The Impact of Progestin-Based Contraceptives on Bone Mineral Density Compared to Estrogen-Based and Non-Hormonal Methods: A Systematic Review

Abstract

Objective: To determine whether or not the long term use of injectable contraceptives (depot medroxyprogesterone acetate) results in loss of bone mass or density, compared to non-hormonal birth control. Methods: Literature was collected from Pub Med, Google Scholar, and CINAHL in January and February of 2026. Observational studies investigating BMD and DMPA vs OC or other non-hormonal contraceptives were selected. Ten studies met this criteria. Results: Nine studies reported that long-term DMPA use was associated with decreased BMD. Conversely, estrogen-based contraceptive use lead to stable or increased BMD. One study found no significant difference compared to non-hormonal methods. Overall, progestin-based contraceptives were related to a reduction in BMD, while estrogen-based or non-hormonal contraceptives conveyed little negative impact on BMD. Conclusions: The overall evidence supports a consistent trend of BMD being reduced with use of progestin based contraceptives, mostly with long-term exposure, while use of estrogen-based contraceptives was seemingly less harmful to BMD and overall bone health. Further research is needed to determine the long term health impacts of reduced BMD during adolescence.