Progestin-Only Contraception and Bone Health

Purpose of Review

Progestin-only contraceptive methods are important and effective options for women trying to prevent unintended pregnancy. There is concern about progestin-only methods and bone health, particularly for depot medroxyprogesterone acetate (DMPA), because progestin-only methods can lower estradiol levels through ovarian suppression. This is of particular concern for adolescents building bone and perimenopausal women heading towards menopause.

Recent Findings

DMPA does cause temporary bone loss, but this is reversible after discontinuation. Evidence is limited as to whether the decreased bone density and subsequent reversal that is seen with DMPA use leads to an increased risk of fracture in the future. Two observational studies indicate a weak association between DMPA use and fracture risk. Progestin-only implants, pills, and the intrauterine device do not have an impact on bone mineral density or fracture risk.

Summary

Use of DMPA or any other progestin-only method should not be restricted due to a theoretical risk of fractures when reproductive-age women face the very real risk of pregnancy.