Hormonal contraception and bone mineral density: Unique issues in adolescent and young adult women

This article offers a review of the relevant literature over the past decade on the relationship between bone mineral density (BMD) and selected forms of hormonal contraception, specifically, depot medroxyprogesterone (DMPA) and oral contraceptives (OC) in women younger than 30 yr of age. In summary, findings to date suggest an adverse impact of DMPA and ultra-low-dose (20 μg ethinyl estradiol) OCs on BMD in young women. The effects appear independent of age; however, the acquisition of optimal peak bone mass, particularly in adolescents, may be impeded in young women utilizing these types of hormonal contraception. Several mitigating issues also need to be considered in evaluating prescription of DMPA and OCs in young women. These include the following: (1) likelihood of at least partial recovery of BMD after cessation of contraceptive method; (2) the short duration of use common among young women, thereby self-limiting loss; (3) the real need for and benefit of effective and appealing contraceptives in this age group; (4) the feasible management approach that appears to ameliorate the problem, i.e., adding estrogen supplementation, in those receiving DMPA or in prescribing a low-dose instead of an ultra-low-dose OC in a young woman.