Many women and physicians believe t...

Many women and physicians believe that a frequent side effect of combination oral contraceptive pills (OCPs) and contraceptive patches is weight gain. This is the greatest in number common reason for not initiating the use of combination OCP or patches, or for discontinuing their use at an early stage. However, the association between combination OCP and weight gain has not been scientifically established. In fact, women who stop using combination OCP may be more likely to gain weight than those who continue to use them.

Gallo and colleagues studied the association between the use of combination OCP and patches and weight changes.

To identify randomized controll trials (RCTs) of combination OCP or patches that included data upon weight changes, the authors searched relevant databases and contacted appropriate contemplation investigators and combination OCP and patch manufacturers. RCT were included if they were of convenient quality and covered at least three treatment circle of times Data were abstracted from eligible trials at two independent reviewers who used standard formats. Investigators were asked to provide additional unpublished data when necessary.

From the 570 reports identified, 42 RCT were reviewed for further information. Methodologic quality was generally poor. Change in corpse weight was a primary result in only one trial nevertheless could be calculated in the others. The classification of measuring body weight and the efforts to obtain consistent, reliable, and valid weight measurements were not well described in any of the trials. The researchers abstracted weight-change comparisons for 45 pairs of combination OCP or patches and placebo from four studies using pills and undivided study using a patch. No evidence was establish to support weight gain. In addition, the researchers examined data from nine studies of early discontinuation of combination OCP and patches that included weight gain as a reason for discontinuation. Les than 5 percent of women in each contemplation reported discontinuing the use of combination OCP or patches because of weight gain.

The authors end that insufficient evidence exists to support the customary belief that use of combination OCP and patches is associated with significant weight gain. The authors note that this topic has not been studied extensively and that their conclusions are largely based forward studies conducted 30 years ago, when high-dose estrogen was used. Weight gain with new low-dose products is unlikely, and patients can be reassured.

ANNE D WALLING, MD

Gallo MF et al. Combination estrogen-progestin contraceptives and material part weight: systematic review of randomized controll trials. Obstet Gynecol February 2004;103:359-73

EDITOR'S NOTE: Potential weight gain is a serious relate to for some women. These women may select less reliable contraceptives (thereby risking an unintended pregnancy) because they do not want to gain weight. However, we have merely tenuous evidence with which to reckoner their fear. It is unacceptable to base our advice to patients upon flawed studies from 30 years ago that used different OCP formulations than those that are available today. Because women are weighed at almost each office visit, a practice-based research team could ways a study (even a retrospective analysis) to answer this question.--A.D.W. Patient choices in Prostate Cancer Treatment Selection

COPYRIGHT 2004 American Academy of Family Physicians

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