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DMPA and bone health — DFSRH MCQ

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HardProgestogen-only methodsDMPA and bone healthDFSRH

A 35-year-old woman has used DMPA for 5 years and asks about bone health. She has a BMI of 19 kg/m2, smokes, and had a low-trauma wrist fracture last year. She wants to continue injections. What is the most appropriate management?

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Correct answer: D — Review DMPA risks and discuss an alternative method

The best answer is “Review DMPA risks and discuss an alternative method”. DMPA should be reviewed at least every 2 years for people who wish to continue it. A low BMI, smoking and a low-trauma fracture make this person’s bone-health context especially important, so benefits and risks should be revisited and alternatives discussed. DMPA does not cause permanent infertility, adding CHC is not a bone-protection strategy, and shortening the injection interval has no role.

Reference: CoSRH/FSRH, Progestogen-only Injectable Contraception (December 2014, amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/progestogen-only-injectable-december-2014-amended-11july2023.pdf