I was on Depo-Provera birth control for years, what can I do to help prevent osteoporosis now?

Depo-Provera is a progesterone-based contraceptive shot injected into the arm, upper thigh or abdomen. It is 97-99.7% effective in preventing pregnancy. Each shot lasts for about 13 weeks. While “the shot” is effective, there are significant side effects that are important to keep in mind if you are, were, or thinking of beginning this method of birth control. 

When Depo Provera was approved for use in the U.S. in 1992, preliminary research indicated that women who used Depo Provera experienced a loss of bone mineral density (BMD), which might put them at higher risk for osteoporosis and bone fractures later in life. The Food and Drug Administration (FDA) responded to this concern by requiring Depo Provera’s manufacturer to conduct post-approval studies to examine Depo’s effect on BMD. 

These studies found that women who use Depo-Provera Contraceptive Injection may lose significant bone mineral density. Bone loss is greater the longer Depo Provera is used. These losses may not be completely reversible. It is unknown if use of Depo-Provera Contraceptive Injection during adolescence or early adulthood, a critical period of bone growth, will reduce peak bone mass and increase the risk for osteoporotic fracture in later life. Depo-Provera Contraceptive Injection should be used as a long-term birth control method (e.g. longer than 2 years) only if other birth control methods are inadequate.

There are a number of things women of all ages can do to strengthen and protect their bones throughout their life. Getting enough calcium and vitamin D by eating a well balanced diet is the easiest way to protect your bones, while also incorporating fruits and vegetables and limiting alcohol and smoking. Exercising is also an effective way to strengthen your bones. The best workouts to incorporate into your routine are weight bearing and muscle strengthening exercises. 

As a long-acting, hormonal contraceptive method, Depo-Provera has advantages and disadvantages that each woman must assess with respect to her own life circumstances and health status. Depo Provera’s effect on BMD increases the need for women to receive thorough counseling and comprehensive education in order to make a fully informed decision about whether or not to use the shot, and for how long. Further research is needed to determine which women, if any, are most likely to experience irreversible BMD loss, and the full impact of any adolescent BMD loss on future fractures and/or osteoporosis.

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