Rational use of oral contraceptives in the perimenopausal woman
Connell, E.B.
Journal of Reproductive Medicine 38(12 Suppl): 1036-1040
1993
ISSN/ISBN: 0024-7758 PMID: 8120861 Document Number: 418693
Few family planning specialists are examining the potential bone-protective effects of oral contraceptives (OCs) in premenopausal and perimenopausal women. Osteoporosis is a major public health problem worldwide, as reflected in its associated morbidity and mortality and economic impact. For example, more than 25 million people in the US have osteoporosis, which costs society $7-10 billion each year. These costs are largely due to the more than 1.3 million fractures each year. The 250,000 hip fractures are responsible for the highest personal and societal cost. 12-20% of women with a hip fracture die within 2-3 months of the fracture. At least 50% need assistance with daily activities. Clinicians and public health specialists are not putting their energy into developing strategies that may preserve bone density in the premenopausal and perimenopausal years. More emphasis is needed on such strategies, since menopause is the time when bone loss accelerates. Clinicians do stress hormone replacement as a preventive therapy, but this is restricted to postmenopausal women. Extensive research and development of lower-dose OCs and data on appropriate screening of women with risk factors (e.g., smoking, obesity, and hypertension) demonstrate that healthy, nonsmoking women can use OCs safely and effectively throughout most of their reproductive years. Perhaps OC use can provide women the noncontraceptive benefit of maintenance and build up of bone mass up to menopause.