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Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review
  1. S L Liu1,
  2. C M Lebrun2
  1. 1Queen’s University, Kingston, Ontario, Canada
  2. 2Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
  1. Correspondence to:
 Dr Lebrun
 Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Ontario N6A 3K7, Canada; clebrun{at}


Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The evidence was appraised using the Oxford Centre for Evidence-Based Medicine levels of evidence. There is good evidence for a positive effect of oral contraceptives on bone density in perimenopausal women, and fair evidence for a positive effect in “hypothalamic” oligo/amenorrhoeic premenopausal women. There is limited evidence for a positive effect in healthy and anorexic premenopausal women. In hypothalamic oligo/amenorrhoeic women, baseline bone density has been shown to be significantly lower than that in healthy controls, therefore the decision to treat is clinically more important. The ideal formulation(s) and duration of treatment remain to be determined by further longitudinal and prospective randomised controlled trials in larger subject populations.

  • BMD, bone mineral density
  • DXA, dual energy x ray absorptiometry
  • IGF-I, insulin-like growth factor I
  • OC, oral contraceptive
  • RCT, randomised controlled trial
  • oral contraceptive
  • bone mineral density
  • hormone replacement therapy
  • oligomenorrhoea
  • amenorrhoea

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  • Competing interests: none declared