Oral contraceptives to prevent bone loss? Too little information
Bone loss in amenorrheic athletes may have long-term consequences, even if amenorrhea is only temporary. Some theoretical and disease-based research suggests a possible role for oral contraceptives to prevent bone loss in pre- and postmenopausal women,6 but little research has investigated younger women with hypothalamic amenorrhea. A recent open-label study that did examine bone mineral density (BMD) in women with hypothalamic amenorrhea before and after 13 cycles of oral contraceptives found a significant increase in BMD in the spine, but not at the hip.7
No published study has demonstrated clinically significant advantages for oral contraceptive therapy in women with secondary amenorrhea. These women should take adequate calcium and vitamin D. Bisphosphonates are not appropriate for women of reproductive age, because of their potential teratogenicity.1
Recommendations
The Committee on Sports Medicine and Fitness of the American Academy of Pediatrics (AAP) encourages exercise to help maintain lean body mass and protect against obesity, diabetes, hypertension, and cardiovascular disease. Athletes with amenorrhea, however, may be at risk for sequelae such as osteopenia, fractures, and dyslipidemia. Amenorrhea during adolescence may inhibit the accretion of BMD, and the lost density may not be re-gained. Amenorrheic athletes are also at risk for the “female athlete triad”—disordered eating, amenorrhea, and osteoporosis.8
The potential negative sequelae of amenorrhea are best prevented with measures that restore physiologic menses.3 For exercise-induced hypothalamic bone loss, the AAP recommends decreased exercise, increased caloric intake, or both.