E-Poster Presentation ESA-SRB-ANZBMS 2021

The negative impacts of depot medroxyprogesterone acetate on perimenopausal symptoms and bone mineral density in mid-life (#364)

Claudia Ashkar 1 , Shoshana Sztal-Mazer 1 2 3 , Susan Davis 1 2
  1. Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
  2. Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. Central Clinical School, Monash University, Melbourne, Victoria, Australia

A 55-year-old woman presented for endocrinologist assessment following 12 years of episodic sweats, heat intolerance, palpitations and migraines. She had undergone extensive investigations for these symptoms without a cause identified, but was recently diagnosed with tachycardia associated cardiomyopathy. The only other past history included a coccyx fracture 6 years ago. Physical examination revealed an overweight BMI (29kg/m2) without any features of endocrinopathy.

On further history her last menstrual period occurred at age 45 coinciding with vasomotor symptoms onset and insertion of an etonogestrel implant. This continued to be utilised until 51 years of age when she was changed to intramuscular depot medroxyprogesterone acetate (DMPA) three monthly, for two years during which her symptoms intensified.

Further investigation identified a low oestradiol level and elevated gonadotrophins, whilst DXA revealed osteoporosis (lumbar spine T score -3.3). On assessment, her symptoms were attributable to peri-/postmenopausal status.

Menopausal hormone therapy (MHT), oral 1mg oestradiol/ 5mg dydrogesterone was therefore commenced but soon ceased due to migraine with minimal improvement in vasomotor symptoms. She was then switched to topical oestradiol 0.06% gel and micronized progesterone, 100mg nocte. Her vasomotor symptoms, palpitations and general heat intolerance subsequently resolved at two-month review without worsening migraines.

This case illustrates the hypoestrogenic effect of progestin-only contraception which has overlapped the menopause transition, both contributing to osteoporosis. Progestin-only contraception use over age 50 causes reduction in bone mineral density and elevates cardiometabolic risk (1,2). DMPA, in particular, is associated with these adverse effects and thus not recommended as first line contraception in women over 45 and should be discontinued over 50. A literature review of such adverse effects attributable to progestin only contraception will be provided.  In conclusion, perimenopausal symptom recognition with MHT consideration is the key to improving quality of life and avoiding adverse health outcomes.

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  1. Curtis KM, Martins SL. Progestogen-only contraception and bone mineral density: a systematic review. Contraception 2006; 73(5): 470-87.
  2. Nappi C, Bifulco G, Tommaselli GA, Gargano V, Di Carlo C. Hormonal contraception and bone metabolism: a systematic review. Contraception 2012; 86(6): 606-621.