a shot in the dark?
May 23, 2007 8:17 PM   Subscribe

is depo-provera affecting my ability to lose weight?

so i'm overweight. by more than i'd like to be. more than a bit of chub, less than mama grape. in the past two years, since i've started and continued to be on depo-provera, i've steadily gained weight. about 7 months ago, i decided i was going to start eating more healthfully and exercising more.

i get a bit of exercise (a lot more than i used to) everyday from walking up and down the monstrous, steep flight of stairs at work about 8 times per day, plus i walk for awhile about once a week (though i truly do not have the time with my job to do it everyday. i know that's a copout excuse, but i work for a startup newspaper and i work roughly 60-65 hours a week at this point).

i'm eating things that are good for me -- i'm avoiding all trans fats, things with high-fructose corn syrup... i stopped drinking soda, i stopped eating fast-food and starting cooking meals. i started eating breakfast, and fruits, and vegetables. i stopped having seconds. since i took my new job (btw, thanks all you who answered that question), i find i have very little time to eat and i eat a LOT less than i used to. like, a LOT. i eat wheat, not white, and whole-wheat pastas with vegetables. i drink water, i take vitamins, i have 8,000 varieties of kashi foods. i keep a food journal! and no more mashed potatoes (sad face).

so why is the weight not coming off? i've only lost like, 5 pounds! the only thing i can think of that would be preventing it woudld be birth control. going off BC is not an option, as i'm pretty sure pregnancy makes you gain weight too, and i need it for medical reasons. is there anything else that could be preventing the weight from coming off?
posted by kerning to Health & Fitness (23 answers total)
Short answer? Probably. There are different types of pills that might not make you gain weight -- I believe Yasmin is one.
posted by sugarfish at 8:32 PM on May 23, 2007

Anecdotally, Depo is infamous for weight gain. (The stats say 1/3 of women gain, 1/5 lose, and 1/10 stay the same, which is pretty special, since all those only add up to about 70%.) More realistically, I've been hearing some pretty sketchy things about bone loss. Add some weight-lifting, I guess, if you won't drop the Depo. It helps weight loss and it might slow some of the more insidious effects.

Some of the low-dose pills out are reputedly less problematic for weight problems (but require serious regularity in taking, which can be a problem if you're working a hectic schedule.)
posted by cobaltnine at 8:32 PM on May 23, 2007

Anecdotally again, everyone I know who has taken Depo gained a lot of weight. Maybe talk to your doctor about other contraceptives?
posted by k8t at 8:37 PM on May 23, 2007

I had the same problem...I gained weight when I was on Depo, and couldn't lose an ounce until I went off of it. In addition to the low-dose pills, I wonder if Nuva ring is also one that doesn't make one gain weight.

Seconding cobaltnine's concern about bone loss. I found out while on Depo that I had osteoporosis (at 30 years old). There are better forms of BC out there.
posted by bolognius maximus at 8:40 PM on May 23, 2007

My friend gained 60 pounds in 3 cycles of Depo. About 20 pounds per shot! Soon as she stopped the weight just fell off her. I'd certainly give it a try. An IUD like Mirena might be a good option for you instead.
posted by fshgrl at 8:41 PM on May 23, 2007

To avoid the issue (mentioned by cobaltnine) of serious regularity in pill-taking since you're so busy, I highly recommend Nuva Ring. I wouldn't take Depo because of the bone loss issues...weight gain is just icing on the cake.

I haven't had any weight troubles on the ring, but I was one of those rare women who lost weight on my first HBC method and still haven't gained it back, so I have no idea whether my experience is typical.
posted by crinklebat at 8:43 PM on May 23, 2007

You mention having little time to eat during the day. This suggests you may be skipping lunch. If you are trying to lose weight, you must make time to eat. I know this sounds counterproductive, but if you don't eat during the day, your body (which is programmed for survival and thinks it knows better than you keeping that weight) will think there is some sort of famine and hold on to every calorie it gets. On the other hand, if you remember to eat a (small) breakfast, (small) lunch, and even a couple of small but healthy snacks (something in the 100 calorie range), your body will think there's lots of food for the taking and no need to save up.

Otherwise, it sounds like you are doing a lot of good things. For that matter, the other folks who have replied make it sound like things could be a lot worse =( If you think you need some chemical help, green tea extract can help. Or you can ask your doctor about things like Phentermine.
posted by ilsa at 8:50 PM on May 23, 2007

Since we're all just throwing out anecdotes: I've been on Depo for five years. I lost nearly fifty pounds two years ago on Weight Watchers. So no, I've never had any trouble losing weight on Depo. Yeah, my weight's slowly starting to creep back up, but that's more attributable to less exercise and bad food choices.

When the bone-density issue came up a few years back, I talked to my doctor about switching to something else. The consensus was that I don't need to worry. It's more of a danger for younger girls who are still growing and forming. For me, I get plenty of calcium and weight-bearing exercise, so I'm not at that great a risk. Besides, I absolutely HATE having my period and, quite frankly, it's a risk I'm willing to take to get rid of it.
posted by web-goddess at 9:14 PM on May 23, 2007

Anecdotally yet again, I gained 60 lbs on depo. My midwife thinks there was actually some interaction between the depo and my respratory meds, but even now, some ten years later, I still haven't lost all the weight.

Get off the depo, would be my advice. Its about 800 kinds of bad.
posted by anastasiav at 9:15 PM on May 23, 2007

If taking a pill on a regular schedule wouldn't work for you, you might consider the patch. Worked quite well for me.
posted by MadamM at 9:20 PM on May 23, 2007

Just an FYI: if you weigh more than 200lbs, you are not supposed to use the patch.
posted by sugarfish at 9:21 PM on May 23, 2007

I definitely gained weight on Depo. I went on it for nine months (three cycles) in college, then again for one year (four cycles) within the last two years. The weight gain, approximately 15-20 pounds, seemed to be permanent -- my pretty sane and healthy diet didn't make a dent, though I suppose I could have worked out a lot more. But the weight barely budged even when I went off the Depo. It was definitely worth it, though, for me, because I wanted and needed a very reliable no-estrogen birth control option, and if the price of that was a somewhat more cushy tushie, then whatevs, I could deal.

You know what has finally taken some of the Depo weight off? Pregnancy. As of right now, I'm 15 weeks along, and so far I've actually lost at least ten pounds, most of it dropping off within the first eight weeks. All that excess hormonal fat that Depo put on me has actually melted away -- I suppose it's gone towards nourishing the baby! Note that my eating habits have not decreased at all -- quite the opposite in the past few weeks -- and my activity level has definitely decreased, if anything, because I've been too fatigued to work out. And yet all that Depo fat was apparently all, as mentioned, hormonal fat -- and so I'm now in my second trimester and I'm still wearing mostly my normal clothes, my boobs are bigger, my tush is normal sized, and my face is notably thinner. Go figure.
posted by Asparagirl at 9:39 PM on May 23, 2007

Anecdotally yet again, I gained ~80 lbs on depo. I haven't been on it for almost 1.5 years and I can't seem to shed much weight no matter how well I do with eating/exercise.
posted by disaster77 at 9:44 PM on May 23, 2007

Anecdotally, it sure is possible that there is a link between the weight and the depo. But at the same time, your exercise regime isn't exactly rigorous, either, and might be the real root of the problem. You are basically sedentary -- a few trips up and down the stairs and one walk per week are far better than nothing, but are not enough to burn a noticeable number of calories. So before you stop using a method of birth control that seems to be working well for you (assuming that you are not dealing with lots of side effects and so on), it would make sense to see what effect an actual exercise regime might or might not have first.
posted by Forktine at 10:41 PM on May 23, 2007

I assume that the only way hormonal BC could cause you to gain weight would be by somehow depressing your basal metabolic rate -- meaning you're not burning as many calories as you normally would, not including exercise.

But I don't think there's any possible way that the Depo could stop you from losing weight, if you drop your food intake below what you're burning off. You have to lose weight at that point, because your body has to get the energy somewhere.

It might be that your diet would be sufficient to cause you to lose weight under normal circumstances, but still contains too many calories to let you lose weight, because of what the hormones have done to your metabolism. The most obvious solution there would be to try to cut even more calories.

But before you do it yourself, particularly if you're really feeling like you've cut all the 'splurge foods' (which it sounds like you have), maybe you want to talk to a nutritionist? I just think it would be wise to have someone else take a hard look at what you're eating, and give you some recommendations of things you can cut further, without compromising your nutrition and overall health.

Also, some nutritionists and even some good fitness places have indirect calorimeters (thing you breathe into, like a SCUBA mouthpiece, for a while, and it measures the O2/CO2 you take in and give off) to compute your body's energy consumption when you're just sitting there. Not sure how accurate they are, but some personal trainers swear by them, and I had very good luck using the measurement from one as a basis for building a nutrition plan for myself. (I had less luck sticking to the plan, but you sound like you're much more organized and committed than I was.)
posted by Kadin2048 at 10:52 PM on May 23, 2007

More anecdotal evidence: I gained about 25lb on Depo over the course of a year or so and had trouble getting rid of it, even when I came off it. A bout of depression, Prozac, nausea and losing my appetite entirely for about a month did the trick in the end. Not a recommended diet strategy.
posted by corvine at 5:05 AM on May 24, 2007

The manufacturer lists changes in weight as a side effect, so it's not just anecdotal evidence. The drug definitely could be causing it. You say you need it for medical reasons - maybe talk to your doctor about a lower dose of progesterone. Provera comes in different forms - "depo" just means it is injected in an oil solution that slowly diffuses into your body over weeks. The tablets come in 2.5 mg - 10 mg so you might be able to get by with a smaller dose and lose the nasty side effect. You'd be amazed how often dose adjustment does the trick, for a variety of drugs.
posted by selfmedicating at 5:13 AM on May 24, 2007

I second the advice to see a nutritionist. I had a friend who was exercising regularly, not overeating, avoiding empty calories and doing all the things you're supposed to do and not losing fat (I'm avoiding saying weight for a reason). Before seeing the nutritionist she was asked to keep a food diary. After examining it the nutritionist found her carb and protein intake seriously out of whack, too much carbs and too little protein. Once she adjusted her diet following the nutritionist's recommendations, she dropped several dress sizes, and looked lean and fit, but without drastic weight loss. It goes without saying this change took several months.
posted by needled at 5:19 AM on May 24, 2007

Oh, and I wanted to add two things. The manufacturer also notes that you should use with caution in diabetic patients because glucose tolerance may be decreased. If you were borderline diabetic before and didn't know it this may have made your ability to process sugar worse, which definitely packs on the pounds.

The other point is that for a lot of medical conditions, just taking the provera during the last 14 days of your menstrual cycle (the 2 wks before your period) is enough. So that is another way to cut down on it if you absolutely need it.

It really sounds to me like the drug and not your diet and exercise habits. This is a well-known side effect of the drug.
posted by selfmedicating at 5:32 AM on May 24, 2007

In response to Sugarfish's comment about Yasmin-

The progesterone in Yasmin works as a diuretic, so you carry less water weight around, it does not necessarily mean you won't gain weight on it. I'm pretty sure all hormonal b/c carries that risk.
posted by sunshinesky at 2:07 PM on May 24, 2007

Another personal anecdote: I was on Depo for five years (I shudder to think of what it did to my calcium). I loved it for the lack of period and the easy schedule. However, I gained about 60lbs on it. I second Mirena as a great birth control which has all the positives of Depo, with none of the negatives. (Also, it's even easier than Depo...screw once every 3 months. Once every five years is friggen awesome)
posted by nursegracer at 4:21 PM on May 24, 2007

I had implanon - the little-stick-in-your arm progresterone-only contraceptive, which I'm led to understand uses similar hormones to Depo.

I got it in the leadup to my wedding. I was, at that point, working out 3-4 times a week, and eating very healthily. This kept my weight barely steady. After my wedding (when I stopped working out so much) I gained about 30kgs (66lb) in 8 months. I wasn't overeating; we were poor as church mice (think 30AUD a week for two adults food budget). My weight stayed pretty much the same for a couple of years. I had difficulty walking and doing normal activities, and I got fed up with it.

I lost the weight in 30weeks.

However, the way I did it was ... suboptimal. I couldn't exercise at all, due to joint problems. My metabolism was totally trashed from (by then) a year or two of basically no activity. The only option open to me was calorie restriction. I stuck to a 1000 calorie a day diet - under medical supervision. I would not advise doing this without medical supervision - it is, quite literally, starving yourself. If you are not *extremely* careful, you will also be depriving yourself of essential nutrients as well as energy. Also, it will ruin your metabolism. Mine was already pretty trashed, but it was distinctly worse afterwards.

Losing weight was hell on earth. Of course, 3 years on, and I've gained a bit of it back. Next priority: fix metabolism.
posted by ysabet at 8:44 PM on May 24, 2007

After years of working in and studying women's health (particularly reproductive health issues) I can assure you that yes, most likely, the depo provera is a factor in your weight gain and inability to lose weight. There have been many studies to support this. One study I read recently showed that the increases in weight are, in particular, due to an increase in body fat. Women who exercise regularly were less likely to have as dramatic of a gain of body fat, but still gained an equivalent amount of weight as sedentary women on depo provera.

Anecdotally, I have noticed that the more overweight or obese a woman is before she starts depo, the more weight she gains on it. This side effect, combined with the recent studies and black box warnings about bone loss on depo, and some other side effects make it, to me, one of the less desirable contraceptive options out there (in general - I acknowledge that for some women, it may be their preference). As others have mentioned, there are other contraceptive methods that are long term (or at least not daily) and less likely to cause weight gain. You mention you need contraception for medical reasons. I am not sure exactly what those are. However, if it is for menstrual suppression, you could use continuous oral contraceptives (assuming it's safe for you to use estrogen). If it's for something like the fact that pregnancy would be really unsafe for you for some medical reason, an IUD(Paraguard) or IUS (Mirena) would be a really effective method of birth control that has little to no chance of affecting your weight (Mirena has a theoretical chance although it is very unlikely to cause this effect; Paraguard has no effect on weight as it's nonhormonal). For more information on contraceptive options, Planned Parenthood's website is really helpful, and it is a good idea to research this before seeing a provider because there is a lot to consider here.

I also want to congratulate you on the lifestyle changes you have made so far and the committment you have made to eat healthfully and get more exercise. Keep at it!
posted by tuff at 4:24 AM on May 25, 2007

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