2 Contraceptive Challenges
Earlier this week I faced a young lady across the table wanting to change her method of contraception as the Mini Pill she was currently using had made her gain weight
As she saw it, she had been doing everything right (but piling on the pounds regardless), since she’d started this pill and so it seemed the obvious cause of her problem.
Looking objectively at her medical 'facts', it was difficult to disagree with her.
Of course, only she can provide the actual evidence of whether she is following an appropriate diet and lifestyle that is supportive of NOT adding weight.
However, when taken at her word the only possible reason for her weight gain must be the daily consumption of Progesterone which constitutes the Mini Pill as we know it today.
When you look at the evidence available for how Progesterone affects the body weight, it shows: The Mini Pill does not directly cause changes in weight*.
From reliable studies women have reported weight changes including weight gain and weight loss while taking the Pill but there isn't enough proof that this change is due directly to the Pill.
From the same reports, it seems that where such observations are made with regards to weight gain it is usually not more than about 2 kg in a 12-month period.
So, what did I do with my patient? We rationalised the above information and agreed to change her Pill.
She accepted that it was unlikely the current Pill was contributing anything more than a small fraction of her weight gain and would focus her energies more on healthy eating and increased activity to achieve her weight loss goals.
Given her dissatisfaction with the old pill, we agreed to continue the Mini-Pill while opting for a change to the type. After 3 months, we would review her experience.
The solution was a lot simpler with my next contraception consultation: A lady who was very near the expiration period for her uterine coil arrived to say she could no longer feel her threads.
Usually women are advised to regularly check the Intra-Uterine Device (IUD) (commonly called 'coil') threads (after each menstruation or regularly at alternate months). The implication of not feeling the threads is either:
1. that the coil has been ‘expelled’ or fallen out of the womb through the vagina; or
2. that the coil may have perforated the womb**
In either case once the coil threads have been confirmed to be absent by physical examination by a clinician, the advice will be to use alternate contraception – pills, condom etc – until an ultrasound scan (and other tests like X-rays if necessary) can be arranged to locate the coil.
And that's what we did.
References:
*Progestogen-only Pills Clinical Effectiveness Unit March 2015 (Updated January 2016) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
**Intrauterine Contraception Clinical Effectiveness Unit April 2015 (Updated October 2015) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
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Editing by AskAwayHealth Team
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