Does over-the-counter (OTC) progestin cause loss of bone density?

From the Guidelines

Over-the-counter progestin is not available, and thus, it does not cause loss of bone density, as progestin-only contraceptives are prescription medications. When considering the potential impact of progestin on bone density, it's essential to look at the specific types of progestin-only contraceptives and their effects. According to the study by 1, Depot medroxyprogesterone, a form of contraception, can cause amenorrhea and hence prolonged use can adversely affect bone mineral density (BMD), and adolescent bone mass accrual, which is reversible to a certain extent on discontinuation. Key points to consider include:

• The effect of progestin on bone density is primarily a concern with specific types of contraceptives, such as Depo-Provera, which has been linked to bone density loss due to its suppression of estrogen production 1.
• Other progestin-only methods generally do not have the same effect on bone density because they do not suppress estrogen to the same degree.
• If concerned about bone health while using hormonal contraception, discussing appropriate options with a healthcare provider, including the potential benefits of calcium and vitamin D supplements, is recommended. Given the information from 1, the primary concern regarding bone density loss is associated with prescription medications like Depo-Provera, not over-the-counter progestin, which is not available.

From the Research

OTC Progestin and Bone Density

• The relationship between over-the-counter (OTC) progestin and bone density is complex, with varying effects depending on factors such as age, dosage, and type of progestin 2, 3, 4, 5, 6.
• Some studies suggest that progestin-only contraception may be associated with a decrease in bone quality, particularly in young women who start using it shortly after pubertal development 5.
• However, other studies have found no evidence of a bone-protective or estrogen-antagonistic effect of progestins in postmenopausal women, and some progestins may even have negative effects on bone due to their inherent glucocorticoid activity 5.
• The use of depot medroxyprogesterone acetate (DMPA), a type of progestin-only contraception, has been associated with reduced bone mineral density, particularly with long-term use (> 2 years) 6.
• The FDA has added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use 6.

Factors Influencing Bone Density

• Age: Adolescent and perimenopausal women may be more susceptible to the effects of progestin on bone density 3, 6.
• Dosage: High-dose progestins may have more significant effects on bone density than low-dose progestins 5.
• Type of progestin: Different progestins may have varying effects on bone density, with some having more negative effects than others 4, 5.
• Duration of use: Long-term use of progestin-only contraception may be associated with a higher risk of bone loss 6.

Clinical Recommendations

• Women using progestin-only contraception should be aware of the potential risks to bone density and discuss their individual risk factors with their healthcare provider 6.
• Alternative forms of contraception may be recommended for women at high risk of bone loss or with a history of osteoporosis 4, 6.
• Regular monitoring of bone density may be necessary for women using progestin-only contraception, particularly those with risk factors for osteoporosis 6.