Have clients aged over 40 on Depo-Provera (DMPA) attending
our Community Contraception and Sexual Health Clinic (CASH) had a documented
discussion on ‘bone health’ in the last two years?
L V Mather, N Mullin
Contraception and Sexual Health, Cheshire West PCT, Cheshire,
United Kingdom
The Faculty of Family Planning and Reproductive Health Care, UK,
recommends women should be informed of the association between DMPA and bone
mineral density (BMD) and women with additional risk factors for low BMD should
be discouraged from using DMPA (Contraceptive use in women over 40, January
2005). The Committee for Safety on Medicines, UK, November 2004, stated “in
women of all ages, careful evaluation of the risks and benefits of treatment
should be carried out in those who wish to continue to use DMPA for more than
two years. In women with significant lifestyle and/ or medical risk factors for
osteoporosis other methods should be considered.” All clinical staff
working for CASH received the written guidance on this issue.
Method In 2005 an audit was undertaken to determine if
clients over 40 years on DMPA had a documented review regarding DMPA use and its
effect on BMD within the last 2 years. The audit standard was 100%. Data was
collected from a well attended city centre clinic (1200 client contacts in 2005)
reviewing attendance for a consecutive three month period of all women over 40
years of age on DMPA.
Results We found 17 women using DMPA aged over 40 (total
number of clients using DMPA was 192). Their mean age was 43 and mean duration
of use was 4.5 years. Fourteen out of seventeen case notes were reviewed
(82.4%). Evidence of a discussion about bone health in last 2 years occurred in
10/14 (71%) of cases. The documentation ranged from “BMD discussed” to
“osteoporosis discussed” to full documentation addressing all risk
factors for osteoporosis. Half the women were smokers but only 2 (14.3%) had
documentation on alcohol consumption. Most, 11/14 (78.6%) had a review of
medical and family history. Four women had an obvious relative contraindication
to DMPA or osteoporosis risk but continued using DMPA. Nearly half 6/14 (42.8%)
had a discussion regarding alternative methods of contraception.
Conclusion Many clients 71% (10/14) had some discussion
regarding BMD but there was no consistent content or documentation. Staff
training and a re-audit is planned.