What causes increased appetite in patients on progesterone-only contraception (specifically medroxyprogesterone [Depo-Provera])? Does it affect carbohydrate metabolism? — TRACY BEADLE, APRN, BC, Nashville, Tenn.

Progestins like depot-medroxyprogesterone acetate (DMPA) are generally implicated in increased appetite through a direct hormonal effect. Though DMPA is reputed to increase appetite and cause weight gain in users, results from epidemiologic and randomized controlled studies vary. The only population documented to be at independent risk of weight gain while using DMPA is obese adolescents. As for glucose metabolism, the available data remain inconclusive, though there is some concern that progestins can decrease the number of insulin receptors. As the authors of a review state, “The effects of DMPA on fasting, half-hour, or one-hour postchallenge insulin measurements were varied and inconsistent” (Diabetes Care 2003;26:216-225; available at care.diabetesjournals.org/content/26/1/216.long, accessed November 15, 2010). DMPA is an appropriate contraceptive method for women at risk for diabetes and even for those with uncomplicated disease. More information is available from the CDC (available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a4.htm, accessed December 15, 2010).—Lisa Stern, APRN (147-9)

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