Menstrual irregularity is associated with higher bone mass in young women which is mediated through alterations in endogenous androgens

Maximizing bone mass in youth is touted as the best strategy to offset the natural losses of aging and the menopausal transition. Not achieving maximum peak bone mineral density (BMD) is an independent risk factor for osteoporosis and thus a public health concern. Adolescence is a critical time of bone mineralization mediated by endogenous estradiol. Research has shown that the highest velocity of bone mass accrual occurs 1 year before menarche and after the first 3 years. Low-peak attainment of BMD in young women is associated with contributing factors such as diets low in calcium, eating disorders, lack of exercise, smoking, and low estrogen states. Oral contraceptives (OCs) suppress endogenous estradiol production by suppressing the hypothalamic–pituitary–ovarian axis. Thus, OCs, by replacing endogenous estradiol with ethinyl estradiol (EE), establish and maintain new hormone levels. The early initiation and the use of very low dose of EE raises the possibility that bone mass accrual at a critical time of bone mineralization in young women or adolescents may be jeopardized. This review examines the studies of BMD in adolescents and young women that use combination hormonal contraception. Some studies had inherent limitations, such as small trial, poor control of confounders, failure to exclude women with prior use of hormonal contraceptives, or prior pregnancy from control groups. The vast majority of reviewed studies showed OCs containing 20 to 30 µg of EE interfere with acquisition of peak BMD. Limited numbers of studies examine the effects of OCs containing 35 µg on adolescents and young adults. Additionally, studies are needed evaluating the progestin component of OCs as their differing androgenic properties may affect bone mineralization as well.

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Period of adolescence during which exercise maximizes bone mass in young women

Journal of Bone and Mineral Metabolism ◽

10.1007/bf01768838 ◽

1996 ◽

Vol 14 (2) ◽

pp. 89-93 ◽

Cited By ~ 2

Author(s):

Shuichi Tsuji ◽

Fuminori Katsukawa ◽

Shohei Onishi ◽

Hajime Yamazaki

Keyword(s):

Bone Mass ◽

Young Women

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Polycystic Ovary Syndrome in the Adolescent

10.2310/obg.19115 ◽

2019 ◽

Author(s):

Tara A. Singh ◽

Kathleen F. Harney

Keyword(s):

Young Women ◽

Early Recognition ◽

Polycystic Ovary ◽

Poor Quality ◽

Lifestyle Changes ◽

Hormonal Contraceptives ◽

Menstrual Irregularity ◽

Oral Contraceptive Pills ◽

Adolescent Women ◽

First Line Therapy

The typical PCOS phenotype of anovulation, androgen excess, and polycystic ovarian morphology can overlap with normal adolescence, thus making the diagnosis more difficult. Early recognition of adolescents at a risk for PCOS allows for earlier intervention with the potential for improved cardiovascular and metabolic health. Mental health issues and poor quality of life are frequently associated with PCOS in adolescent women and, therefore, should be identified and addressed. As with many issues confronting the adolescent, peer and family support should be encouraged. Lifestyle changes and weight loss should be thought of as first-line therapy for young women with PCOS. Combined hormonal contraceptives remain the medical therapy of choice for the treatment of menstrual irregularity, hirsutism, acne, and contraception. Metformin and spironolactone may be considered, with metformin particularly beneficial in young women with metabolic abnormalities. This review contains 2 tables and 50 references. Key Words: antiandrogens, antimüllerian hormone, hirsutism, hyperandrogenism, hyperinsulinemia, insulin resistance, menstrual irregularity, obesity, oral contraceptive pills, polycystic ovary

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