Abstract
BackgroundThe aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants. This is a continuation of a previous study in which BMD was evaluated at baseline and at 18 months of use.MethodsA total of 111 women, 19–43 years of age, wererandomly allocated to use one of the two implants. At 36 months of follow-up, only 36 and 39 women were still using the ENG- and LNG-releasing implants, respectively. BMD was evaluated at the distal and at the ultra-distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry.ResultsThere was no difference in the BMD of users of either implant at 18 and at 36 months. BMD was significantly lower at 18 and at 36 months at the distal radius in both groups of users compared to pre-insertion values; however, no difference was found at the ultra-distal radius.ConclusionWomen 19–43 years of age using either one of these two contraceptive implants for 36 months had lower BMD values at the distal radius compared to pre-insertion values; however, no difference was found at the ultra-distal radius.
Highlights
The aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants
A recommendation issued by the World Health Organization (WHO) established some restrictions to the use of depot-medroxyprogesterone acetate (DMPA), principally in adolescents and in women in the menopausal transition [11], it has established that the data on levonorgestrel (LNG)-releasing implants suggest no adverse effect on BMD and recommended no restriction on the use of other ponlycontraceptive methods by women who are eligibleto use them [11]
Our results show that there were no significant differences in BMD at ultra-distal radius, in which trabecular bone predominates, between the users of the two types of subdermal contraceptive implants prior to implant insertion or at 18 and at 36 months of use, and these results were almost identical to those found at pre-insertion and at 18 months of use [15] albeit there was a significant reduction in BMD at the distal radius in both groups of women
Summary
The aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants. Users of hormonal contraceptives include women of different ethnic groups and ages, ranging from adolescence through the final reproductive years. The impact of these contraceptive methods on BMD may be measured during use, after discontinuation or in the post menopause, and may be evaluated according to bone loss or risk of osteoporotic fracture [1]. Reproductive Health 2007, 4:11 http://www.reproductive-health-journal.com/content/4/1/11 known that the use of some of the p-only contraceptive methods, mainly the injectable depot-medroxyprogesterone acetate (DMPA), affects serum levels of estradiol [4,5] For this reason and based on several publications showing that the use of DMPA may affect BMD [4,6,7,8], the US Food and Drug Administration [9] and the United Kingdom Committee on the Safety of Medicines [10] required inclusion in the package insertof DMPA of a warningthat the drug may impair BMD.
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