Bone mineral density in a cohort of adolescents during use of norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives and after discontinuation of norethisterone enanthate

Contraception. 2009 May;79(5):345-9. doi: 10.1016/j.contraception.2008.11.009. Epub 2009 Jan 17.


Background: Depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives (COCs) have been shown to have a negative effect on bone mineral density (BMD) in adolescents. The aim of this study was to investigate BMD in 15- to 19-year-old new users of DMPA, NET-EN and COCs.

Study design: This 5-year longitudinal study followed up new users of DMPA (n=115), NET-EN (n=115) and COCs (n=116) and 144 nonuser controls. BMD was measured at the distal radius using dual-energy X-ray absorptiometry.

Results: BMD increased in all groups (annual percent increase: nonusers, 1.49%; DMPA, 1.39%; NET-EN, 1.03%; COCs, 0.84%) during follow-up (p<.001). There was evidence for lower BMD increases per annum in NET-EN (p=.050) and COC (p=.010) users compared to nonusers but no difference between DMPA and nonusers (p=.76). In 14 NET-EN discontinuers, an overall reduction of 0.61% per year BMD was followed upon cessation by an increase of 0.69% per year (p=.066).

Conclusion: This study suggests that BMD increases in adolescents may be less in NET-EN and COC users; however, recovery of BMD in NET-EN users was found in the small sample of adolescents followed post-discontinuation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Bone Density / drug effects*
  • Contraceptives, Oral, Combined / pharmacology*
  • Delayed-Action Preparations
  • Female
  • Humans
  • Medroxyprogesterone Acetate / pharmacology*
  • Norethindrone / analogs & derivatives*
  • Norethindrone / pharmacology
  • Prospective Studies
  • Young Adult


  • Contraceptives, Oral, Combined
  • Delayed-Action Preparations
  • Medroxyprogesterone Acetate
  • norethindrone enanthate
  • Norethindrone