Bone health and hormonal contraception

Hormonal contraception, including progestin-only and combined estrogen and progestin methods, represent the majority of commonly used, effective, reversible contraceptives available. However, observed changes in bone mineral density (BMD) among users of these methods have prompted concerns about skeletal health. This chapter aims to review current knowledge about the association between hormonal contraception and bone density, and the observed or possible consequences of those changes resulting from exposure at various time points across the life cycle. In addition, the hypoestrogenic effects of lactation will be considered in this discussion. Most of the chapter focuses on the impact of hormonal contraceptive use on bone health in healthy women and adolescents. In addition, consideration will also be given to the use of hormonal contraception in women at elevated risk for impaired bone health.