Abstract
The long-acting progestogen injectable contraceptives depot medroxyprogesterone acetate and norethisterone enanthate have been found to adversely affect bone mineral density in adult premenopausal women and adolescents. The effect of combined oral contraceptives on bone mineral density is variable, with no effect reported in premenopausal women; however, growing evidence suggests that low-dose combined oral contraceptives may be detrimental to bone mineral density in adolescents and young women. Much less information is available on other hormonal methods. Concerns regarding bone loss in depot medroxyprogesterone acetate users resulted in a US FDA black-box warning for this method. No restriction has been placed on the use of other progestogen-only or combined oral contraceptive methods. There are now concerns that these recommendations should be reviewed as new information emerges regarding low-dose combined oral contraceptives and evidence grows that supports recovery of bone mineral density postdiscontinuation of depot medroxyprogesterone acetate. There is a need to balance loss of bone mineral density with the benefit of effective contraception, especially in adolescents.
Financial & competing interests disclosure
The authors would like to acknowledge the William and Flora Hewlett Foundation for their support. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.