Longitudinal evaluation of perimenopausal bone loss: Effects of different low dose oral contraceptive preparations on bone mineral density
Introduction
Low bone mineral density is an important determinant of fracture risk and the chronic hypoestrogenism in the first postmenopausal years can cause a critical bone density decrease [1], [2], [3], [4]. Hormone replacement therapy prevents the reduction in bone density related to the postmenopausal hypoestrogenism [5], [6]. During the menopausal transition, a progressive impairment in bone metabolism and a significant bone loss can occur, particularly in women suffering from hypoestrogenic oligomenorrhea [7], [8], [9], [10], [11]. We have reported that the administration of oral contraceptives (OC) containing low dose ethinyl estradiol is able to prevent the perimenopausal decrease in radial [10], vertebral [11] and femur [12] bone density. However, the bone effects of different doses, type and preparations may differ. The possible effects of different steroids in the modulation of bone metabolism and density have been recently reviewed and discussed [13]. The aim of the present study was to evaluate the possible effects of different progestins contained in OC preparations with the same ethinyl estradiol (20 mcg) content on spine bone density in perimenopausal women.
Section snippets
Materials and methods
In the present study, we enrolled women, aged 40–49 years, attending the Menopause Clinic of our Department. Bone density was measured as a part of the screening program for perimenopausal women. Out of them, 20 women reported regular menstrual cycles, while 80 women experienced oligomenorrhea in the 3–6 months before they entered the study. Oligomenorrhea was defined as episodes of menstrual bleeding occurring at intervals of more than 35 and less than 90 days. Regardless to their menstrual
Results
There were no significant differences in age, body mass index (BMI) (Table 1), hormone values and spine BMD (Table 2), in the different groups before the study. During the 24 months observation period, no modification in the menstrual pattern or in plasma hormone levels was observed in eumenorrhoic women (Table 2). Conversely, in oligomenorrhoic subjects an increase in cycle length was evident, with a significant (p < 0.05) increase in circulating plasma FSH, that paralleled a significant (p <
Discussion
To our knowledge, this is the first longitudinal study that evaluates the possible influence of different progestins on the OCs effects on BMD in perimenopausal women. These results confirm that a gradual decrease in spine bone density takes place during the perimenopausal years [7], [8], [9], [10], [11], [12]. The bone loss characterises the perimenopausal women suffering from hypoestrogenic oligomenorrhea. In fact, no evidences of a bone loss was evident in age-matched, normally menstruating
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Cited by (39)
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No. 329-Canadian Contraception Consensus (Part 4 of 4): Chapter 9 - Combined hormonal contraception
2017, Journal of Obstetrics and Gynaecology CanadaThe combined oral contraceptive pill- recent developments, risks and benefits
2014, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Androgen-sensitive hair growth is also altered with COC use; hair shaft diameter is reduced, with maximal benefits being observed after one to two years of use [45]. Perimenopausal and postmenopausal women (over the age of forty) using COC tend to gain or preserve bone mineral density (BMD) while non-users experience typical age-related bone losses [46–54]. Other women with hypoestrogenic conditions (e.g. hypothalamic amenorrhea) treated with COC also demonstrate increases in BMD [55–57].
Impact of oral contraceptive on bone metabolism
2013, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :A review paper1 of 13 studies in women using low-dose oral contraceptives reported a positive effect of COC on BMD in 9 studies and 4 studies did not show an association. It is during the late perimenopausal years that the bone effect of COC appears the most relevant in preventing the activation of bone metabolism and the decrease in BMD.2–8 In perimenopausal oligomenorrheic women, the progressive ovarian failure is associated with a decreased production of estradiol which activates bone turnover with a subsequent increase in bone loss.
Hormonal contraception and bone metabolism: A systematic review
2012, ContraceptionCitation Excerpt :In this study, the prevalence of fracture did not differ between ever-users and never-users or by duration (in years) of COCs use. In summary, evidence from prospective studies suggests that use of COCs in perimenopausal women may reduce bone demineralization and could significantly increase BMD even at a 20-mcg dose [163,164]. Most cross-sectional studies indicate that having ever-used COCs is not associated with differences in comparison to women who have never used COCs in BMD values at any anatomical site, after the menopause.