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.