A Pilot and Feasibility Study of Combined Oral Contraceptive Pills and Metabolic Outcomes in Premenopausal Women with Overweight or Obesity

Combined oral contraceptive pills (COCPs) are commonly used by reproductive-aged women with overweight or obesity, but their metabolic effects remain understudied. This pilot study examined the feasibility of recruiting and retaining women with overweight or obesity initiating COCPs and evaluated changes in body weight, body composition, energy intake (EI), eating behaviors, and cardiometabolic markers. Premenopausal women aged 18–40 years with a body mass index between 25 and 45 kg/m2 initiating COCPs (n = 10) or using nonhormonal contraception (NHC; n = 10) were followed for six months. Outcome measures included body weight, body composition, EI, eating behavior questionnaires, ecological momentary assessment of appetite and satiety, and fasting laboratory measures. There were no between-group differences in changes in weight, EI, or appetite. Binge-eating severity decreased in COCP users and increased in NHC users, though the within-group change in COCP users was not statistically significant. Exploratory analyses demonstrated increases in hemoglobin A1c and triglycerides among COCP users compared to NHC users, while bioavailable testosterone decreased in COCP users only. This study demonstrates high retention and feasibility among women with overweight/obesity undergoing intensive dietary and metabolic monitoring. Although weight outcomes were similar between groups, these preliminary findings identify potential metabolic signals warranting confirmation in adequately powered studies.