Debunking Myths About Birth Control, Weight, and GLP-1 Medications

There is a lot of misinformation about birth control on social media and in everyday conversations. In this post, I want to lay out the facts about how different birth control options can affect weight and overall health, explain what to know if you’re using GLP-1 medications, and offer practical guidance to help you choose a method that fits your life and goals.

A quick note about my background

I’m Dr. Lindsay Ogle, a family medicine and obesity medicine physician. I chose family medicine because I wanted to care for patients in the outpatient setting and build a solid foundation in women’s health and reproductive health. During training, I cared for patients across the lifespan—from newborns to older adults—and I learned a great deal about pregnancy, postpartum care, and how to integrate these experiences into ongoing primary care and obesity medicine. I’ve shared more information birth control options in a YouTube video from early 2023, and you can revisit that for more details. I also encourage you to explore Bedsider.org, a trusted resource that lets you compare all birth control options in one place.

Birth control options and weight: what tends to affect weight

Options that can be associated with weight gain:

• The Depo-Provera shot (medroxyprogesterone acetate): Given every 3 months, usually in the arm. It’s highly effective and convenient, particularly for younger patients who don’t want daily pills. However, it is well known for weight gain in a substantial proportion of people. If weight gain is a concern for you, Depo-Provera may not be the best choice.
• Combined oral contraceptives (estrogen + progestin) and the progestin-only pill: There are many formulations. Some can be associated with mild weight gain for some people, though this is not universal.
• Transdermal patch and vaginal ring: These deliver hormones through the skin or vaginally. They are generally weight-neutral for many people, but some may notice weight changes.

Weight-neutral options:

• Long-acting reversible contraception (LARC): This category includes intrauterine devices (IUDs) and implants which are highly effective, reversible, and typically weight-neutral.
  • Progesterone IUDs (Mirena, Kyleena, Liletta, and Skyla)
    • effective for 5-8+ years
  • Copper (non-hormonal) IUDs
    • effective for 12+ years
  • Nexplanon (implant in the arm)
    • effective for 3–5 years
• Condoms: only option that protect against sexually transmitted infections (STIs)
• Phexxi: prescription non-hormonal vaginal gel that helps maintain natural pH and reduces sperm mobility
• Emergency contraception
  • Plan B (levonorgestrel) is available over the counter in many places, but can be less effective in individuals with higher body weight or obesity.
  • Prescription-strength options (e.g., Ella, ulipristal acetate) may be more effective for people with higher body weight.
• Fertility tracking (natural family planning): if you’re motivated, diligent, and have a regular menstrual cycle, then fertility awareness methods can work. They require consistent tracking of body temperature, cervical mucus, and other cues. Bedsider.org provides practical guidance on how to do this correctly.
• Permanent sertilization: for those who are sure they do not want future pregnancies.
  • Tubal ligation for women
  • Vasectomy for men

GLP-1 medications and birth control

When you’re on GLP-1 therapy, it’s important to coordinate contraception with your prescribing clinician because GLP-1 medications have not been proven safe during pregnancy.

Importantly, tirzepatide products (Zepbound and Mounjaro) have data suggesting that they can reduce the absorption of oral birth control pills during initiation and dose-titration. If you are starting tirzepatide or increasing your dose and you rely on an oral birth control pill, then you should use a backup contraception method for the next four weeks. This effect on oral birth control pills does not appear to be the same for other GLP-1 medications such as semaglutide (Ozempic or Wegovy).

Backup options include:
- Condoms
- Phexxi
- Long-acting reversible methods (IUDs, implants)
- Emergency contraception
- Fertility tracking
- A contraceptive patch or vaginal ring
- The depo shot (though weight gain concerns apply)

Important safety considerations when taking birth control, especially for people in larger bodies

Estrogen-containing methods (many combined pills, patches, rings) can slightly increase the risk of blood clots, particularly in people with additional risk factors -- which include: personal or family history of blood clots, migraines with aura, clotting disorders, smoking, age (over 35), and any history of cancer or cardiovascular disease. If you have risk factors for clots, your clinician might steer you toward non-estrogen methods or carefully monitor estrogen-containing options.

 

Practical guidance: how to choose the right method for you

1. Start with your goals: Do you want long-term protection without daily pills? Is avoiding weight gain important? Do you need contraception that also helps with acne or heavy periods?
2. Consider your lifestyle and preferences: Do you want a “set-it-and-forget-it” method (IUD/implant) or are you comfortable managing a daily or weekly regimen?
3. Talk with a clinician who will listen and tailor recommendations to you. Birth control is highly individualized, and a fluid approach—adapting to life stages, weight changes, or other health goals—is common and appropriate.
4. Resources to help you compare: Bedsider.org is a widely used, user-friendly resource for comparing birth control options based on your goals and medical history.
5. If you’re using GLP-1 therapy: plan contraception with your healthcare team and ensure you have a reliable method that aligns with your fertility goals and medication plan. Specifically, if you’re using tirzepatide products, be aware of the four-week titration period during which you should use backup contraception if you rely on oral birth control.

A closing note

Choosing birth control is a highly individual decision. It can be fluid as you move through different life stages, and it should be guided by safety, efficacy, and your personal goals. If you’re unsure where to start, a conversation with your clinician can help you map out options that are both effective and aligned with your health priorities.

 

Disclaimer: This blog is for educational purposes only and does not substitute for personalized medical advice. If you have risk factors for blood clots, a history of cardiovascular disease, or other medical concerns, please discuss them with a qualified healthcare professional.