Hormonal contraception and bone mineral density. (May 2011)

• Record Type: Journal Article
• Authors: Beksinska, Mags E; Smit, Jennifer A
• Is Part Of: Expert review of obstetrics & gynecology. Volume 6:Number 3(2011)
• Page Start: 305
• Page End: 319
• Publication Date: 2011-05
• Subjects: adolescents -- bone mineral density -- combination contraceptives -- progestogen-only contraceptives -- women; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618.05
• DOI: 10.1586/eog.11.19
• Languages: English
• ISSNs: 1747-4108

Abstract

The long-acting progestogen injectable contraceptives depot medroxyprogesterone acetate and norethisterone enanthate have been found to adversely affect bone mineral density in adult premenopausal women and adolescents. The effect of combined oral contraceptives on bone mineral density is variable, with no effect reported in premenopausal women; however, growing evidence suggests that low-dose combined oral contraceptives may be detrimental to bone mineral density in adolescents and young women. Much less information is available on other hormonal methods. Concerns regarding bone loss in depot medroxyprogesterone acetate users resulted in a US FDA black-box warning for this method. No restriction has been placed on the use of other progestogen-only or combined oral contraceptive methods. There are now concerns that these recommendations should be reviewed as new information emerges regarding low-dose combined oral contraceptives and evidence grows that supports recovery of bone mineral density postdiscontinuation of depot medroxyprogesterone acetate. There is a need to balance loss of bone mineral density with the benefit of effective contraception, especially in adolescents.