Understanding Nextstellis and Its Place in Contraception
Nextstellis is a combination hormonal birth control pill approved by the FDA to prevent pregnancy [1.2.4]. What sets it apart is its unique formulation, which contains a novel estrogen called estetrol (E4) and a well-known progestin, drospirenone (DRSP) [1.2.6]. Estetrol is the first new type of estrogen to be used in a contraceptive in the United States in over half a century [1.4.1]. This distinction has prompted discussions about its side effect profile, particularly concerning weight changes, a common concern for individuals starting any hormonal contraceptive.
Like other combination pills, Nextstellis primarily works by suppressing ovulation, the release of an egg from the ovary [1.3.1]. Without ovulation, fertilization cannot occur. The hormones also thicken cervical mucus, making it more difficult for sperm to reach the uterus, and thin the uterine lining. With typical use, it is about 91% effective at preventing pregnancy [1.5.3].
The Clinical Evidence: Weight Gain vs. Weight Loss
When addressing the question, "Does Nextstellis make you lose weight?" the clinical data is quite clear: weight loss is not a reported side effect in the drug's studies [1.2.1, 1.3.3]. In fact, the opposite—weight gain—is listed as a possible side effect. The official prescribing information and subsequent analyses of clinical trials confirm that a small percentage of users experience an increase in weight [1.2.3, 1.4.3].
In one study, about 3% of participants taking Nextstellis reported weight gain [1.5.3]. Another analysis found the incidence of weight gain to be 2.2% [1.4.7]. It's important to note that a study comparing US participants with and without obesity found that those with obesity were more likely to report weight gain (5.3% vs 2.7%) [1.4.6]. However, some sources suggest that weight gain may be reported less often with Nextstellis than with some other oral contraceptives [1.5.2]. For context, one analysis showed that during treatment, 22% of participants gained at least 5% of their baseline weight, while 14% lost at least 5% [1.4.7]. This highlights that weight can fluctuate in either direction for a minority of users, but significant weight loss is not a documented outcome.
Why Might Hormonal Contraceptives Affect Weight?
The perception that birth control pills cause significant weight gain is widespread, but large-scale reviews have found little to no evidence to support a causal link for most combination pills [1.7.5, 1.7.4]. When weight changes do occur, they are often attributed to a few key factors:
- Fluid Retention: The estrogen component in birth control pills can cause the body to hold on to more water, leading to a feeling of bloating and a slight increase on the scale [1.7.3, 1.5.3]. This effect is often temporary and may resolve after the first few months as the body adjusts.
- Increased Appetite: Some progestins can have an appetite-stimulating effect in some individuals, which could potentially lead to consuming more calories [1.7.6].
- Changes in Body Composition: Estrogen can affect fat cells, potentially making them larger, though not more numerous [1.7.3].
Drospirenone, the progestin in Nextstellis, is unique. It is a derivative of spironolactone, a diuretic, which may help counteract the fluid retention that other progestins and estrogens can cause. This property is why some users of drospirenone-containing pills (like Yaz) anecdotally report feeling less bloated. However, even with this attribute, the official data for Nextstellis points towards a small risk of weight gain, not loss [1.4.3].
Comparison of Weight Effects: Nextstellis vs. Other Contraceptives
It's helpful to contextualize Nextstellis's side effect profile by comparing it to other forms of birth control.
| Contraceptive Method | Common Association with Weight Change |
|---|---|
| Nextstellis (E4/Drospirenone) | Weight gain is an uncommon side effect (2-3% of users in trials); weight loss is not reported. Generally considered to have minimal impact on weight [1.5.3, 1.4.7]. |
| Other Combination Pills (Estrogen + Progestin) | Most studies show no significant causal link to weight gain. Temporary fluid retention is possible [1.7.5]. |
| Progestin-Only Pills ('Minipill') | May be associated with modest weight gain in some users [1.7.1]. |
| Depo-Provera (Injection) | This is the hormonal method most consistently linked to weight gain, with an average of about 5 pounds in the first year for some users [1.7.4, 1.7.7]. |
| Hormonal IUDs & Implants | Research has generally not found a strong link to significant weight gain [1.7.4]. |
| Copper IUD (Non-Hormonal) | No hormones are involved, so there is no mechanism to cause weight changes [1.7.4]. |
Managing Weight While on Nextstellis
If you are taking Nextstellis and are concerned about weight changes, it's important to focus on lifestyle factors that are within your control. General health advice applies:
- Maintain a Balanced Diet: Focus on whole foods, including fruits, vegetables, lean proteins, and whole grains.
- Engage in Regular Physical Activity: Aim for consistent exercise to manage weight and improve overall health.
- Monitor Fluid Intake: Staying hydrated can sometimes help with water retention.
- Consult Your Doctor: If you experience significant or concerning weight changes after starting Nextstellis, speak with your healthcare provider. They can help determine if the change is related to the medication or another underlying factor and discuss alternative contraceptive options if necessary [1.2.1]. It is also noted that Nextstellis may be less effective in females with a BMI ≥ 30 kg/m2 [1.2.4, 1.2.7].
Conclusion
The available clinical evidence does not support the idea that Nextstellis causes weight loss. It is not a listed side effect, and user experiences are more likely to involve either no change in weight or, in a small percentage of cases, slight weight gain [1.2.2, 1.3.1]. The unique formulation with estetrol and drospirenone is considered to have a minimal impact on weight for most people, with some data suggesting it may cause less weight gain than other oral contraceptives [1.4.1, 1.5.2]. As with any medication, individual experiences can vary, and consulting with a healthcare provider is the best course of action for personalized advice. For more detailed information, you can refer to the FDA-approved patient labeling.
