Increase in POCS and obesity due to young-age use of progesterones?
Professor Balen and colleagues write that PCOS is increasing because
more women are becoming obese.1 Progesterone use can cause rapid weight
gain and many adolescent girls therefore refuse to continue taking the
Pill.
In an attempt to cut the numbers of unplanned teenage pregnancies
more longer-acting forms of progesterone are being used. Unfortunately
depo medroxyprogesterone acetate (DMPA) caused significantly greater
weight gain with longer use in adolescent girls than the Pill. After 18
months obese girls gained 9 kg while non-obese girls gained 4 kg. The
authors considered that the potential contribution of DMPA to severe
obesity in adolescents is concerning.2 DMPA is reported to have no
inherent oestrogenic or androgenic effects, which suggests that weight
gain induced by DMPA is a progestogenic effect.
Use of progestogens can also increase the risk of PCOS. In the Walnut
Creek Contraceptive Drug Study significantly more oral contraceptive users
aged 18-39 had non-functioning ovarian cysts than never users (50/7506
with 4/2556).3 Fewer functioning cysts would be expected in users of
progestogens designed to stop ovaries functioning. Use of fertility drugs
can also cause ovarian cysts.
Progestogen use also increases the risk of diabetes. In a study of
210 women taking 150 µg levonorgestrel and 30 µg ethinyl oestradiol, 60%
had stopped by 15 months and only 8% were current users at 3 years.
Glucose tolerance tests deteriorated into the diabetic rangein 6 women but
improved when oral contraceptives were stopped for side-effects including
weight gain.4
It is reasonable that obese women with PCOS are not given fertility
drugs risking more ovarian cyst development and further weight gain.
Advice about weight reducing high protein/low allergy diets and life-style
changes is preferable.
1 Balen AH, Dresner M, Scott EM, Drife JO. Should obese women with
polycystic ovary syndrome receive treatment for infertility? BMJ 2006;
332: 434-435.
2 Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and
nonobese adolescent girls initiating depot medroxyprogesterone, oral
contraceptive pills, or no hormonal contraceptive method. Arch Pediatr
Adolesc Med. 2006; 160: 40-5.
3 Ramcharan S. Pellegrin RR, Hsu J-P, et al. Walnut Creek
Contraceptive Drug Study 1981; Center for Population Research Monograph;
Vol 111: P 162.
4 Wynn V. Effects of duration of low-dose oral contraceptive
administration on carbohydrate metabolism. Am J Obstet Gynecol 1982: 142:
739-43.
Rapid Response:
Increase in POCS and obesity due to young-age use of progesterones?
Professor Balen and colleagues write that PCOS is increasing because
more women are becoming obese.1 Progesterone use can cause rapid weight
gain and many adolescent girls therefore refuse to continue taking the
Pill.
In an attempt to cut the numbers of unplanned teenage pregnancies
more longer-acting forms of progesterone are being used. Unfortunately
depo medroxyprogesterone acetate (DMPA) caused significantly greater
weight gain with longer use in adolescent girls than the Pill. After 18
months obese girls gained 9 kg while non-obese girls gained 4 kg. The
authors considered that the potential contribution of DMPA to severe
obesity in adolescents is concerning.2 DMPA is reported to have no
inherent oestrogenic or androgenic effects, which suggests that weight
gain induced by DMPA is a progestogenic effect.
Use of progestogens can also increase the risk of PCOS. In the Walnut
Creek Contraceptive Drug Study significantly more oral contraceptive users
aged 18-39 had non-functioning ovarian cysts than never users (50/7506
with 4/2556).3 Fewer functioning cysts would be expected in users of
progestogens designed to stop ovaries functioning. Use of fertility drugs
can also cause ovarian cysts.
Progestogen use also increases the risk of diabetes. In a study of
210 women taking 150 µg levonorgestrel and 30 µg ethinyl oestradiol, 60%
had stopped by 15 months and only 8% were current users at 3 years.
Glucose tolerance tests deteriorated into the diabetic rangein 6 women but
improved when oral contraceptives were stopped for side-effects including
weight gain.4
It is reasonable that obese women with PCOS are not given fertility
drugs risking more ovarian cyst development and further weight gain.
Advice about weight reducing high protein/low allergy diets and life-style
changes is preferable.
1 Balen AH, Dresner M, Scott EM, Drife JO. Should obese women with
polycystic ovary syndrome receive treatment for infertility? BMJ 2006;
332: 434-435.
2 Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and
nonobese adolescent girls initiating depot medroxyprogesterone, oral
contraceptive pills, or no hormonal contraceptive method. Arch Pediatr
Adolesc Med. 2006; 160: 40-5.
3 Ramcharan S. Pellegrin RR, Hsu J-P, et al. Walnut Creek
Contraceptive Drug Study 1981; Center for Population Research Monograph;
Vol 111: P 162.
4 Wynn V. Effects of duration of low-dose oral contraceptive
administration on carbohydrate metabolism. Am J Obstet Gynecol 1982: 142:
739-43.
Competing interests:
None declared
Competing interests: No competing interests