How to prevent Bone loss in long term progesterone monothrfapy

Quite often we prescribe synthetic progesterone in cases of A) senile endometritis  as diagnosed with the onset of symp of  Postmeno bleeding)  and or  Ormeloxifene (Sevista)  for months together B) similarly in meno (AUB) or say endometrioses we sometimes prescribe  MPA/ Primolut N for months together  .  But does such therapy cause bone loss??  If so how, then to  prevent bone loss  in women who is on long term progesterone therapy ?? .

A)                   Dose of MPA:-If medroxyprogesterone were taken instead of Primolut N / Crina R to control senile endometritis or say Endometrial hyperplasia then the dose  will be initially is 10 mg in the morning and evening. As with progesterone, this suppressive dose should be continued for six months, then once a day for another month or two and finally cyclically for a further six months.

Steps for prevention of bone  loss when long term progesterone therapy is planned be it cycling women or postmenopausal women ??:-Can we use natural progesterone & suppl Ca & Vit D?? For this reason it is very important to do the following things to prevent bone loss.

1.  Take elemental calcium in a total daily dose of 2000 mg/d. Calcium is not stored so it is best absorbed when spread across the day with meals and at bedtime. Calcium can be obtained from foods (a glass of milk -250 ml of milk or a fortified beverage provides 300 mg of calcium) and supplements taking a maximum dose of 500 mg at a time.

2.  I would recommend 800-1200 IU of vitamin D a day to assist in the absorption of calcium. It can be taken all at once.

3.  Continue to be physically active with at least a half an hour a day of walking.

4.  Don’t lose weight as because more weight (I mean NORMAL BMI will maintain endogenous oestrogen from adipose tissue.  I think that using natural progesterone to suppress endometrial growth is safer than other therapies. Why?

A)  First, natural progesterone stimulates new bone formation. If bone loss can be controlled by higher doses of calcium and vitamin D, progesterone will be less negative for bones than other suppressive therapies.

B)  Second, natural progesterone suppresses the ovaries without causing hot flushes like GnRH agonist therapy does

C) Third, progesterone has no side effects such as hair growth or acne like danazol does.

D) Fourth, this treatment is flexible and can be adjusted based on a women’s See The ABCs of Osteoporosis Prevention for Premenopausal Women). Note that any medicine that suppresses periods will lower estrogen levels will cause bone loss (much like DepoProvera  does).