Media Advisories
New recommendations from national ob/gyn society address Depo-Provera®, bone loss
May 11, 2006
Ottawa, Ontario - The Society of Obstetricians and Gynaecologists of Canada (SOGC) today released new guidelines for Canadian healthcare professionals to provide clear recommendations on the use of the injectable contraceptive Depo-Provera® (Depot Medroxyprogesterone Acetate [DMPA]). The guidelines arrive following industry and government warnings linking the drug to the loss of bone-mineral density (BMD).
Use of the hormonal contraceptive has plummeted since November 2004, when the United States Food and Drug Administration and Depo-Provera® maker Pfizer issued a "black box" warning concerning the long-term use of Depo-Provera® and its effect on bone-mineral density (BMD). In June 2005, Health Canada followed suit, issuing a public advisory to Canadian women.
"There is certainly strong evidence that Depo-Provera is linked to loss of bone-density, and patients need to be carefully informed of the potential risks of this loss," said Dr. André B. Lalonde, Executive Vice-President of the SOGC. "Much research still needs to be done in this area, but this new guideline encompasses the best evidence available and is certainly a step in the right direction."
Research has confirmed that use of DMPA is associated with a decrease in bone-mineral density, though this decrease has not been shown to result in adverse outcomes such as osteoporosis or fractures. There is also evidence that the majority of this bone-loss is temporary, as bone-mineral density is regained once the contraceptive is stopped.
A similar loss and recovery of bone-mineral density is experienced by women who breastfeed their children, who may lose 4% - 5% of their bone-mineral density after breastfeeding over six months. This density is then recovered once breastfeeding is discontinued.
The new SOGC guidelines recommend that healthcare professionals carefully weigh the risks and benefits of Depo-Provera® before prescribing the medication. Patients should be informed about the potential decrease in bone density. The guideline also recommends that healthcare professionals counsel their patients on ways to improve their "bone health" such as calcium and vitamin D supplementation and smoking cessation.
"Depo-Provera is not recommended for everyone," said Dr. Amanda Black, principal author of the guideline and Chair of the SOGC's Contraception Awareness Project. "But, for some women - such as women who can't take estrogen, women who are over 35 and smoke, or women who have trouble remembering to take a pill each day - the benefits of an effective contraceptive may outweigh these risks."
Key Recommendations:
- Healthcare providers should inform patients of the potential effects of Depo-Provera® on bone-mineral density and counsel them on "bone health", including calcium and vitamin D supplements, smoking cessation, weight-bearing exercise, and decreased alcohol and caffeine consumption.
- SOGC endorses the World Health Organization recommendation that "there should be no restriction on the use of DMPA; including no restriction on the duration of use, among women aged 18 to 45 who are otherwise eligible to use the method".
- The overall risks and benefits of continuing DMPA use should be discussed with DMPA users at intervals throughout the course of treatment.
- Current evidence does not support performing routine BMD testing in DMPA users.
- The new guidelines will be published in the SOGC's peer-reviewed medical journal, The Journal of Obstetrics and Gynaecology of Canada (JOGC).
What is Depo-Provera®?
Depo-Provera® is an injectable contraceptive that is administered by a healthcare professional every 12-13 weeks. It contains the hormone progestin (MPA) but it does not contain estrogen. It is over 99% effective in preventing pregnancy. It may be recommended for women who cannot take estrogen, or women who have trouble adhering to other birth control regimens such as birth control pills, which are taken daily. Aside from birth control, Depo-Provera® may be used to treat certain medical conditions such as endometriosis, menorrhagia, dysmenorrhea, and other conditions where menstrual suppression is advantageous.
About the SOGC and the Contraception Awareness Project
The SOGC is one of Canada's oldest national specialty organizations. Established in 1944, the Society's mission is to promote excellence in the practice of obstetrics and gynaecology and to advance the health of women through leadership, advocacy, collaboration, outreach and education. The SOGC represents obstetricians/gynaecologists, family physicians, nurses, midwives and allied health professionals in the field of sexual reproductive health.
Administered by the SOGC, the Contraception Awareness Project is a national initiative aimed at raising contraception and safer sex awareness in the public as well as in the medical community. Built on three pillars, the Contraception Awareness Project promotes contraception use and adherence; safer sexual practices and; sexual well-being free from coercion. The Contraception Awareness Project administers the sexual health website www.sexualityandu.ca, which was selected as one of the top five e-health applications in the world at the 2005 World Summit Awards in Tunisia.
Last Modified: September 5, 2006
