We use corticosteroids for many conditions — allergies, autoimmune and skin disorders, and musculoskeletal problems — given as tablets, sprays, or injections. Their side effects depend on the dose, the duration, and how they’re given. One of the most common worries is simple: do cortisone shots cause weight gain, and how do we avoid the other side effects?
What is cortisone?
Cortisone is a synthetic version of cortisol, the hormone your adrenal glands make to regulate inflammation, hormone levels, temperature, and the immune system. As a drug, it has a powerful anti-inflammatory effect.
Injections vs tablets: a crucial difference
This distinction is the key to the weight-gain question. Cortisone tablets (such as prednisolone) are used for serious conditions such as lupus or severe eczema, at high doses, for a long time. The gut absorbs them into the bloodstream, affecting the whole body, which is why they can cause weight gain, insomnia, and other systemic effects.
Most cortisone for musculoskeletal problems is given as a shot — a high concentration in one local area (a joint, bursa, or tendon sheath). Very little is absorbed into the rest of the body, so systemic side effects are far less likely, and a single injection clears within about 4–6 weeks.
So, do cortisone shots cause weight gain?
As a general rule, no. The amount of cortisone absorbed by the body after a single joint or tendon injection is minimal, and a few injections over 3–6 months are unlikely to cause weight gain. Contrast that with tablets: in one study, high-dose oral steroids over two years caused a weight gain of at least 5%. So the weight-gain reputation belongs to long-term tablets, not the occasional injection.
The side effects of cortisone shots can cause
While weight gain is unlikely, local side effects are worth knowing about:
- Cortisone flare — increased pain, typically 12–24 hours after the shot, lasting up to a week. Rest, ice, and anti-inflammatories help.
- Skin colour change — cortisone near the skin can reduce pigmentation; it’s not permanent, but it can take months to settle, especially in darker skin.
- Fat atrophy — unlike tablets (which add fat), a local injection can shrink fat, dimpling the skin, which some find cosmetically unappealing.
- Tendon weakening — a local shot can weaken a diseased tendon and raise the rupture risk, mostly in the first six weeks.
- Infection — a small risk, reduced by strict sterile technique.
- Cartilage damage — repeated injections into one joint may reduce cartilage, so we’re cautious about repetition.
- Raised blood sugar — cortisone can raise blood sugar for 2–4 weeks, especially in people with diabetes.
- Facial flushing — a flush starting 2–4 hours after the shot, lasting up to 24 hours.
Ultrasound guidance reduces several of these — particularly skin changes and fat atrophy — by accurately placing the cortisone.
Frequently asked questions about cortisone shots and weight gain
Do steroid injections cause weight gain like steroid tablets do?
No — that’s the key distinction. Tablets are absorbed throughout the body at high doses over long periods, which can cause weight gain. A local injection delivers cortisone to a single site with minimal whole-body absorption, so it rarely affects weight.
Can a cortisone shot increase my appetite?
A single local injection is very unlikely to increase appetite noticeably. The appetite and weight effects people associate with steroids come from prolonged high-dose tablets, not the occasional shot.
Could I retain water or feel bloated after a cortisone shot?
Some people notice mild, short-lived fluid retention, but significant water retention is more characteristic of high-dose oral steroids than of a single local injection.
How can I avoid side effects from a cortisone shot?
Have it done by an experienced doctor using ultrasound guidance for accurate placement, limit how often the same area is injected, and follow the aftercare advice (including resting the injected tendon).
Final word from Sport Doctor London: Do cortisone shots cause weight gain?
Cortisone shots concentrate the drug where it’s needed, so whole-body side effects such as weight gain are uncommon. Local effects — skin depigmentation, fat atrophy, a flare — are the ones to watch, and an experienced doctor using ultrasound minimises them.
To discuss a cortisone injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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