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Care of patients using progestogen-only injectables
  1. Deborah J Lee
  1. Associate Specialist in Sexual and Reproductive Health, Salisbury Department of Sexual Health, Salisbury Hospital, Salisbury, UK
  1. Correspondence to Dr Deborah J Lee, Salisbury Department of Sexual Health, Salisbury Hospital, Salisbury, Wiltshire SP2 8BJ, UK; Deborah.J.Lee{at}nhs.uk

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Why was change needed?

There has long been uncertainty as to how the continued use of the contraceptive injection depot medroxyprogesterone acetate (DMPA) affects bone mineral density (BMD). DMPA inhibits ovulation.1 Hence women on long-term DMPA may have relatively low estradiol levels, and some experience estrogen deficiency symptoms. Estrogen is integral to bone health.2 However, low serum levels of estradiol are not reliable indicators of BMD.3

What needed changing?

A systematic review by the National Institute of Health and Care Excellence4 concluded that DMPA use is associated with a small loss of BMD, but it appears that this recovers to normal or near normal when DMPA is discontinued. At present clinicians are advised to use DMPA judiciously. A risk–benefit equation should be undertaken for every patient to help them choose the most appropriate method of contraception. For women who are at risk of osteopenia or osteoporosis, methods other than DMPA may be preferable.

Two particular groups of patients represent higher risk groups for poor bone health and DMPA. The first are young teenagers who have not yet achieved their peak bone mass, and the second are older women (aged over 40–45 years) who have been using DMPA and who are now approaching menopause.

The 2014 Faculty of Sexual & Reproductive Healthcare (FSRH) guidance on the use of progestogen-only injectable contraception states that DMPA can be used in young …

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