⓇ injectionyou also won’t make estradiol and progesterone but instead have medroxyprogesterone medicine.
- In a progestin-only method such as a plant o progestin-only pill (sometimes called a “progesterone-only” pill despite not being progesterone), you’ll make some estradiol but no progesterone. Instead of progesterone, you will have a progestin such as norethindrone (norethisterone), levonorgestrel, etonogestrel, or drospirenone. Read the label to see which progestin you are taking.
- Finally, in a hormonal IUD (which delivers the progestin levonorgestrel directly to the uterus), you can still ovulate and make your own estradiol and progesterone. you will too have low levels of levonorgestrel throughout your body, including your brain.
Ethinylestradiol can cause fluid retention and possibly reduce muscle mass. Can also impair insulin sensitivity. That’s in contrast to estradiol (natural estrogen), which improves insulin sensitivity.
The metabolic effects of progestins vary with the individual progestin and how androgenic or testosterone it is.
Medroxyprogesterone (from DepoProvera injection) is interesting because it is slightly androgenic at the androgen receptor, but in women, that’s enough to cause androgen side effects like acne, facial hair, and weight gain. In men, on the other hand, a high dose of medroxyprogesterone can be used to shut down testicular function and act as a strong anti-androgen.
Another mechanism by which Depo-ProveraⓇ may cause weight gain is by interacting with cortisol receptors, thereby causing cortisol-induced insulin resistance, which, according to research, can (in some women) result in “uncontrollable weight gain,” or weight gain that does not plateau or level out.
Finally, estrogen (even synthetic estrogen) is anti-androgen, so all combined estrogen birth control methods have a somewhat anti-androgen effect, even if they contain androgenic progestin. Androgenic progestins are most likely to promote weight gain (and other androgen side effects) when they are taken by themselves with progestin-only methods such as implants, IUDs, or progestin-only pills. .
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What is your experience with hormonal birth control and metabolic health? Sound off in the comments.
