Access to Contraception: A Critical Need
Access to contraception is incredibly important, especially for younger women or those who don’t have access to medical termination of pregnancy. Each year, millions of unintended pregnancies occur, often among adolescents who have less access to healthcare and lower health literacy. Ensuring access to contraception is crucial in addressing this issue.
Choosing the Right Contraception
I’m often asked what the “best” contraception is, and the answer is that there is no one-size-fits-all solution. The best contraception is the one that suits the individual patient’s needs. Personally, I use the pill, but it’s not appropriate for everyone.
Depo-Provera and Bone Health
I want to highlight a clinical issue I frequently encounter: patients with severe osteoporosis who have been on the Depo-Provera injection every 12 weeks for many years, sometimes decades, without being aware of its negative impact on bone density. Depo-Provera contains a high dose of synthetic progesterone called Medroxyprogesterone, which lowers estrogen levels below the bone-protective range, leading to a decrease in bone density by a few percent per year. This can increase the risk of fractures and stress fractures.
Understanding the Risks
Data generally shows that bone density improves once Depo-Provera is stopped, but long-term use can result in a significant decrease in bone density. There is a black box warning on the medication due to its impact on bone density. If you are using Depo-Provera, don’t worry, but if you plan to use it for more than a year or have other risk factors for osteoporosis, such as coeliac disease or a family history, I recommend bone density screening and discussing with your doctor whether it’s the most suitable contraceptive for you in the long term.
Other Contraceptive Options
The pill and Implanon may slightly decrease bone density in adolescents, but the impact is very small to negligible compared to Depo-Provera. Depo-Provera still plays an important role in contraception, especially in the short term for younger people, but long-term use needs to be carefully considered.
Making Informed Decisions
Both contraception and bone health are important to prevent future fractures. What’s right for you may be different from others, and the key is to make informed decisions in consultation with your doctor. 👩🏼⚕️