REVIEW  BONE HEALTH IN WOMAN’S REPRODUCTIVE LIFE AND POSTMENOPAUSE 

Minerva Obstetrics and Gynecology 2021 December;73(6):678-96

DOI: 10.23736/S2724-606X.20.04688-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Bone health and hormonal contraception

Morena L. ROCCA ¹ ✉, Anna R. PALUMBO ², Giovanna BITONTI ², Caterina BRISINDA ², Costantino DI CARLO ²

¹ Operative Unit of Obstetrics and Gynecology, Pugliese-Ciaccio Hospital, Catanzaro, Italy; ² Department of Obstetrics and Gynecology, Magna Græcia University of Catanzaro, Catanzaro, Italy

INTRODUCTION: Short-term and long-term steroid contraceptive systems are widely employed in adolescents and premenopausal women; they could induce variation in bone metabolism, but whether these changes increase the overall fracture risk is not yet clear.
EVIDENCE ACQUISITION: A systematic search of scientific publications about “hormonal contraceptives” and “bone metabolism” in reproductive age women was conducted.
EVIDENCE SYNTHESIS: In adolescent girl, combined oral contraceptives could have a deleterious effect on bone health when their onset is within three years after menarche and when they contain ethinyl estradiol at the dose of 20 mcg. In perimenopausal women, steroid contraceptives seem not influence bone health nor increase osteoporotic fractures risk in menopause. The oral progestogens intake is not related to negative effects on skeletal health. Depot medroxyprogesterone acetate (DMPA) induce a prolonged hypoestrogenism with secondary detrimental effect on healthy bone; the higher bone loss was observed at the DMPA dose of 150 mg intramuscular such as after long-term DMPA-users. Progestin-based implants and intrauterine devices have not negative effect on bone health.
CONCLUSIONS: Since sex-steroid drugs induce variations in hormonal circulating concentrations, they may negatively affect bone metabolism. Contraceptive choice should be tailored evaluating any possible effect on bone health. Clinicians should always perform a precontraceptive counselling to identify any coexisting condition that may affect bone health. Further randomized studies are needed to confirm these results.

KEY WORDS: Bone density; Contraceptive agents, hormonal; Menopause; Osteoporosis