The link between contraceptives and weight gain has long been a source of anxiety, debate, and confusion. For some women, it is a lived experience; for others, it is fear that influences their reproductive choices long before they even step into a clinic.
But what does the science say, and why do some women gain weight while others don’t?
To clear the air, we turned to Dr Dulcy Rakumakoe, a medical doctor and CEO of Quad Care Clinics, who has become a widely trusted voice in providing accessible and compassionate healthcare.
With her insight, we unpack the truths, the myths, and the empowering strategies every woman deserves to know.
While many women believe that contraceptives automatically cause weight gain, research shows the picture is more nuanced.
According to Rakumakoe, most contraceptives cause little to no long-term weight gain.
However, some hormones can trigger increased appetite, temporary water retention, and mild metabolic changes.
The contraceptive most strongly associated with weight gain is Depo-Provera, commonly known as the injection. Some women using hormonal implants or certain birth control pills may also report weight changes.
On the other hand, intrauterine devices (IUDs), especially non-hormonal copper IUDs, have almost no impact on weight.
“Hormonal contraceptives work by adjusting levels of oestrogen and progesterone.
“These hormones affect not just fertility but also how the body retains water, stores fat, and regulates hunger.
“What most women experience in the beginning is bloating or water retention, not actual fat gain,” Rakumakoe explains.
Over time, increased appetite can lead to fat gain if eating patterns change significantly.
Biology plays a huge role. Each woman’s hormonal balance, metabolism, and genetic makeup influence how her body responds to contraceptives. You may be more likely to experience weight changes if you already have issues with water retention, insulin resistance, PCOS or hormonal imbalance, a sedentary lifestyle and stress/emotion-triggered eating
Starting a new contraceptive does not mean losing control over your body.
Small, consistent lifestyle choices can help prevent or manage weight changes during the adjustment phase, usually the first three–six months.
A hormone-friendly diet includes high-fibre foods, lean protein, fermented foods like yoghurt or kombucha, fruits and vegetables, whole grains, and healthy fats such as avocado and nuts.
A balanced exercise routine is key; strength training boosts metabolism and builds muscle, and cardio such as daily movement like walking or stretching is important.
She encourages women to openly discuss concerns with their healthcare provider.
Questions to ask your doctor:
Which methods have the fewest hormonal side effects?
How do hormone levels differ across contraceptives?
Are there non-hormonal options suitable for me?
Do I have any metabolic or hormonal conditions to consider?
What should I expect in the first few months?
While mild bloating or fluid retention is normal early on, some symptoms may indicate an underlying issue unrelated to contraceptives, but the following may point to thyroid issues, insulin resistance, depression, or another medical condition.
- Rapid weight gain (over 3–5 kg in a short period)
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Severe swelling
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Unexplained fatigue
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Hair loss
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Intense hunger or mood swings.
You don’t need an extreme routine to stay in control. Rakumakoe recommends simple habits:
- Drink enough water
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Move your body daily
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Sleep well
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Reduce your processed foods diet
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Listen to your emotional and mental wellbeing
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Stay consistent with your routines
“Small, everyday actions add up to big improvements.
“Contraceptives should empower women, not frighten them. With the right information and support, you can make a confident choice about your reproductive health without feeling overwhelmed by myths or fear of weight gain.”
