Increase in POCS and obesity due to young-age use of progesterone...

Increase in POCS and obesity due to young-age use of progesterones?2 March 2006 Ellen C G Grant, physician and medical gynaecologist Kingston-upon-Thames, KT2 7JU, UK Send response to journal: Re: 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 Thanks, Mo! ;)