Obese Women On Depo-Provera May Increase Diabetes Risk, Study Shows

Highlights of this news release:

-Obese women became less effective at lowering their blood sugar levels after taking depot medroxyprogesterone acetate, a progestin-only contraceptive sold under the name Depo-Provera and administered by injection.
-The study consisted of 15 women (5 normal weight, 10 overweight) from the Women’s and Children’s Hospital of the Los Angeles County+USC Medical Center.
-Despite the small sample size of the study, researchers say the results may help guide health care providers who counsel obese women about contraception.

Full news release is below.

LOS ANGELES — Obese women may increase their risk for developing type 2 diabetes by using the birth control shot marketed as Depo-Provera, according to a small study by researchers from the Keck School of Medicine of the University of Southern California (USC).

The first to examine the drug’s effect on obese women, the study suggests that other forms of long-term birth control, namely intrauterine contraception, may be a more effective choice for overweight women.

“Obese women have a higher risk of developing type 2 diabetes and other cardiovascular diseases. They also have an increased risk for pregnancy complications. We don’t want to prescribe a contraceptive that will push these women from borderline hyperglycemic to diabetic,” said Penina Segall-Gutierrez, M.D., assistant professor of clinical obstetrics and gynecology, and family medicine at the Keck School of Medicine.

Segall-Gutierrez led the study, “Deterioration in cardiometabolic risk markers in obese women during depot medroxyprogesterone acetate use,” which appears in the January 2012 issue of the journal Contraception.

Depot medroxyprogesterone acetate (DMPA) is a progestin-only contraceptive that is administered by injection every three months. DMPA and other progestin-only methods are the only hormonal contraceptives recommended by the American Congress of Obstetricians and Gynecologists for obese women older than 35. Because most oral contraceptives increase the risk for developing blood clots, they are not recommended for obese women, who are more susceptible to clots than normal-weight women.

For the study, researchers compared the insulin sensitivity, body mass index, blood sugar and cholesterol levels of 15 women (five of normal weight and 10 who were overweight) before injection and 18 weeks after. The participants, recruited over a seven-month period at the Women’s and Children’s Hospital of the Los Angeles County+USC Medical Center, received an injection of DMPA upon acceptance into the study and another 12 weeks later.

The researchers found that both normal-weight and obese women became more insulin resistant after receiving DMPA, which means that their bodies became less effective at lowering blood sugars. However, it appears that the normal-weight women were able to compensate by producing more insulin. The data suggest that weight gain, an increase in insulin resistance, or both play a role in the increased susceptibility for diabetes among obese women who use DMPA.

Future research should observe effects over a longer period of time and compare how obese women using non-hormonal contraception fare to those using DMPA, Segall-Gutierrez said. Despite the small sample studied, Segall-Gutierrez said the results are useful for clinicians who counsel obese women about contraception.

“Depo is used by 6 percent of American women, but it’s more popular than the intrauterine device or implant,” she said. “These are other forms of contraception that don’t increase one’s risk for diabetes.”

Co-authors include Anny H. Xiang, Ph.D.; Richard M. Watanabe, Ph.D.; Enrique Trigo; Frank Z. Stanczyk, Ph.D.; Xinwen Liu; Ronna Jurow, M.D.; and Thomas A. Buchanan, M.D., all of the Keck School of Medicine. The research was funded by an anonymous donor.

Contact: Alison Trinidad at (323) 442-3941 or alison.trinidad@usc.edu

Article cited:
Segall-Gutierrez, P., Xiang, A.H., Watanabe, R.M., Trigo, E., Stanczyk, F.Z., Liu, X., Jurow, R. & Buchanan, T.A. (2012). Deterioration in cardiometabolic risk markers in obese women during depot medroxyprogesterone acetate use. Contraception, 85(1), 36-41. Published online June 11, 2011; doi:10.1016/j.contraception.2011.04.016