Introduction: Hormonal contraception is widely used for pregnancy prevention, but concerns remain about changes in body weight, body mass index (BMI), and blood pressure during use. Evidence from Zambia on these changes is limited. This study examined changes in BMI and blood pressure among women using hormonal contraception at the University Teaching Hospital (UTH) in Lusaka, Zambia, and assessed whether contraceptive type and age were associated with these outcomes. In Zambia, Simuyemba et al., (2025), including Munjili as a co-author, reported that hypertension self-care practices were associated with patients’ knowledge and attitudes, underscoring the importance of patient-centred hypertension prevention and management in the local context [13]. Methods: A quantitative retrospective cohort design was used. Records of 382 women aged 15–49 years who had received hormonal contraception at least twice and had relevant clinical measurements recorded were reviewed. Data on age, contraceptive type, duration of use, weight, height, systolic blood pressure, diastolic blood pressure and BMI were extracted into an electronic data-extraction form and analysed using STATA version 14. Descriptive statistics, tests of proportional differences, and multivariable regression models were used, with statistical significance set at p<0.05. Results: The median age was 30 years and median height was 1.6 m. Median weight increased from 60.5 kg to 72.0 kg, while median BMI increased from 24.6 to 28.7. The proportion classified as overweight increased from 46.6% to 80.9% (p<0.001). Median systolic blood pressure increased from 118 to 122 mmHg, and median diastolic pressure increased from 70 to 80 mmHg. Recent systolic hypertension increased from 3.4% to 29.3%, while recent diastolic hypertension increased from 11.8% to 34.5%. However, contraceptive type was not consistently associated with hypertension after adjustment. Age was significantly associated with recent BMI (adjusted coefficie