Depot injection bone health — DRCOG MCQ

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HardContraceptionDepot injection bone healthDRCOG

A 17-year-old requests DMPA because privacy and four-times-yearly dosing suit her. She has no fracture history, eating disorder or glucocorticoid use. Which bone-health message is accurate?

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Correct answer: E — Counsel about usually reversible DMPA-associated bone-density loss

The best answer is “Counsel about usually reversible DMPA-associated bone-density loss”. DMPA can be used by adolescents after individual assessment, but counselling should include its association with a reduction in bone mineral density that is usually recovered after stopping. The decision balances contraceptive priorities against additional bone-health risks. Routine DXA is not required in an otherwise healthy adolescent, and there is no automatic one-year limit. UK contraceptive decisions use UKMEC 2025, not US MEC, and require method-specific rather than class-wide reasoning. Oestrogen-related stroke and thrombosis risks may rule out CHC while leaving progestogen-only or intrauterine methods available. Emergency contraception and quick-start decisions additionally require precise timing and follow-up pregnancy testing.

Reference: FSRH: Progestogen-only pills: https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-ceu-clinical-guideline-progestogen-only-pills-aug22-amended-11july-2023-.pdf