Medroxyprogesterone and bone mineral density and long term use

Medroxyprogesterone and bone mineral density

Women using medroxyprogesterone contraception have a small reduction in bone mineral density (BMD) while using this method of contraception, which may be at least partly reversible on discontinuation. It is not known whether this increases the risk of osteoporosis in later life. The effect on BMD may be most marked in adolescents, who have yet to achieve their peak bone mass. For adolescent women, the MRHA recommends that medroxyprogesterone is prescribed as first line contraception only after other methods have been discussed and deemed unsuitable or unacceptable.

Whilst further clarification of this is awaited, suggested management in women who wish to continue with this method of contraception follows (see below). Gonadotrophin checks or oestrogen replacement are not advised.

Long term use of medroxyprogesterone - longer than 2 years

If medroxyprogesterone is used for longer than 2 years, regardless of bleeding pattern:

1. Discuss effects of DMPA on bone density and uncertainty about risk of later osteoporosis/fracture.
2. Review risk factors for osteoporosis: alcohol, exercise, diet, smoking, family history, medical conditions, e.g. Crohn’s, or drug use, e.g. steroids.
3. Discuss alternative forms of contraception.
4. Document discussion and client’s choice in notes.
5. Continue client contraceptive method of choice
6. Review indications, risk factors, alternatives every 2 years