Brief Answer:
I would not recommend Lyza as your choice of birth control at this time

Detailed Answer:
Hello, and I would be happy to answer your question today.

First of all, I reviewed your previous questions and discussion with the nutritionist regarding the Nuvaring while you were using it. She was completely correct in the advice that she gave you- all forms of hormonal birth control have different side effects on different women and only trial and error can determine which type your body tolerates the best. Just as many women lose weight on hormonal birth control as those who gain, however in every individual there is no way to know in advance how the hormones will affect you.

The hormones in birth control completely leave your system as soon as you stop using it; that is why you get a period once you take your Nuvaring out for the week.

The current brand of pill you are taking, Lyza, is a pill that only contains the hormone progesterone. Progesterone is the hormone that is mostly responsible for weight gain and mood changes when on birth control pills, so I really do not think that XXXXXXX is the best choice for you to change to after discontinuing NuvaRing. In addition, Lyza is generally prescribed for women who are breast-feeding, as it is not as effective as combination (estrogen and progesterone) contraceptives, like the NuvaRing and other brands of birth control pills (only about 90 percent as opposed to 99 percent like the Nuvaring or other combination pills)

I agree with the nutritionist that trying to be off hormones for a few months would be the best way to determine if the NuvaRing was a contributing factor to your weight gain. If the weight gain was purely due to hormones it should gradually come off without much effort. Weight loss takes time in anyone, and is unrealistic to expect weight loss more than a pound or two a week even with changing your diet and exercise.

If you decide to discontinue hormonal birth control, I can suggest an alternative, more convenient and effective nonhormonal birth control method that you might try as an alternative rather than a diaphragm or condom.

The most popular form of birth control in the world (short of sterilization) is the IUD. In the US, there are two types of IUDs available on the market: one that contains a low dose of hormone similar to the pill (the hormones are not absorbed by your body, but give you shorter and lighter menstrual periods) and another that contains no hormones. The hormonal IUD works for up to five years and the nonhormonal one (Paragard) works for up to 10 years. The IUD needs to be inserted by your healthcare provider, and can be removed as soon as you are ready to get pregnant. I highly recommend the IUD to patients who have trouble tolerating or get bothersome side effects from hormonal birth control.

So in summary, I really do think that it is best for you not to use hormonal contraception for a few months and see how that affects your weight. If you are not on hormones and still are finding it hard to lose weight, factors other than your birth control may be contributing to the problem.

I hope I was able to adequately answer question today, and that the information advice I've given you is helpful to you. If I can be of any further assistance, please do not hesitate to contact me.

Best wishes,

Dr. Brown

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Brief Answer:
The weight gain may not all have to do with hormones; other factors exist

Detailed Answer:
Hello again,

If you used the Nuvaring for three years and only in the last year have you noticed significant weight gain, then your birth control method may not be the only factor. Only you know what and how much you eat every day and whether your diet or lifestyle could have been an issue. In addition, even if you are still young, your metabolism slows every year you live and it gets harder to maintain at the same weight, or to lose it if you've gained excessively. You will gain about a pound a year on average due to natural slowing of your metabolism. Many people find it harder to keep weight off after getting married or when they become a parent, as it is more difficult to maintain a healthy diet if you are eating together as a family. Lastly, obesity runs in families, so if you have other family members who are overweight, it may be a contributing factor as well.

I know you do not have health insurance, but a general physical would be beneficial as the doctor can check for any medical factors that may be contributing to your weight gain, such as thyroid disease or diabetes.

As far as diets and weight loss programs go- the most successful program for long-term weight loss is Weight Watchers. However, the principles regarding weight loss are relatively simple- if you take in fewer calories that your body needs to function, it will use your stored fat to make energy. The more calories you burn every day, the more energy your body expends. An average woman usually needs to eat less than 1800 calories a day to lose weight, unless you are aerobically exercising a lot. Aerobic exercise is anything that makes your heart rate go up and makes you break a sweat and have to breathe faster. Exercising moderately for 30 minutes 3 to 5 times a week is recommended.

Regarding your birth control- if effectiveness is your main concern, the progesterone-only pills like Micronor and Lyza are only 90 percent effective in preventing pregnancy. Condoms prevent pregnancy very well (also 90 percent) as long as you put them on before any penetration and they don't break. I do not think adding additional spermicide with a condom (especially if it already contains spermicide) will significantly increase the effectiveness. As a back-up for a condom, I recommend purchasing the morning-after pill (Plan B or similar- you can buy it in the drugstore) to have around at home in case you have a condom accident.

Lyza has the exact same ingredients as Micronor, so you may find you tolerate that pill better than the Nuvaring. If you are using the Lyza as a backup along with condoms, you are very well protected against pregnancy.

So in summary- there is no way to know if the Lyza is contributing to your difficulty losing weight unless you stop taking it... but if you didn't gain weight from Micronor in the past (though you were breastfeeding, which burns a lot of calories) it may not be a factor now. The fact that you have lost some weight is encouraging... I know you would like to see it happen faster, and possibly working with a professional weight loss program may be more successful than trying on your own.

I wish I could be more helpful, but weight gain is a complex health issue that can happen for many reasons, but with the information you have given me, it may not have much to do with your birth control method. The only way to know if hormones were the issue is to stop taking them- but if effectiveness of your birth control method is your main priority, then I suggest you see how things work with the Lyza. You may want to investigate if they have any Planned Parenthood clinics in your area, as they have greatly discounted prices on IUD's and even though the initial cost is higher than a pack of birth control pills, you can get nearly foolproof pregancy protection for many years if you desire.

I hope this information was helpful and best of luck with everything,

Dr. Brown

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