Modern Metabolic Health with Dr. Lindsay Ogle, MD

Birth Control, Weight, And GLP-1s

• Lindsay Ogle, MD

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We explain how common birth control methods affect weight, why LARCs are often the most reliable and weight neutral choice, and how tirzepatide can reduce pill effectiveness during dose changes. We also lay out safer options for higher BMI, emergency contraception that still works well, and practical backup strategies.

• weight gain risk with depot medroxyprogesterone
• modern low-dose pills mostly weight neutral with PCOS benefits
• patch and ring similar efficacy and side effect profile to pills
• LARCs as effective, reversible, weight neutral options
• condoms for STI protection and pregnancy prevention
• Phexxi as user-controlled non-hormonal option
• emergency contraception timing and Ella for higher BMI
• estrogen and clot risk factors to review with a clinician
• tirzepatide reducing oral contraceptive absorption during titration
• backup methods and planning around GLP-1 dose changes

If you found this helpful, please share with somebody who may benefit from this information, as well as subscribing so you don't miss next week's episode. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health.


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Dr. Lindsay Ogle:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. I want to take the time today to uncover the truths, the facts about birth control options, what are the impacts on weight, and if you're using a GLP1, what to be aware of to ensure that you are protected against pregnancy if that is not something that you are hoping for. My name is Dr. Lindsay Ogle and I'm a board-certified family medicine and obesity medicine physician. And I went into family medicine because I wanted to treat patients in the outpatient setting, and I really wanted some really solid foundational knowledge about women's health and reproductive health. And I'm so thankful for that. During my training, I was able to take care of patients throughout their lifespan from newborn babies to the end of life. And I treated both men and women, and I helped women who were pregnant in their prenatal care and helped deliver babies at the hospital and take care of both baby and mom at the hospital, which was a wonderful experience and taught me a lot. I brought to my primary care practice, and then even now to my obesity medicine practice. And I want to share as much as I can with you that I have learned. Back in early 2023 on YouTube, I released another video going over all of the or most of the birth control options in greater detail than I will have time to review today. Today I'm focusing on birth control and its impact on weight and the interplay with GLP1 medications. But if you want to learn more specifics about these types of birth control, go back to my YouTube channel, the beginning of 2023, and check out that episode to learn more about the birth control options available to you. I will also link one of my all-time favorite websites, bedsider.org, where you can compare all birth control options and again find the one that might be best suited for you. We're gonna talk about birth control options that negatively impact weight that tend to make people gain weight. We'll talk about weight neutral options, and then we will talk about the impact of GLP1 medications on birth control. So, first with weight positive birth control options. So the one by far that is associated with weight gain while on this birth control is the depot prevera or the shot, sometimes it's called. This is a progesterone shot that is given three months every three months. Um, usually just give it in the arm. This is a very effective form of birth control and can be very convenient. It tends to be popular in younger patients because they don't have to remember taking a birth control pill every day and it maintains its effectiveness as long as you go for your appointments every three months. But it is very well known to cause weight gain. It doesn't happen for everybody, but for I would say a majority of people do gain weight while on Depo Pervera. So if weight is a concern for you, I would not recommend this birth control option. The next category of birth control options that are sometimes associated with weight gain, but again, not everybody. And this option is usually more minimal that I see in clinical practice is birth control pills. Now it is important to know that there are dozens of birth control pills to choose from. Between you and your doctor, you can choose what is best for you. They are ones that have estrogen and progesterone, that is most commonly prescribed. And then there's progesterone-only birth control pills. Over the years, we have found that we are able to use lower and lower amounts of hormones in these birth control pills and they maintain their effectiveness at preventing pregnancy. And this has helped to decrease the side effects, including weight gain, with these medications. These medications can be really helpful for people who have PCOS because it can regulate hormones, it can help with the acne that comes with PCOS or just hormonal acne in general, and it can help regulate cycles and make cycles predictable. Again, on average, birth control pills are fairly weight neutral, but they tend to have a little bit of weight gain for some people. Similar to the birth control that is giving estrogen and progesterone, we also have those hormones available in a formulation that through the patch that will give you the medication through your skin, or a vaginal ring that will provide the medication through that route. The patch is either weekly or monthly, and the vaginal ring is either monthly or annually. So these are other options that tend to be weight neutral, but some people may notice some weight gain when taking these birth control options. So on to the weight neutral birth control options. First, I'm gonna start with my favorite category of birth control, which is LARCS, long-acting reversible contraception. The reason that I love these birth control options and many family medicine and OBGYN doctors really like these medications is that they last for many years. So you do not have to remember to take your medication every day. They are extremely effective, close or even surpassing, you know, tubal ligation, having your tubes tied or a vasectomy, but you have an option to reverse them, take them out whenever you desire. So they are extremely effective, weight neutral, and reversible. And so they are wonderful options. What are they? They are the IUDs or Nexonon. There are two categories of IUDs. An IUD stands for interuterine device. It is a T-shaped device that is placed inside the uterus, and there are the hormonal options, which is progesterone only, and then there's the non-hormonal option, which is a copper IUD. These last anywhere from 5 to 12 years, and depending on which one you and your doctor choose to utilize. The next blanon is an implant that goes in your arm, and this lasts for three years. There is some evidence, maybe it's closer to five, but talk to your doctor about what is recommended at the time of insertion or removal. And again, check out my video, my YouTube video back in early 2023 to find out more nuances about these options, but they are wonderful options for preventing pregnancy and even managing heavy periods. Another option of birth control is in the moment devices. So this is either condoms or fexy. And condoms are well known, they are the best option and really the only option for preventing sexually transmitted infections, but they also protect against pregnancy. But FEXI is less known. It's a prescription that is a gel, and this can be placed prior to sex to keep the vagina's pH in a in its healthy, you know, natural place, which will in turn prevent the sperm from being mobile and prevent that the sperm from ever reaching the egg. And so it's a great non-hormonal option that you know the women, the woman can control and is very effective when used appropriately. So lesser known option, but wonderful to try, especially if you're looking for a non-hormonal option. And then condoms are the only option that will both protect against pregnancy and sexually transmitted infections. Next, we have our emergency contraceptions. These are available over-the-counter in some areas or by prescription. Emergency contraception can be used up to five days after unprotected sex and still be extremely effective. It's important to know that the over-the-counter option plan B is not as effective in women who are overweight or have obesity. And so if that is you and this is your form of birth control or you have it as a backup option, ask for prescription strength, um, emergency contraception. The brand name for that is Ella. If you are not wanting to use any of these options, then fertility tracking is available. However, this does take some effort on the part of the patient and involves monitoring body temperature andor cervical mucus. And there is more information about how to accurately do that at bedsider.org. And if you are looking for a more permanent option, there is tubal ligation or getting your tubes tied for women and vasectomy for men. So those are all of the birth control options that are available to you. This is an individualized choice, and this is something that can change as you get older or enter different phases of your life. It can be a fluid choice about which contraception is best for you. So finding a doctor that is willing to work with you and listen to what your goals are is ideal. And if you are living in a larger body, remember what I mentioned about the emergency contraception, that plan B may not be as effective. And also it's important to know that the option for at the patch may also not be as effective. And then finally, for my patients living in larger bodies, they are at higher risk for developing blood clots. And so we need to be a little bit more careful whenever we are prescribing estrogen to these patients. This does not mean that you are not able to take anything with estrogen. You may still be able to safely take birth control pills or any form that has estrogen in it or otherwise low risk. If you have a personal history of a blood clot, if you have a family history of blood clots, if you have migraines with aura, if you have a clotting disorder, if you are a smoker, if you are over 35, all of these things add up and increase your risk of developing clots and decrease the safety of using estrogen. So talk about your clotting risk with your doctor whenever you are studying a birth control and make sure that it is something that is safe for you to take. And then finally, consideration of birth control when taking a GLP1. And the GLP1 medications that we are specifically worried about are trisepatide products. So this would be a brand name Zeppound or Monjaro. And studies show that the way that this medication is working on the stomach decreases the absorption of birth control pills. And so when you are starting trisepatide, Zepbound or Monjaro, and then every time you're titrating up on your dose for the four weeks after that, and if you are on an oral birth control pill, you need a backup form of contraception. So that can be anything else that we mentioned today. It can be condoms, Vexy, an IUD, emergency contraception. It can be fertility tracking if you have regular cycles. It can be a patch or an Uber rein. It could be depot, but I wouldn't recommend that because of the weight gain associated with it. But you have lots of different options to fit what is best for you. But anybody who is on trusepatite and has a potential for becoming pregnant should be aware of that possibility. We don't see the same effect on semaglutide or wiggle or ozemphic. Um, it seems to be specific to trusepatide. I hope you found this review regarding birth control options, weight gain associated GLP1 medications and consideration in people who are living in larger bodies to be helpful. If so, please share with somebody who may benefit from this information, as well as subscribing so you don't miss next week's episode. I'll see you then. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.