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Area of Science:

  • Reproductive Endocrinology
  • Bone Metabolism
  • Pharmacology

Background:

  • Steroid contraceptive systems are common in adolescents and premenopausal women.
  • Potential impact on bone metabolism and fracture risk requires clarification.

Purpose of the Study:

  • To systematically review the effects of hormonal contraceptives on bone metabolism in reproductive-aged women.
  • To clarify the association between contraceptive use and fracture risk.

Main Methods:

  • Systematic literature search on "hormonal contraceptives" and "bone metabolism" in reproductive-aged women.
  • Analysis of studies examining effects on bone health and fracture risk.

Main Results:

  • Combined oral contraceptives may negatively impact bone health in adolescent girls within three years of menarche, especially with 20 mcg ethinyl estradiol.
  • Depot medroxyprogesterone acetate (DMPA) can cause hypoestrogenism and bone loss, particularly at 150 mg IM and with long-term use.
  • Perimenopausal women using steroid contraceptives and users of progestin implants or IUDs show no significant negative effects on bone health or fracture risk.

Conclusions:

  • Sex-steroid contraceptives can alter circulating hormone levels, potentially affecting bone metabolism.
  • Contraceptive selection should consider individual bone health, necessitating pre-contraceptive counseling.
  • Further randomized controlled trials are needed to validate these findings.