Common Questions
What happens to bone mineral density when DMPA is discontinued?
BMD increases in both adolescents and women, except for those who reached menopause, when DMPA use is discontinued (1).
Adolescents
There is only one longitudinal study looking at recovery of BMD after discontinuation of DMPA in adolescents (2). The girls who discontinued DMPA had a significantly greater increase in BMD at all anatomic sites at 12, 18, and 24 months compared to the non-users. The annualized adjusted mean percentage changes in BMD among discontinuers were 1.34%, 2.86%, and 3.56% for hip, spine and whole body, respectively, compared with -0.19%, 1.32% and 0.88% for the same sites in nonusers. Throughout follow-up, the discontinuers continued to gain BMD and the amounts did not differ by the duration of DMPA use. Adjusted mean BMD values for discontinuers were at least as high as those for nonusers at all follow-up periods. It is not clear whether the loss in BMD among adolescent users of DMPA prevents attainment of potential peak bone mass.
Women
BMD values in pre-menopausal women appear to return to those of comparable non-DMPA users over a period of 2-3 years (1).
There are several cross-sectional and longitudinal studies that examined BMD recovery in postmenopausal women with previous DMPA use after the age of 18 (3-8). In these studies, BMD increased at a greater rate in former users of DMPA compared to never users. Spinal BMD recovered more quickly and to greater amounts than hip BMD. Overall, BMD in postmenopausal women who previously used DMPA is similar to those who were never users. There does not appear to be a correlation between the mean BMD and the duration of DMPA use, the age of initiation or discontinuation of DMPA, or the time between DMPA discontinuation and menopause.
There is some evidence that women who use DMPA up until the time of menopause do not gain BMD after stopping the medication; however, they also appear to not suffer from the rapid bone loss that occurs early on in the postmenopausal estrogen deficient state (7).
- D'Arcangues C. WHO statement on hormonal contraception and bone health. Contraception 2006; 73(5): 443-444.
- Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM. Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Arch Pediatr Adolesc Med 2005; 159: 139-44.
- Orr-Walker BJ, Evans MC, Ames RW, Clearwater JM, Cundy T, Reid IR. The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post menopausal women. Clin Endocrinol 1998; 49: 614-18.
- Petitti DB, Piaggio G, Mehta S, Cravioto MC, Meirik O. Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. The WHO Study of Hormonal Contraception and Bone Health. Obstet Gynecol 2000; 95: 736-44.
- Cundy T, Cornish J, Evans MC, Roberts H, Reid IR. Recovery of bone density in women who stop using medroxyprogesterone acetate. BMJ 1994; 308: 247-8.
- Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM. Injectable hormone contraception and bone density: results from a prospective study. Epidemiology 2002; 13: 581-587.
- Cundy T, Cornish J, Roberts H, Reid IR. Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception. Am J Obstet Gynecol 2002; 186: 978-983.
- Curtis KM, Martins SL. Progestogen-only contraception and bone mineral density: a systematic review. Contraception 2006; 73: 470-487.