Use of hormonal contraception in adolescents: skeletal health issues

Abstract

To summarize the current literature regarding the effects of hormonal contraceptives on adolescents' bone health. Use of progestin-only pills, implant and progestin-releasing intrauterine device is associated with low systemic progestin levels that do not appear to impact ovarian estradiol production or bone mineral density (BMD). In contrast, higher systemic progestin levels associated with the use of depot medroxyprogesterone acetate and combination oral contraceptives suppress ovarian estradiol production and reduce acquisition of BMD in teenagers and young adult women who use injectable and oral contraceptives. Although BMD is a predictor of the risk of fracture in postmenopausal women, the clinical implications of BMD changes in teenagers and young women are unknown. Following the hypoestrogenemia associated with the use of depot medroxyprogesterone acetate or lactation, BMD deficits have been found to completely reverse. Although BMD data following combination oral contraceptive use in adolescents is sparse, observations suggest that rapid and complete reversibility of BMD deficits is likely. Although more data on skeletal health outcomes following the use of oral and injectable contraceptives would be welcomed, theoretic concerns regarding the impact of depot medroxyprogesterone acetate and combination oral contraceptive use on adolescent and young women should not restrict the initiation or continuation of these important contraceptive methods.