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Ever quit taking the pill because your best friend told you her cousin got fat on birth control? I can’t tell you how many times I’ve heard this story. I’m not going to sugar-coat it: there are some side effects from hormonal birth control methods. But chances are they’re not as bad as you think. What I try to explain to my patients is that there are always cousins with bad experiences on birth control, but they are usually the exception, not the rule. All that said, here are three things you should know about birth control and weight gain.

Fact 1: Women on the pill don’t gain any more weight than women not on birth control.

There have been studies about this over and over again, and they all show the same thing, namely that the pill does not make you fat. Many young women are starting birth control for the first time while their body is going through many other changes. Some women gain weight naturally when transitioning from their teens into their twenties. If that happens to be when a woman starts birth control, it’s easy to put the blame on the pill, patch, or ring. The truth is each of these methods can be used without an expected weight gain. So go ahead, buy those new skinny-leg jeans and start your birth control the same day. Trust me.

Fact 2: The shot can lead to weight gain for some women.

Here’s what we have seen: the birth control shot (Depo-Provera) can cause weight gain for about a quarter of users. A recent study showed that, in the first six months of use, 1 out of 4 shot users gained 5 percent or more of their starting weight. (For example, if you were one of these women, you’d start using the shot weighing 170 pounds and gain 9 or more pounds within 6 months.) The women who gained weight in the first six months were more likely to go on gaining weight while they continued to use the shot. However, the majority of women (3 out of 4) didn’t gain much weight, averaging 1.4 pounds in the first year of using the shot. So most women using the shot are able to keep their weight steady with healthy eating and regular exercise. (Things we all should be doing!) However, the shot might not be the best choice if you already have trouble with your weight, particularly as there are many other options that provide excellent birth control and aren’t linked to weight gain (like the implant, an IUD, the ring, the patch and the pill).

Fact 3: Healthy choices you make now not only will make you feel better, but also will prevent diseases like high blood pressure and diabetes when you are older.

If you do struggle with your weight, you’re not alone! About 1 in 3 women in the U.S. are obese, and this number is growing. While fashion magazines, with their airbrushed photos, are notorious for setting unrealistic and unhealthy body standards for women and girls, there is such a thing as healthy weight. Talk to your doctor or nurse about the right weight for you. If together you and your doctor decide it’s time to make some changes in how you eat and exercise, there are some simple tips below that can make a big difference in reaching a healthy weight. Make one change at a time, and don’t expect immediate results. Changing everything you eat at once is hard to maintain and often leads to gaining back weight quickly.

  • Carry a water bottle: Drinking water all day instead of sugary drinks like soda or fruit juice will cut out a ton of calories, while keeping you hydrated.

  • Eat breakfast: Even a granola bar or a piece of string cheese will get your metabolism going in the right direction in the morning.

  • Trade out your chips for carrots: Most potato and tortilla chips are fried in oil that your body doesn’t need. Choose baked chips or pretzels—or, even better, carrots or a piece of fruit—for a snack instead.

  • Turn off the TV…and the computer, the iPhone, anything with a screen of flashing lights: Keeping your screen time limited to less than an hour a day inevitably leads to more physical activity. You don’t have to join the track team right now, just start with a walk around the neighborhood with friends.

For more good ideas, check out these tips before your screen time is up for the day!

Robin Wallace, MD, is a Family Physician for the San Francisco Department of Public Health and is currently a clinical fellow in Family Planning at the University of California, San Francisco. As the middle of three daughters in her family, she has always been a passionate advocate for girl power and women’s health, and appeared as Captain Contraception for a super heroes party in medical school.

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When you hear the term “birth control,” the Pill probably springs to mind, followed by methods that are growing in popularity, like intrauterine devices and the Nexplanon implant. But there’s a slew of other options out there, including one that doctors say is popular but often overlooked in birth control conversations: the shot.

Depo-Provera, the brand name for medroxyprogesterone (which is often just referred to as “the shot”), is a contraceptive injection for women that contains progestin, a synthetic version of the hormone progesterone. It’s given as an injection once every three months, the Mayo Clinic says, and it works by suppressing ovulation, i.e., it keeps your ovaries from releasing an egg each month that could get fertilized, resulting in pregnancy. The shot also thickens your cervical mucus to keep sperm from reaching an egg.

According to Planned Parenthood, the shot is more than 99 percent effective when it’s used perfectly but, in real life, the shot is about 94 percent effective because sometimes people forget to get their shot in time. That means about six out of every 100 shot users will get pregnant each year.

Rebecca Starck, M.D., an ob/gyn and clinical assistant professor of surgery at Cleveland Clinic Lerner College of Medicine, tells SELF that she tends to prescribe hormonal birth control pills, IUDs, and the implant more often than the shot, but Depo-Provera is among the range of options she discusses with her patients.

On the other hand, Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at The University of Illinois College of Medicine at Chicago, tells SELF that Depo-Provera is fairly popular with her patients. “It’s a great option for women looking for some type of long-term reversible contraception, and allows people to have a little more flexibility with their contraceptive management,” she says.

However, no birth control method is perfect, and the shot isn’t an exception. Here are a few potential side effects to be aware of if you use it.

1. You might stop having periods.

The most common side effect of the shot is a change in a woman’s bleeding pattern, Jason James, M.D., medical director at Miami’s FemCare Ob-Gyn, tells SELF. In the short-term, that can mean you might have irregular periods and spotting. But after a few months, the progesterone in the shot causes your uterine lining to thin, and as a result, your period may go away. However, once you go off the shot, you may have irregular bleeding again as your body eliminates the extra progesterone from your system.

2. After you stop using the shot, it can take some time to get pregnant.

Michael Cackovic, M.D., the obstetric director of the maternal cardiac disease in pregnancy program at The Ohio State University Wexner Medical Center, tells SELF that a person’s “return to fertility” can take anywhere from 10 to 22 months after they stop using the shot. “It’s not a good medicine for family planning” if you want to get pregnant soon, he says, in the sense that you can have a pretty much instant return to fertility with options like the Pill.

3. It can mess with your bones.

Using Depo-Provera for more than two years can cause you to lose bone density. “This is concerning now, as we are finding more and more women have been on it for long periods of time,” Cackovic says, noting that Depo-Provera’s label warns that the decline in bone density increases with duration of use and may not be completely reversible even after the drug is discontinued. As a result, Cackovic says that some doctors recommend that women take calcium and vitamin D supplements while they’re on the shot.

4. You might start to get headaches.

However, Shepherd says this is a potential side effect of pretty much every form of hormonal birth control. “What I would recommend is that if someone experiences a new onset of headaches with starting a new method of birth control, they really should talk to their doctor,” she says. While it’s probably just a normal side effect of the birth control, “it could be triggering something or may be exacerbating something that’s already there,” Shepherd explains.

5. It won’t help your skin the way the Pill can.

If you’ve been on a combination estrogen and progesterone birth control pill, you’ve probably noticed that your skin looks clearer. This is because combination pills tend to help remove excess testosterone in your body that can exacerbate acne. “We often see women on combination birth control pills have an improved complexion,” Starck says. However, progesterone-only methods like the shot don’t impact your skin. It won’t necessarily make your skin worse, Starck says, but it also won’t make it better.

6. You could get bloated.

Bloating and stomach cramps are a common initial complaint on the shot, says James. It’s due to the fact that progesterone can slow down your intestines’ digestion slightly—but it doesn’t last forever. “These symptoms, like most side effects, tend to improve with time as women become accustomed to the medication,” James says.

7. You could gain some weight.

James says that some women mention gaining weight on the shot. In fact, a 2009 study published in the American Journal of Obstetrics and Gynecology found that Depo-Provera users gained an average of 11 pounds over three years, compared to the three to four pounds gained by women who used other forms of contraception. Of course, using the shot isn’t a guarantee that you’ll gain weight, but it’s a potential side effect that causes concern in some people.

Despite the possible side effects, most experts say the shot is a good birth control method. But, as with any medication, it’s really best to talk to your doctor about all of your options before deciding on one.

Related:

  • Which Birth Control Option Is Right For You?
  • No, You Should Absolutely Not Remove Your IUD At Home
  • 6 Mistakes You Might Be Making With The Pill

Watch: Can Birth Control Cause Depression?

Q: I’ve heard that going on birth control can make you gain weight. Is this true?

A: Many women start birth control at a time in their lives when they’re already at risk for gaining weight — they’re going off to college or doing other things that can cause weight gain. So it can be really difficult to untangle someone’s weight gain from whether or not it’s related to their birth control.

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We do know that the only method of birth control in the studies that’s associated with weight gain is the Depo-Provera® injection. That’s because it’s a large dose of progestin that you get all at once and it has to last for three months. On average, women in these studies who were on the Depo-Provera injection only gained a few pounds, like up to five pounds in that first year. But we know that some women gained no weight and other women gained more than five pounds. So it’s a little tricky to predict who’s going to gain weight.

— Ob/Gyn Ashley Brant, DO

Birth Control Shot

Advantages of the birth control shot

  • The birth control shot is safe and works well to prevent pregnancy.
  • The shot is required about four times a year. Compared to birth control pills, it may be easier for some women to manage the birth control shot since daily pills can be missed more easily.
  • Using the shot means you do not have to think about birth control when you want to have sex.
  • Many women who use the birth control shot have lighter periods or no periods at all and fewer menstrual cramps.
  • It is private. It is your choice if your partner knows about it.

Drawbacks of the birth control shot

  • The birth control shot does not protect against sexually transmitted diseases (STDs), including HIV, and may increase the risk of getting an STD if your sexual partner has an STD. Always use a condom to reduce the risk of STDs.
  • It requires a visit to a healthcare provider every 12 weeks.
  • It may take longer after stopping the shot to become pregnant, especially the longer you use the shot.
  • Using the shot continuously for more than two years may cause some thinning of a woman’s bones. However, normal bone growth returns when a woman stops taking the birth control shot.
  • Side effects of the birth control shot experienced by some women include breast tenderness, spotting or bleeding between periods, weight gain, nervousness, abdominal discomfort, and headaches. Let your healthcare provider know if you have any of these side effects.

Do Not Let “Depo-” Medications Be a Depot for Mistakes

Depo-Medrol vs. Depo-Provera

Several years ago, ISMP received a report of a similar mix-up, again leading to patient harm, but in this case, the patient was supposed to receive Depo-Provera but received Depo-Medrol in error. A 19-year-old woman went to a clinic to receive an injection of Depo-Provera for contraception, which was to be repeated every 12 weeks. After providing a negative pregnancy test, the young woman was mistakenly given an intramuscular injection of Depo-Medrol. The lot number of the vial of medication was recorded in her medical record. The woman returned in 12 weeks and reported a positive home pregnancy test. An ultrasound confirmed the pregnancy, with an estimated date of conception about 3 ½ weeks after her first injection. The error was uncovered when the documented lot number was found to be associated with Depo-Medrol.

In this case, Depo-Medrol and Depo-Provera had previously been stored in separate cabinets. However, a few days before the event, the medication cabinets had been consolidated, and the medications were stored alphabetically in bins. The stock in the consolidated cabinet had been labeled with Depo-Provera and Depo-Medrol, which were stored next to each other. Working with only a verbal order for the drug, the clinic staff had accidentally selected a vial of Depo-Medrol instead of the intended Depo-Provera.

Wrong strength Depo-Testosterone

ISMP has received reports regarding potential errors with Depo-Testosterone for which the wrong strength or volume of the drug might be administered to patients. This drug is available in two strengths: 100 mg/mL and 200 mg/mL. The 200 mg/mL strength is available in a 1 mL vial and a 10 mL vial. However, the vial sizes are extremely hard to differentiate when looking at the medication cartons (Figure 3).

Wrong route Depo-Medrol

In late 2015, a patient received 100 mg of Depo-Medrol IV. The route of administration was not specified on the written order given to the nurse, who assumed the drug should be administered IV, like the other medications the patient was receiving. The nurse did not recall seeing the statement, “Not for IV Use” on the back of the vial label; the statement is in a very small font size. Fortunately, the patient was not harmed. The reporting pharmacist found many case reports of similar errors published in the literature.

Other errors involving Depo-Medrol being administered IV instead of intramuscularly have resulted from mix-ups between SOLU-MEDROL (methylPREDNISolone sodium succinate) and Depo-Medrol, often due to stocking errors. Depo-Medrol’s milky white appearance rarely gives pause anymore before administration given the wide variety of other cloudy or opaque medications that are administered IV.

Aggregate reports

Analysis of aggregate data regarding mix-ups between Depo-Medrol and Depo-Provera between 1999 and 2015 identified 5 additional cases reported to FAERS and 4 more reported to the ISMP MERP database, for a total of 11 reports. One of the events occurred as recently as December 2015, although no harm occurred when the patient received an injection of Depo-Medrol instead of Depo-Provera. Date ranges for the reported errors were distributed evenly between 1999 through 2015; therefore, we did not find any trends in the occurrence of the errors over time. In most of the cases (n=7), Depo-Provera was the intended drug and Depo-Medrol was administered instead. The errors occurred in a variety of settings, so it is difficult to associate patterns of error within a specific clinical setting (e.g., clinic vs. hospital). Five of the reports identified the Pfizer Depo-Medrol 80 mg/mL vials, and 2 involved the Pfizer Depo-Provera 150 mg/mL vials (both distributed by Pharmacia & Upjohn, a division of Pfizer). In four of the 11 cases, both products were available as unit stock. This may have contributed to errors due to the similarities in the names. For example, confusion may have occurred if staff misread the correct drug name when stocking the drug product (i.e., stocked in the wrong bin) and then the wrong drug was selected prior to administration, leading to a medication error. Other than name similarity, none of the reports identified container labels or carton labeling similarities as a contributing factor.

Another analysis of aggregate data regarding IV administration of a “Depo-“ medication shows that the most frequent wrong route errors were associated with Depo-Medrol (n=11 out of 12 total IV administrations). In 5 of these cases, the route of administration was misunderstood, and Depo-Medrol was administered intravenously. In the remaining 6 cases, Depo-Medrol was administered in error when the order was for IV Solu-MEDROL. It should be noted that there is also a product named DEPO-ESTRADIOL (estradiol cypionate), although we have only one error report for this drug indicating that it was given by the IV route instead of intramuscular route of administration.

The recent close calls associated with Depo-Testosterone (n=2) were both caused by volume or strength confusion due to look-alike labeling and packaging.

Safe Practice Recommendations

Today, the “Depo-” naming convention would be a concern for FDA based on its proprietary name review criteria. However, when these drugs were first approved, the risk associated with this prefix was not considered. It would be very difficult to change the names of these products today—it may even make the risk of errors greater since these drug names are widely recognized. However, there are steps manufacturers, regulatory agencies, and healthcare practitioners can take to reduce the risk of potentially harmful mix-ups between these medications, strengths/container volumes, and routes of administration.

Manufacturers and regulatory agencies

Clarify labeling. Address the look-alike labels and packages of Depo-Testosterone as soon as possible. Most people look at the 1 mL and 10 mL vials and fail to realize that they are not the same.

Enhance warnings. Make warnings against IV use of depot products more prominent. The warnings should be clearly visible on the front label panel of cartons and vials, not on the back.

Healthcare practitioners

Keep vials apart. Separate the storage of Solu-MEDROL, Depo-Medrol, and Depo-Provera vials in the pharmacy and in all clinical settings where these drugs are stocked. Store only one medication in each bin or other storage container. Evaluate whether all three drugs need to be stocked in patient care units.

Differentiate the products. Consider stocking Depo-Provera in prefilled syringes for single patient use instead of single-dose vials. Depo-SubQ Provera 104 is available in single use 0.65 mL (104 mg) prefilled syringes for subcutaneous injections, and Depo-Provera 1 mL (150 mg) is available in prefilled syringes for intramuscular injections. Since Depo-Medrol is not supplied in prefilled syringes, this may increase differentiation between the two products, but only if staff know to expect Depo-Provera in a syringe. Thus, staff awareness is a necessary component of this differentiation strategy.

Limit access. Attempt to limit inventory of Depo-Testosterone to a single strength and vial size. Also evaluate which “Depo-” medications need to be stocked in patient care units, and limit access to those that can be dispensed as needed from the pharmacy.

Include auxiliary labels. Highlight or circle important information on labels to draw attention to it, or add an auxiliary label if necessary. For example, given the small font of the warning on Depo-Medrol vials, an auxiliary label that states, “IM Use Only” or “Intra-articular Use Only” may be required. For Depo-Testosterone labels, circle or point an arrow toward the total volume in each vial.

Express generic names safely. Use tall man letters when expressing the generic names of Depo-Medrol and Depo-Provera (i.e., methylPREDNISolone, medroxyPROGESTERone) to prevent confusion. When expressing generic names for Solu-MEDROL and Depo-Medrol, include the correct form of methylPREDNISolone (i.e., acetate, sodium succinate) to help differentiate the drugs.

Highlight the route. Always include the route of administration, easily visible in a prominent location, on orders and medication administration records.

Use barcode scanning. Implement barcode scanning to verify medications when stocking and restocking medications in automated dispensing cabinets, and prior to drug administration at the bedside as a method to help mitigate confusion that may lead to wrong drug medication errors. When used at the bedside, this technology confirms not only the drug but also the patient’s identity, dose, time, and dosage form of the medication being delivered. Track scanning compliance to ensure that staff is using the technology.

Increase staff awareness. Assess staff understanding of the term “depot,” and increase their understanding regarding why “Depo-” medications should not be administered IV. Be sure staff know the risk of confusion between “Depo-” products with similar names, such as mix-ups between Depo-Provera and Depo-Medrol, or the risk of errors related to labeling and packaging similarities with Depo-Testosterone.

Routine hormone injections into the buttocks of 320 men dramatically shrunk their sperm counts and prevented pregnancies during a year-long, early-phase trial, researchers reported Thursday.

The findings suggest that a future hormonal male contraceptive may one day be possible. However, the data also revealed high rates of side effects, such as acne and mood swings, suggesting much more work is needed before such a birth control method is realized.

“A male hormonal contraceptive is possible,” lead author Mario Festin, a medical officer with the department of reproductive health and research at the World Health Organization, told the Chicago Tribune. “We have to continue searching for or investigating the right drugs, and their combinations, with the highest efficacy and safety, and acceptability, with the least side effects.”

Earlier work showed that high doses of testosterone could rub out sperm counts in men, but they also raised concerning side effects. Cutting the dosage level with a steroid hormone known as progestogen, which activates the progesterone receptor, was a potential workaround.

In the new study, published in the Journal of Clinical Endocrinology and Metabolism, Dr. Festin and colleagues gave men, aged 18 to 45 injections into their bums once every eight weeks over the course of a 24 week “suppression” phase. The injections contained 200mg of progestogen and 1000mg of testosterone. By the end, nearly 96 percent of those remaining in the study (some dropped out) saw their sperm counts fall to less than 1 million per milliliter. (Normal levels can range from 15 to more than 200 million/mL.)

From there, 266 sperm-suppressed men moved into a “testing” phase for up to 56 weeks. All of the men were in monogamous, heterosexual relationships and, at this point of the trial, were asked to give up alternative forms of birth control. (Their female partners were also screened at the onset of the whole trial. They had to have no desire to have a child within a two-year time period but also be willing to accept a low risk of pregnancy.) The men kept getting shots every eight weeks and had their sperm-counts monitored.

During the testing phase, four women got pregnant and six men saw their sperm counts rebound. Counting the failure rate during the “suppression” phase, the overall failure rate of the hormone shots was 7.5 percent—i.e., the shots had a 92.5 percent success rate.

However, many of the men reported of side effects. Nearly half of the 320 men (46 percent) reported developing acne. Thirty-eight percent reported an increased sex-drive. Twenty-three percent had injection-site pain, and 17 percent had emotional disorders.

After the study was complete, five percent of men didn’t recover their sperm count levels in the year after their last injection.

Still, in the end more than 75 percent of participants said they’d be willing to use the contraception method in the future if it were available. The study’s authors concluded that the method was “relatively good,” but needed tweaking.

The National Health Service in England noted that condoms are still clearly the better bet, with a 98 percent effective rate when used properly.

Journal of Clinical Endocrinology and Metabolism, 2016. DOI: 10.1210/jc.2016-2141 (About DOIs).

The birth control shot (Depo-Provera) is a very effective method of birth control. It works best when you get the shot every 12 weeks.

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How effective is the birth control shot?

When used perfectly, the birth control shot effectiveness is more than 99%, meaning less than 1 out of every 100 people who use it will get pregnant each year. But when it comes to real life, the shot is about 94% effective, because sometimes people forget to get their shots on time. So, in reality, about 6 out of every 100 shot users will get pregnant each year.

The better you are about getting your shot on time, the better it will work. But there’s a very small chance that you could still get pregnant, even if you always get the shot on time.

If effectiveness is the most important thing to you when picking what birth control to use, you might want to check out IUDs and the implant. They’re the most effective kinds of birth control. But if you decide the shot is right for you, make sure you always get your follow-up shots on time.

What if I’m late getting my birth control shot?

If you get your shot late, you may not be protected from pregnancy — but it depends on how late you are. You can get your follow-up shots as early as 10 weeks after your last shot, or as late as 15 weeks after your last shot. But, if you get your shot more than 15 weeks after your last shot, you’ll need to use another method of birth control, like a condom, for the first week after getting your shot.

If you have vaginal sex without using a condom more than 15 weeks after your last shot, you should use emergency contraception. You may also need to take a pregnancy test before getting your next shot. The best way to prevent pregnancy while using the shot? Make sure you always get your shot on time, every time.

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Birth control pills (oral contraceptives) and the Depo-Provera shot are two hormonal methods of birth control. Both methods work by changing the hormone levels in your body, which prevents pregnancy, or conception. Differences between “the pill” and “the shot.”

Birth control pills are available as combination pills, which contain the hormones estrogen and progestin, or mini-pills that only contain progestin. In comparison to the Depo-Provera injection, which prevents pregnancy for three consecutive months.

Both methods of birth control are very effective in preventing pregnancy. Both the combination pill (if you take them as directed) and shot are up to 99% effective in preventing pregnancy. While the mini-pill is only about 95% effective in preventing pregnancy.

Both methods cause weight gain, and have other similar side effects like breast pain, soreness or tenderness, headaches, and mood changes. They may lead to decreased interest in sex in some women. There are differences between the other side effects of these methods (depending upon the method) that include breakthrough bleeding or spotting, acne, depression, fatigue, and weakness.

Both oral contraceptives and the Depo-Provera shot have health risks associated with them, such as, heart attack, stroke, blood clots, and cervical cancer. Birth control pills appear to increase the risk of cervical cancer. Talk with your OB/GYN or other doctor or health care professional about which birth control method is right for you.

Read more: Birth Control Pill vs. Shot (Depo-Provera): Similarities and Differences Article

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