Do IUDs cause weight gain. What are the potential side effects of Skyla and other IUDs. How do hormonal and copper IUDs differ in terms of weight-related impacts. What factors contribute to weight changes during reproductive years.

Types of IUDs and Their Mechanisms

Intrauterine devices (IUDs) are highly effective forms of reversible contraception. There are two main types of IUDs available:

Copper IUDs

The copper IUD, such as ParaGard, is a non-hormonal option that works by creating an inflammatory reaction in the uterus. This reaction is toxic to sperm, thereby preventing pregnancy. Copper IUDs can remain effective for up to 10 years before requiring replacement.

Hormonal IUDs

Hormonal IUDs, like Mirena and Skyla, release progestin into the uterus. This hormone thickens cervical mucus, thins the uterine lining, and may prevent egg release. Skyla lasts up to 3 years, while Mirena can be effective for up to 5 years.

Common Side Effects of IUDs

While IUDs are generally safe and effective, they can cause various side effects. It’s important to understand these potential effects when considering your contraceptive options.

Copper IUD Side Effects

• Anemia
• Backaches
• Cramps
• Vaginitis
• Painful intercourse
• Irregular bleeding
• Heavy menstrual periods
• Severe menstrual pain
• Vaginal discharge

Notably, weight gain is not listed as a side effect of copper IUDs.

Hormonal IUD Side Effects

• Changes in menstrual bleeding patterns
• Missed periods
• Acne
• Depression
• Heavy menstrual bleeding
• Headaches, including migraines
• Potential weight gain

The Truth About IUDs and Weight Gain

Weight gain is a common concern among those considering or using IUDs. But what does the evidence say about this relationship?

Copper IUDs and Weight

Research suggests that copper IUDs do not contribute to weight gain. The National Collaborating Centre for Women’s and Children’s Health reviewed multiple studies and found no evidence linking copper IUD use to weight changes.

Hormonal IUDs and Weight

Hormonal IUDs, including Skyla, list weight gain as a potential side effect. However, the impact appears to be minimal. A 2020 study comparing weight gain among users of hormonal IUDs, copper IUDs, and birth control implants found that hormonal IUD users gained an average of 0.72 kg (about 1.59 lbs) after 12 months of use.

Factors Contributing to Weight Changes During Reproductive Years

While contraceptive methods are often blamed for weight gain, it’s crucial to consider other factors that may contribute to weight changes during reproductive years:

1. Natural aging process
2. Changes in metabolism
3. Lifestyle factors (diet, exercise habits)
4. Hormonal fluctuations
5. Stress levels
6. Sleep patterns
7. Medications

Studies indicate that most individuals tend to gain weight during their reproductive years, regardless of their chosen birth control method. This suggests that weight changes often attributed to contraceptives may be part of a broader trend.

Managing Weight and Overall Health

Maintaining a healthy weight is an important aspect of overall health. The U.S. Department of Health and Human Services reports that more than 66 percent of women in the United States have overweight or obesity. This statistic underscores the importance of adopting healthy lifestyle habits, regardless of contraceptive choice.

Tips for Maintaining a Healthy Weight

• Balance calorie intake with energy expenditure
• Engage in regular physical activity
• Adopt a balanced, nutritious diet
• Get adequate sleep
• Manage stress levels
• Stay hydrated
• Monitor portion sizes

Choosing the Right Contraceptive Method

When selecting a contraceptive method, it’s essential to consider various factors beyond potential weight effects. These may include:

• Effectiveness in preventing pregnancy
• Duration of protection
• Convenience of use
• Hormonal vs. non-hormonal options
• Potential side effects
• Personal health history
• Future fertility plans

If you’re concerned about weight gain or any other side effects related to your chosen contraceptive method, it’s crucial to discuss these concerns with your healthcare provider. They can help you explore alternative options that may better suit your individual needs and preferences.

Beyond Contraception: IUDs and Sexual Health

While IUDs are highly effective at preventing pregnancy, it’s important to note that they do not protect against sexually transmitted infections (STIs). For comprehensive sexual health protection, consider the following:

• Use barrier methods like condoms in addition to IUDs
• Get regular STI screenings
• Communicate openly with sexual partners about sexual health
• Stay informed about safe sex practices

By combining effective contraception with STI prevention methods, you can take a holistic approach to your sexual and reproductive health.

Monitoring and Managing IUD Side Effects

If you choose to use an IUD, it’s important to be aware of potential side effects and know when to seek medical attention. Here are some guidelines:

When to Contact Your Healthcare Provider

• Severe abdominal pain or cramping
• Unusually heavy bleeding
• Fever or chills
• Foul-smelling vaginal discharge
• Inability to feel IUD strings
• Suspected pregnancy

Regular check-ups with your healthcare provider can help ensure that your IUD is properly positioned and functioning as intended. These visits also provide an opportunity to discuss any concerns or side effects you may be experiencing.

The Bigger Picture: Contraception and Body Image

Concerns about weight gain associated with contraceptives often reflect broader societal pressures and body image issues. It’s important to approach these concerns with a balanced perspective:

Challenging Weight Stigma

Weight stigma can negatively impact mental and physical health. Recognizing that bodies come in diverse shapes and sizes is crucial for fostering a healthy relationship with your body.

Focusing on Health, Not Just Weight

Rather than fixating solely on weight, consider overall health markers such as energy levels, sleep quality, and emotional well-being when evaluating the impact of your contraceptive method.

Seeking Support

If concerns about weight or body image are significantly impacting your quality of life, consider seeking support from a mental health professional or a support group focused on body acceptance and health at every size.

Future Directions in Contraceptive Research

As our understanding of reproductive health evolves, ongoing research continues to explore the relationship between contraceptives and various health outcomes, including weight. Some areas of focus include:

• Developing new contraceptive methods with fewer side effects
• Investigating the long-term impacts of different contraceptive options
• Exploring personalized approaches to contraception based on individual health profiles
• Examining the intersection of contraception, weight, and other health factors

Staying informed about these developments can help you make more educated decisions about your reproductive health in the future.

Making Informed Decisions About Contraception

Choosing a contraceptive method is a personal decision that should be based on a comprehensive understanding of available options, potential side effects, and individual health needs. Here are some steps to help you make an informed decision:

1. Educate yourself about different contraceptive methods
2. Consult with a healthcare provider to discuss your options
3. Consider your lifestyle, health history, and future family planning goals
4. Weigh the potential benefits and risks of each method
5. Be open to trying different options to find what works best for you

Remember that what works well for one person may not be the best choice for another. It’s okay to change methods if you’re not satisfied with your current contraceptive option.

Empowering Yourself Through Knowledge

Understanding the facts about IUDs, their potential side effects, and their relationship to weight can help you make more informed decisions about your reproductive health. Here are some key takeaways:

• Copper IUDs are not associated with weight gain
• Hormonal IUDs may contribute to minimal weight gain, but the effect is generally small
• Weight changes during reproductive years are common and often unrelated to contraceptive use
• Overall lifestyle factors play a significant role in weight management
• Open communication with healthcare providers is crucial for addressing concerns and managing side effects

By staying informed and proactive about your health, you can make choices that align with your personal goals and values, ensuring that your contraceptive method supports your overall well-being.

IUDs and Weight Gain: Is There a Connection?

IUDs and Weight Gain: Is There a Connection?

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Medically reviewed by Valinda Riggins Nwadike, MD, MPH — By Natalie Silver — Updated on May 5, 2023

Unintentional weight gain likely has more to do with the natural aging process and your overall lifestyle than your choice of birth control.

An IUD is one form of contraceptive used by people who menstruate. It’s a small device that your doctor inserts into your uterus. It’s one of the most effective methods of reversible birth control.

Two forms of IUDs are available:

Copper IUDs

The copper IUD (ParaGard) is a plastic, T-shaped device with copper wire wrapped around it. It creates an inflammatory reaction in your uterus, which is toxic to sperm. This helps prevent pregnancy. The device lasts up to 10 years before you need to replace it.

The copper IUD may cause side effects, such as:

• anemia
• backaches
• cramping
• vaginitis
• painful sex
• bleeding between periods
• heavy bleeding during periods
• severe menstrual pains
• vaginal discharge

Weight gain isn’t a listed side effect of the copper IUD.

Hormonal IUDs

Hormonal IUDs such as Mirena and Skyla are plastic T-shaped devices that release the hormone progestin into your uterus.

This thickens your cervical mucus to prevent sperm from reaching and fertilizing your eggs. The hormone also thins your uterine lining and helps prevent your eggs from being released.

The Skyla IUD lasts up to 3 years before you need to replace it, and the Mirena IUD can last for up to 5 years before it needs to be replaced.

Hormonal IUDs may cause side effects, such as changes in your menstrual bleeding and missed periods. Other side effects include:

• acne
• depression
• heavy bleeding during menstruation
• headaches, such as migraines

Hormonal IUDs also list weight gain as a possible side effect.

One 2020 study compared weight gain with the hormonal IUD, the copper IUD, and the birth control implant among a large group of racially diverse women. The hormonal IUD showed that hormonal IUD users gained about 0.72 kg (about 1.59 lbs) on average after 12 months.

This suggests that hormonal IUDs could contribute to low levels of weight gain. It should be noted that weight gain can have many causes and that more research needs to be done.

If you choose to use an IUD, your doctor will have to insert it. Contact your doctor immediately if you experience any side effects after the IUD is inserted.

IUDs don’t prevent the spread of sexually transmitted infections (STIs). You should use other barrier methods, such as condoms, to protect yourself and your partner from STIs.

It’s commonly assumed that using certain contraception methods leads to weight gain. However, studies indicate that most people tend to gain weight during their reproductive years, regardless of their chosen birth control methods.

The National Collaborating Centre for Women’s and Children’s Health reviewed several studies on weight gain and copper IUDs. It found no evidence that IUD use affects weight.

According to the National Center for Biotechnology Information, hormonal forms of birth control probably won’t cause you to gain a lot of weight either.

If you think you’ve gained weight because of your hormonal contraceptive, talk to your doctor. There are many forms of contraceptives available.

Managing a healthy weight for you is a lifelong endeavor. More than 66 percent of women in the United States have overweight or obesity, reports the U.S. Department of Health and Human Services (HHS).

Doing what you can to maintain a healthy-for-you weight and avoid significant weight gain or loss is important to your overall health.

If you’d like to lose weight, avoid eating more calories than you burn each day. Follow these tips to have a balanced and nutrient-dense diet:

• Eat a variety of fruits, vegetables, whole grains, low-fat dairy products, and lean sources of protein.
• Avoid high-fat meats, fried foods, and sweets.
• Drink plenty of water, and reduce consumption of high-calorie beverages such as soda.

You should avoid fad and elimination diets that deprive you of vitamins, minerals, and other nutrients you need.

To achieve and maintain a healthy weight, you also need to get regular physical exercise. For optimum health, your weekly exercise routine should include:

• aerobic exercises, such as running, walking, bicycling, dancing, or swimming
• strength-training exercises, such as lifting weights, using resistance bands, or doing bodyweight exercises
• stretching exercises

You should spend at least 150 minutes on moderate-intensity aerobic activities every week, according to the Centers for Disease Control and Prevention.

Making healthy food choices and engaging in regular physical activity can help you maintain a healthy weight.

Finding the right birth control method for you and managing your weight are important factors in staying healthy.

Talk to your doctor if you have concerns about your IUD or your weight. If you exercise and eat a well-balanced diet, but you still notice a significant fluctuation in your weight, there may be a medical reason for it.

Your doctor can help you find the best IUD based on your lifestyle, health, and reproductive plans.

Last medically reviewed on May 12, 2021

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How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

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May 5, 2023

Written By

Natalie Silver

Edited By

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May 12, 2021

Medically Reviewed By

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Medically reviewed by Valinda Riggins Nwadike, MD, MPH — By Natalie Silver — Updated on May 5, 2023

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Do IUDs Cause Weight Gain?

IUDs have not been shown to cause weight gain. Learn why your weight may change with an IUD.

Like all medications, birth control can have side effects. They’re important to consider when choosing the method that’s right for you. Birth control side effects may include acne, breakthrough bleeding, mood changes, and more. Weight gain is a concern among women choosing birth control, but it’s a common misconception that IUDs cause weight gain. To answer some frequently asked questions about IUD weight gain, we talked to Christina Madison, PharmD, FCCP, BCACP, AAHIVP, founder of The Public Health Pharmacist and clinical researcher of women’s health.

What is an IUD?

An IUD, or intrauterine device, is a small, T-shaped plastic device placed in the uterus to prevent pregnancy. With less than a 1% risk of pregnancy each year, IUDs are the most effective form of birth control available. IUDs are a great choice for those who often forget to take their daily birth control pills. After insertion, an IUD lasts anywhere from three to 12 years. It can be used by women of all ages, according to the CDC. They are also a reversible contraception option, allowing you to go back to regular fertility once your IUD is removed.

There are two types of IUD products: copper and hormonal. While both are effective in preventing pregnancy, there are some key differences to keep in mind. 

RELATED: How does IUD birth control work?

Copper IUDs

Copper IUDs are hormone-free. They use plastic and copper coils instead of levonorgestrel. Copper is a natural spermicide, killing sperm before it can reach an egg. Copper IUDs, like ParaGard, can be used for up to 12 years.

Hormonal IUDs

Sometimes referred to as intrauterine systems, hormonal IUDs release small amounts of a progestin hormone called levonorgestrel into the uterus, which prevents sperm from reaching and fertilizing an egg. These IUDs can last anywhere from three to eight years. 

One of the most common hormonal IUD brands is Mirena, manufactured by Bayer. Mirena prevents pregnancy for up to five years but may remain effective for up to eight years. 

The cost of Mirena varies, but Bayer recently reported that 95% of women are covered with little to no out-of-pocket costs. The list price of Mirena is $1,410, which comes out to about $15 per month over eight years. If your insurance doesn’t cover it, there are Mirena coupons available. 

Other common brands include Skyla, Liletta, and Kyleena. Each hormonal IUD brand is different, so be sure to consult with your OB-GYN on which is right for you.

RELATED: What is Mirena? | What is Skyla? | What is Liletta? | What is Kyleena?

What are the side effects of an IUD?

Both hormonal and copper IUDs do much more than just preventing pregnancy. For example, Mirena treats heavy bleeding, which benefits those who experience endometriosis-related pain. ParaGard, the copper IUD, is also used as an emergency contraceptive since it begins working immediately.

Side effects of intrauterine dosage forms, like the Mirena IUD, are typically less severe than those seen with oral contraceptives, according to Dr. Madison.

While IUDs are 99% effective, there are some common side effects that include:

• Cramping and back pain after placement
• Irregular bleeding and spotting
• Irregular periods, which may become lighter or even stop
• Ovarian cysts, which usually disappear
• Heavy menstrual bleeding or longer periods with copper IUDs

Rare, but serious, side effects of IUDs include:

• Potential risk of pelvic infection within 20 days after insertion
• The IUD slipping or moving, which will need to be taken out by a professional
• Expulsion of the device from the uterus

Mirena side effects

Possible side effects of IUDs vary from patient to patient. Side effects may also depend on the type of IUD used. The Mirena IUD may have additional, hormone-based side effects, such as:

• Headaches
• Acne
• Breast tenderness
• Mood swings
• Nausea
• Fatigue

Since Mirena and other hormonal IUDs use the progestin hormone instead of estrogen, some patients may experience weight gain or hair loss due to lower estrogen levels. However, these side effects are uncommon and may be related to a number of other health issues, such as stress or other illnesses.

 “Benefits of using these highly effective and long-acting products outweigh the risk of potential side effects,” says Dr. Madison, but make sure to consult with your doctor to determine if an IUD is the right option for you.

RELATED: Mirena alternatives

IUD weight gain

The majority of IUD users do not experience weight gain. Copper, non-hormonal IUDs do not cause weight gain, whereas about 5% of patients using hormonal IUDs report weight gain. Since Mirena is a hormonal IUD, Mirena weight gain is possible, but unlikely.

“The perception of weight gain from these products is widely thought of, but has not been substantiated,” says Dr. Madison. “There was no difference in body weight or composition seen among [IUD] products after 12 months of continuous use.” While you may have some weight gain after getting your IUD, it should subside.

Weight gain can happen with hormonal IUDs due to the hormone, progestin. Any IUD weight gain is likely not an increase in body fat, but instead an increase in water retention. The hormone progestin may increase water retention that causes bloating, typically adding about five pounds. The amount of weight gained will vary from patient to patient, but any water retention will likely go down three months post-insertion.

It’s important to know that gaining any weight post-insertion is likely due to the patient’s lifestyle as opposed to the IUD itself. Many American women naturally gain two pounds each year, entirely unrelated to any hormonal contraceptives, according to Yale Medicine.

Consider making some lifestyle changes to avoid weight gain after getting an IUD. Exercising regularly, eating a balanced diet, and other common healthy habits should minimize the chances of any weight change after getting an IUD.

Should bloating not subside three months after IUD insertion, consider speaking with a healthcare professional about other options. Copper IUDs, like Paragard, have not been linked to weight gain, making them a great alternative.

What birth control doesn’t cause weight gain?

Should an IUD prove to be not the best birth control method for you, there are plenty of other contraceptive options to consider. Consult your healthcare provider about what would work best for you. Some common birth control options include:

• Birth control pills
• Xulane patches
• Birth control injections, like Depo-Provera
• Contraceptive implants, like Nexplanon 
• Vaginal rings, like NuvaRing

Hormonal birth control gets a bad reputation for causing weight gain. However, weight gain is not a side effect of most birth control methods. Any weight gain reported while taking birth control is likely natural, like aging or your metabolism slowing down.

Only one form of birth control has been linked to weight gain, and that’s the injection Depo-Provera. If you’re looking to avoid weight gain, stay away from injectable contraceptives. These injectables have been shown to activate signals that control hunger, resulting in weight gain in some patients.

As you consider other birth control options, keep in mind that some, like the pill, injections, patches, and vaginal rings, have 10% yearly failure rates due to human error. 

“Choosing the best contraceptive product is very individualized,” says Dr. Madison, so make sure to speak openly and honestly with your gynecologist about which birth control method is right for you.

IUD weight gain FAQs

Does Mirena cause weight gain?

Mirena has not been shown to cause weight gain. Less than 10% of Mirena users experienced weight gain in its manufacturer clinical trials. There was not enough evidence to show that these participants’ weight gain was caused by Mirena. However, it is possible to initially gain a few pounds due to an increase in water retention, which should subside after a few months. 

What should I do if I gain weight on Kyleena?

If you experience weight gain with Kyleena, try to find the cause of the weight gain. Was there a recent change in your life that may be causing it? There is a multitude of reasons that someone can gain weight. Kyleena does not have evidence of weight gain by itself, but an initial weight gain of a few pounds due to water retention should not be alarming. Practicing a healthy lifestyle with a balanced diet and regular exercise can help prevent weight gain. However, if you experience unexplained weight gain, talk to your healthcare provider because it could be caused by another medical condition.

Why do people gain weight with IUDs?

People can gain weight with IUDs due to water retention. This usually goes away within a few months of getting an IUD inserted. Generally, IUDs do not show an increase in actual weight or body fat. 

Can a copper IUD make you gain weight?

Studies have shown that Copper IUDs do not cause weight gain. This is because they do not have progestin, the hormone present in hormonal IUDs that causes water retention. If you gain weight unexplainably with a copper IUD, speak to a healthcare provider. It could be caused by an underlying condition. 

Which drugs make you gain weight

If you are prescribed a drug and start to gain weight, the two events are not necessarily related. Some groups of drugs can really affect weight gain, but not in the way you think.

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Excess weight

The fight against excess weight

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Perhaps you are taking some kind of medication and have started noticing how the numbers on the scale are getting bigger. Look in the instructions for the group of your drug and perhaps it will be on this list.

Contents of the article

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

1. Why does the drug cause weight gain?

By itself, the drug does not form fatty tissue from nothing. Reasons your drug may cause weight gain include side effects such as:

• increased appetite

• water retention

• intense accumulation of fat from incoming food (faster than usual)

• slow metabolism 900 31

• fatigue, lethargy or weakness

2. Medicinal drugs

2.1 Antidepressants

Some antidepressants can cause weight gain by affecting the neurotransmitter serotonin, which affects our mood. You become more relaxed, your well-being improves, and with it your appetite. Other antidepressant options can cause drowsiness and fatigue, which reduces your level of activity, and therefore the expenditure of energy, which is then stored as adipose tissue.

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2.2 Contraceptives

This class of drugs is most often blamed for weight gain. In general, birth control pills are not associated with weight gain, especially the newer pills with lower doses of estrogen and progestin. A significant effect can be observed only with injections. And so again we return to the revision of the calorie content of the diet and the level of physical activity.

2.3 Antihistamines

Blocking histamine activity may increase appetite. Used to treat allergic conditions.

2.4 Antipsychotics and treatment of mood disorders

Although all antipsychotics have been shown to cause some metabolic and weight changes, each drug has its own risk profile. They have a similar effect to antidepressants. This class of drugs is used for mental illness.

2.5 Beta blockers

Beta blockers are a class of heart drugs used to treat high blood pressure and chest pain (angina). They can cause fatigue. A person lacks energy and slows down, which can affect the number of calories burned per day

2.6. Corticosteroids

Steroids can affect the metabolic rate and lead to increased appetite and overeating. This class of drugs can lead to additional deposits of fat in the middle part of the body (in the abdomen). They are often used for a short time

2.7 Diabetes medicines

May cause weight gain, both by increasing appetite and by increasing glucose uptake into cells. Too many calories in the form of glucose will lead to weight gain (as insulin injections can). But remember that nutrition and physical activity can control such effects.

2.8 Anticonvulsants, mood stabilizers and migraine medicines

Have a similar weight gain mechanism to the previous classes. Long-term use of this group of drugs can cause significant weight gain

3. What should I do?

Other drugs will not have any significant effect on your weight. Get back to the basics:

1. a balanced diet

2. regular physical activity

3. quality sleep and rest

If you are all – you are still taking one of the above drugs, consult your doctor, but do not stop the drug yourself .

(Also: How antidepressants affect weight: here’s what the scientists say)

Weight gain

Numerous studies suggest that psychotropic drugs, including modern atypical antipsychotics, can lead to weight gain, while indirectly disrupting glucose metabolism and promote the development of diabetes. Weight gain is also associated with hypertension, coronary heart disease, stroke, varicose veins, and some other somatic diseases.

Only a few authors believe that overweight is less common in patients with schizophrenia than in other people.

Drugs with a sedative effect that limits the patient’s physical activity can slow down the metabolism of substances, which also contributes to the patient’s weight gain.

Mechanisms of weight gain with antipsychotics:

1. Restriction of physical activity as a result of the sedative effect of the drug.
2. The pleasure of eating as a means of combating depression.
3. Changing the mechanism of saturation.
4. Deceleration of metabolism due to the effect of antipsychotics on various networks of neurons: serotonin (5HT1A receptor agonists cause hyperphagia, 5HT2 antagonists cause hypophagia), histamine (blockade), dopamine, norepinephrine, muscarinic, etc.
5. Fluid retention in the body.
6. Endocrine disorders: increase in prolactin, changes in insulin and cortisol secretion.
7. Changes in the level of the hormone – leptin peptide in the blood plasma and changes in the sensitivity of the hypothalamus receptors to it.

Patients with schizophrenia have been observed to prefer sweet foods, drink large amounts of high-calorie drinks (cola and sprite), eat more, while getting a certain pleasure from eating.

Many psychotropic drugs also have an anticholinergic effect that reduces metabolic processes. They delay the release of fluid from the body, contributing to endocrine system disorders (increase in prolactin, changes in the secretion of cortisol, insulin, etc.), which also increases the weight of patients.

In the development of obesity that occurs while taking some atypical antipsychotics, the hormone peptide leptin is of great importance, which is produced by adipocytes in an amount that is directly proportional to the amount of fat in the cells of the body.

Leptin plays an important role in the regulation of body weight, affects appetite by blocking leptin receptors in the hypothalamic satiety center proportional to the mass of adipose tissue. It stimulates a sequence of responses that regulate appetite, metabolism, energy expenditure, and food satisfaction.

The peripheral effect of leptin is expressed in the suppression of intracellular lipid metabolism. Taking leptin reduces appetite and thus leads to weight loss. However, obesity is often accompanied by an increase in the level of leptin in the blood and, probably, a decrease in the sensitivity of the hypothalamic receptors to this hormone, which in turn leads to an increase in appetite and an increase in body weight.

Elevated blood leptin also has an effect on tissue insulin resistance. The connection of the latter with the development of obesity is well known. Insulin stimulates the secretion of leptin by adipocytes. The effect of leptin, both stimulating and inhibitory in relation to insulin, on the function of pancreatic beta cells was noted

Weight gain as a result of taking antipsychotics is quite variable and is determined by the characteristics of the individual. In other words, not all patients with schizophrenia, even receiving antipsychotics such as olanzapine and clozapine, show weight gain. Currently, many experts explain this phenomenon as a genetic variation of pharmacodynamic factors. There is ample evidence to support this view, as well as the influence of genetic factors on eating behavior. Some researchers have found a relationship between single nucleotide polymorphisms – 759C/T and weight gain at 6 and 10 weeks of hospitalization in patients with a first psychotic episode treated with antipsychotics such as clozapine and risperidone. Other authors have determined that patients without the 759T allele have a higher risk of weight gain during a 6-week course of olanzapine therapy than patients with the 759T allele. At the same time, individuals without the allele – 759T of the 5HT2C receptor gained weight to a much greater extent than individuals with the T allele. Thus, it turned out that carriers of the T allele have a lower risk of weight gain than individuals without this allele. The study of polymorphisms of promoter regions in the 5HT2C serotonin receptor and leptin genes for the presence of an association with weight gain as a result of taking antipsychotics showed that patients prone to weight gain had a 5HT2C receptor polymorphism – 759C/T and leptin polymorphism – 2548A/G. Leptin polymorphism – 2548 did not correlate with short-term weight gain, but significantly correlated with this indicator after 9 months of antipsychotic therapy. At the same time, variations in the H1 and H2 receptor genes were not associated with weight gain in patients treated with clozapine for 5 weeks.

Tricyclic and tetracyclic antidepressants (amitriptyline, nortriptyline) significantly increase weight. Selective serotonin reuptake inhibitors (SSRIs), with the exception of paroxetine, are neutral in relation to weight gain, mirtazapine, on the contrary, increases body weight. Valproate and lithium have a fairly high potential in terms of weight gain. Among the classic antipsychotics, thioridazine increases weight the most, and pimozide has been reported to reduce body weight.

Usually, weight gain is observed in the first months of therapy and subsequently its rate decreases markedly in its severity. At the same time, the stigma of schizophrenia is aggravated by the stigma of obesity, which significantly affects the social status and the level of compliance of the patient with the medical staff.

Weight gain at 3-6 weeks of therapy is a predictor of overall weight gain.

The total level of high and low density lipoproteins practically differs little when taking various antipsychotics. When taking classical neuroleptics, the average level of triglycerides corresponds to 1.8 mmol / l.

The central norepinephrine and dopamine neural networks play an important role in the regulation of food intake.

It is likely that weight gain during treatment with some atypical antipsychotics (olanzapine) depends on many factors and includes effects on histamine (H1), serotonin receptors (5HT2A, 5HT2C), and alpha-adrenergic receptors (alpha 1 and alpha 2) , muscarinic M3 receptors and changes in plasma leptin levels.

Note that sulpiride (selective blocker of D2/D3 receptors), which noticeably increases the body weight of patients with schizophrenia, does not affect histamine receptors (H1).

Among atypical antipsychotics, clozapine therapy is most often associated with an increase in triglyceride levels and does not affect cholesterol levels.

Comparative studies of the effect of atypical antipsychotics on lipid metabolism in patients with schizophrenia indicate that patients treated with olanzapine exhibit higher triglyceride levels (mean level – 2.3 mmol / l) than those patients who received risperidone (mean level – 1.7 mmol / l) and ziprasidone.

Despite the small number of publications on the effect of quetiapine and zotepine on lipid metabolism, it can be assumed that due to the structural similarity of the latter with clozapine and olanzapine, these drugs may affect lipid levels.

In patients receiving clozapine and olanzapine, there is an increase in serum leptin levels, while, as noted above, white adipocyte leptin regulates insulin secretion and energy metabolism by acting on specific receptors (OB-R) of the hypothalamus, fat cells and skeletal muscles .

With respect to amisulpiride and aripiprazole, there are no data in the literature regarding their effect on lipid metabolism.

The risk group for weight gain includes women, individuals prone to narcissism, and patients with a hereditary burden of obesity.

Weight gain during therapy with psychotropic drugs makes it difficult to cooperate with the doctor and is, especially in women, one of the main reasons for discontinuation of the drug.

Unfortunately, at present, almost 60% of patients with schizophrenia with signs of dyslipedemia do not receive the therapy they need, aimed at correcting metabolic disorders.

If weight gain due to the use of antipsychotics is detected, a psychoeducational program specially designed for a particular case should be carried out with the patient and his relatives. Typically, the duration of such a program, which includes information about the features of the action of antipsychotics and a healthy lifestyle, is several weeks.

A strict diet, including the restriction of high-calorie foods, and physical exercise reduce the severity of the development of obesity that occurs against the background of taking psychotropic drugs.

A significant increase in body weight when taking atypical antipsychotics (olanzapine, quetiapine, risperidone) is usually observed in 14-27% of cases by 6-8 weeks of therapy, in 40% of patients after 3.5 years.

Patients taking clozapine gain an average of 4.5 kg of weight within 10 weeks (Allison D. et al., 1999), with an annual weight gain ranging from 5.7 to 8.0 kg (Lamberti Y. et al., 1992). Up to 94% of patients taking olanzapine also gain weight (Gupta S. et al., 1999). Patients using olanzapine for 10 weeks increase their weight by
4.15 kg (Allison D. et al., 1999), an average of 12 kg per year (Beasley C., 1997).

Risperidone causes moderate to minimal weight gain (2.1 kg in 10 weeks (Allison D. et al., 1999), patients gain an average of 1. 7 kg in one year) (Sachs G. 1999) .

For quetiapine, average weight gain over several months of therapy is between 1.0 and 4.0 kg (Borison R. et al., 1996). If against the background of taking respiridone, weight gain is especially noticeable in the first year and a half of using the drug, then the effect of quetiapine on this indicator lasts up to two years.

Ziprasidone causes the least weight gain (Allison D. et al., 1999). According to some researchers, almost the same weight gain is observed against the background of taking amisulpiride.

Weight changes with antipsychotics are shown in Table 42.

Table 42. Weight changes with antipsychotics

Weight gain while taking atypical antipsychotics does not depend much on the dosage of the atypical antipsychotic, but is associated with the effectiveness of the drug (positive therapeutic response), body mass index before the start of the medication, the age of the patient and, apparently, from belonging to one or another different ethnic group of people.

Due to the high risk of developing this complication of antipsychotic therapy, preliminary screening of patients at risk of weight gain with subsequent special control of body weight of this group of individuals is recommended.