The pill and bone health: does hormonal contraception impact bone mass?

A pill packet

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Strong Women


The pill and bone health: does hormonal contraception impact bone mass?

By Chloe Gray

2 years ago

3 min read

The pill is often prescribed as a way of maintaining bone health for those with hormonal imbalances. But are contraceptives really the way to improved bone density?

From endometriosis to painful PMS, millions of women use hormonal contraception for reasons other than to prevent pregnancy. But we’re learning more and more that the pill and other contraceptive methods aren’t the cure-alls they were once sold to us as. While they might help with acne, we also know that they can impact our mental health. They might regulate your cycles, but they also mask symptoms that might need investigation. 

We’re also learning more about the effect the pill can have on our bone health. Any woman with irregular or missing periods caused by hormonal irregularities has likely been advised to go on the pill, with one of the reasons being to protect their bones. In fact, a 2021 paper on college students found that 73% of women with menstrual irregularities use hormonal contraception for cycle consistency. 

“Oestrogen is the queen of bone health. We need that hormone to build and maintain healthy bone mass,” says endocrinologist Nicky Keay, author of Hormones, Health And Human Potential. “If you look at the packet of the combined pill, you’ll definitely see that it contains a synthetic type of oestrogen that replaces your own cycle to stop ovulation. 

“It’s instinctive that doctors would think that would be OK to support the bones while you don’t have a lot of natural osteogen, but the bones are very fussy. They want the oestrogen that your body makes and the synthetic hormone won’t have any impact on your bone health.”

A review from last year, published in Frontiers In Endocrinology, concluded that oral combined hormonal contraceptives do not change the bone mineral density of women with missing periods, and this can lead to stress or fragility fractures. For years, the Endocrine Society has advised against putting women with these types of cycles on the pill for this reason, but NICE only changed its guidance for GPs last year as a result of Keay’s work. 

A woman flexing her arm

Credit: Getty

In normal cycling women, the risks to your bones are less extreme. “If you’ve got some oestrogen in the bank and your bones are strong then you will probably not suffer from low bone density because of taking the pill. Your oestrogen will still be flatlined, but your other hormones like your thyroid will still be working normally to support your bones. It’s most problematic if you’re starting already in a bad situation of low hormonal profiles,” says Keay.

A 2020 paper by Stanford University noted that bone mineral density is similar or greater in women who have used combination oral contraceptives as compared to non-users. The one caveat is that “it is age dependent”, says Keay. Puberty is a key time for us to put down bone mass. Simultaneously, it’s a time when many girls begin hormonal contraception. “There is research to show that switching off the hormones during teenage years can stop initial bone mass developing. It’s a time when you really need those hormones to ensure that you’re in good stead for bone health,” explains Keay. 

A 2010 paper published in Contraception found that 19–30-year-old women’s bone mineral density was lower with longer contraceptive use, while studies in young people have reported bone mineral accumulation is compromised when hormonal contraceptives are used in the first three years after beginning their periods.

Try not to freak out if you’ve been on the pill since you were young. Bone mineral density can be built in adult life with strength training and nutrition. But with osteoporosis impacting over half of women over 50, it’s really important to get working on your bone strength.

“Combined contraceptives are still good options for many people with hormonal related conditions like endometriosis, and if you like your contraceptive option you don’t have to stop,” reminds Keay. Progesterone-only contraception doesn’t impact your bones in the same way as oestrogen-containing pills, although the mini pill is associated with other side effects, and non-hormonal contraception options, such as the copper coil, don’t seem to impact bone mass.

“It comes down to individual choices and knowing all the information about your contraceptives is important,” says Keay.

If your periods are irregular or missing or if you are worried about your bone health, talk to your GP. 


Images: Getty

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