>Mechanism of Weight Change in Combined Contraceptive Users There are several possible mechanisms in which weight gain could occur as a result of COC use. Increased appetite could result from a suppression of serum cholecystokinin.[12] One study reported that half of adolescents and providers believed that COC use increased appetite and 60% of the adolescents in this study also believed that COCs caused weight gain.[7] It is suggested that estrogen in COCs causes fluid-retention weight gain by direct stimulation of the renin–angiotensin system, which can lead to water retention,[43]which in turn leads to sodium retention. Several older studies comparing different dosages of estrogen suggested that lower dose COCs reduce fluid retention.[44,45] One study that compared low-dose estrogen COCs users with non-user controls found that there was no difference between users and controls in weight gain, and where there was small weight gain in both groups this was due to fat deposition and not fluid retention.[45] COCs containing the progestin drospirenone may assist in helping women who are susceptible to weight gain minimize fluid retention, in particular related to premenstrual syndrome. This progestin has antimineralocorticoid and antiandrogenic properties.[46,47]
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