Do IUDs cause weight gain. How does Skyla compare to other IUDs in terms of side effects. What are the potential benefits and risks of using an IUD for birth control. How can you manage your weight while using contraceptives.

Understanding IUDs: Types and Their Effects

Intrauterine devices (IUDs) are a popular form of reversible birth control, known for their effectiveness and convenience. There are two main types of IUDs available: copper IUDs and hormonal IUDs. Each type works differently and may have varying effects on the body.

Copper IUDs: Mechanism and Side Effects

The copper IUD, such as ParaGard, is a non-hormonal option that creates an inflammatory reaction in the uterus, making it inhospitable for sperm. This T-shaped device can remain effective for up to 10 years. While it may cause side effects like heavier periods or cramping, weight gain is not typically associated with copper IUDs.

Hormonal IUDs: How They Work

Hormonal IUDs, including Mirena and Skyla, release progestin into the uterus. This hormone thickens cervical mucus, thins the uterine lining, and may prevent ovulation. Skyla can last up to 3 years, while Mirena remains effective for up to 5 years.

Skyla and Weight Gain: Examining the Evidence

Concerns about weight gain are common among those considering hormonal contraceptives. However, is there a significant link between Skyla and weight gain?

A 2020 study comparing weight gain among users of different contraceptive methods found that hormonal IUD users gained an average of 0.72 kg (about 1.59 lbs) after 12 months. This suggests that while there may be a slight increase in weight, it’s relatively minimal.

Does this mean Skyla directly causes weight gain? Not necessarily. Weight fluctuations can occur due to various factors, including age, lifestyle changes, and natural body processes. It’s crucial to consider these aspects when evaluating any potential weight changes.

Comparing IUDs: Weight Gain and Other Side Effects

When considering different IUD options, it’s important to understand how they compare in terms of potential side effects, including weight gain.

Copper IUDs vs. Hormonal IUDs

Copper IUDs like ParaGard do not list weight gain as a side effect. Their primary side effects tend to be related to menstrual changes, such as heavier periods or increased cramping. On the other hand, hormonal IUDs like Skyla may list weight gain as a potential side effect, although the evidence suggests any gain is typically minimal.

Other Common Side Effects

Both types of IUDs can cause various side effects. For copper IUDs, these may include:

• Anemia
• Backaches
• Vaginitis
• Painful intercourse
• Irregular bleeding
• Heavy menstrual flow

Hormonal IUDs like Skyla might cause:

• Acne
• Depression
• Changes in menstrual bleeding patterns
• Headaches or migraines

The Bigger Picture: Contraception and Weight Management

When discussing contraception and weight, it’s crucial to consider the broader context. Many individuals experience weight changes during their reproductive years, regardless of their chosen birth control method.

The National Collaborating Centre for Women’s and Children’s Health reviewed several studies on weight gain and copper IUDs, finding no evidence that IUD use significantly affects weight. Similarly, the National Center for Biotechnology Information suggests that hormonal forms of birth control are unlikely to cause substantial weight gain.

Are there more influential factors affecting weight than contraceptive choice? Absolutely. Age, diet, physical activity, and overall lifestyle play significant roles in weight management. The U.S. Department of Health and Human Services reports that over 66% of women in the United States have overweight or obesity, highlighting the importance of broader health considerations beyond contraceptive choices.

Managing Weight While Using Contraceptives

If you’re concerned about potential weight gain while using an IUD or any other form of contraception, there are several strategies you can employ to maintain a healthy weight:

1. Balanced diet: Focus on nutrient-dense foods and practice portion control.
2. Regular exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity per week.
3. Stress management: Chronic stress can contribute to weight gain, so find effective ways to relax and unwind.
4. Adequate sleep: Poor sleep patterns can affect hormones that regulate appetite and metabolism.
5. Regular check-ups: Discuss any concerns about weight or side effects with your healthcare provider.

Can lifestyle changes help mitigate potential weight gain associated with contraceptives? While individual responses may vary, maintaining a healthy lifestyle can certainly support overall weight management, regardless of the contraceptive method used.

Beyond Weight: Other Considerations for IUD Users

While weight concerns are valid, it’s essential to consider other aspects of IUD use that may impact your health and well-being.

Protection Against STIs

IUDs are highly effective at preventing pregnancy, but they do not protect against sexually transmitted infections (STIs). Using barrier methods like condoms in addition to an IUD is crucial for comprehensive sexual health protection.

Long-term Benefits

Despite potential side effects, IUDs offer several long-term benefits. They provide highly effective, long-lasting contraception without the need for daily attention. Some hormonal IUDs may also help manage heavy menstrual bleeding or reduce menstrual pain.

Making an Informed Decision: Is an IUD Right for You?

Choosing a contraceptive method is a personal decision that should be based on various factors, including your health history, lifestyle, and personal preferences. While concerns about weight gain are valid, they should be weighed against the overall benefits and potential risks of using an IUD.

How can you determine if an IUD is the right choice for you? Consider the following steps:

1. Consult with a healthcare provider: Discuss your medical history, concerns, and contraceptive needs.
2. Evaluate your lifestyle: Consider factors like your desire for long-term contraception and willingness to manage potential side effects.
3. Weigh the pros and cons: Compare the benefits of IUDs (such as effectiveness and convenience) against potential drawbacks.
4. Consider alternatives: Explore other contraceptive options if you’re unsure about IUDs.
5. Monitor your body: If you choose an IUD, pay attention to how your body responds and communicate any concerns with your healthcare provider.

The Future of Contraception: Ongoing Research and Development

As concerns about contraceptive side effects persist, researchers continue to explore new options and improvements to existing methods. What developments can we expect in the future of contraception?

Ongoing research focuses on developing contraceptives with fewer side effects, including those related to weight gain. Some areas of investigation include:

• Non-hormonal methods that offer similar effectiveness to hormonal options
• Improved delivery systems for hormonal contraceptives to minimize systemic effects
• Personalized contraceptive approaches based on individual genetic and metabolic profiles
• Male contraceptive options to expand reproductive responsibility

These advancements may provide more options for individuals concerned about weight gain or other side effects associated with current contraceptive methods.

Empowering Yourself: Knowledge and Advocacy in Reproductive Health

Understanding the potential effects of different contraceptive methods, including IUDs like Skyla, empowers you to make informed decisions about your reproductive health. However, it’s equally important to advocate for yourself and seek professional guidance when needed.

How can you become a more informed and empowered contraceptive user? Consider these strategies:

1. Stay informed: Keep up with the latest research and developments in contraceptive technology.
2. Ask questions: Don’t hesitate to discuss concerns or ask for clarification from your healthcare provider.
3. Track your health: Monitor any changes in your body, including weight fluctuations, and document them for discussion with your doctor.
4. Seek second opinions: If you’re unsatisfied with your current contraceptive method or the advice you’ve received, consider consulting another healthcare professional.
5. Participate in research: If possible, consider participating in clinical trials or studies related to contraceptive research.

By taking an active role in your reproductive health decisions, you can ensure that your contraceptive choice aligns with your overall health goals and lifestyle needs.

Navigating Side Effects: When to Seek Help

While some side effects are common and often subside over time, it’s important to know when to seek medical attention. For IUD users, including those using Skyla, certain symptoms may warrant immediate consultation with a healthcare provider.

When should you contact your doctor about IUD side effects? Be alert for the following signs:

• Severe abdominal pain or cramping
• Unusually heavy or prolonged bleeding
• Signs of infection, such as fever or unusual discharge
• Sudden changes in menstrual patterns
• Unexplained weight gain or loss
• Mood changes or depression
• Suspicion that the IUD has moved or been expelled

Remember, while side effects like slight weight gain may occur, significant changes in your health or well-being should always be discussed with a medical professional.

Balancing Contraceptive Needs and Overall Health

Choosing a contraceptive method involves balancing effectiveness, convenience, and potential side effects with your overall health goals. While concerns about weight gain with methods like Skyla are valid, it’s crucial to consider the broader picture of your reproductive and general health.

How can you strike this balance? Consider these approaches:

1. Holistic health assessment: Work with your healthcare provider to evaluate how different contraceptive options might interact with your overall health profile.
2. Regular health check-ups: Schedule regular visits to monitor your health and discuss any concerns about your contraceptive method.
3. Lifestyle integration: Choose a contraceptive method that aligns well with your lifestyle and health habits.
4. Flexibility: Be open to changing methods if your current choice isn’t meeting your needs or is causing unwanted side effects.
5. Education: Stay informed about new developments in contraceptive technology and reproductive health.

By taking a comprehensive approach to your reproductive health, you can make decisions that support your contraceptive needs while maintaining 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

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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.