Making Informed Choices About Your Birth Control
The Birth Control Pill, in Brief
Synthetic hormone birth control has been approved since 1960, re-formulated to a safer version in 1970, and expanded in formulations and delivery methods since (pills, patches, injections, IUDs).
Synthetic hormone birth control offers women a reliable way to prevent pregnancy. Hormone birth control options work by preventing follicle development and ovulation, and in some forms, preventing adequate uterine lining development for implantation of a fertilized egg. Birth control pills and other synthetic hormone birth control have given women more control over their own bodies and choosing pregnancy.
In the past few decades, more research has been done around bone density in women using various forms of synthetic birth control hormones (pills, patches, injections, IUDs).
Bone Mineral Density
Bone mineral density (BMD) development is critical in the first 3 decades of life. Adolescent years are essential for healthy bone development, with peak BMD obtained between 18-20 years of age.
Estrogen is a key controller in osteoblast activity (the cells that build bone), making the estrogen created by the ovaries in a teenage girl’s body essential for healthy bones.
When women are in their mid-30’s until menopause, further bone development is minimal. The goal is to maintain bone density. Healthy estrogen levels, optimal vitamin and mineral intake, and weight-bearing exercise are essential components to maintenance.
Ethinyl Estradiol and Bone Health
Oral birth control either contains ethinyl estradiol and progestins (combination pills), or progestins only. Don’t let that name of estrogen fool you. Ethinyl estradiol is not bio-identical to estradiol (the most active estrogen in our body), and does not appear to support healthy bone development, especially in adolescent use.
There is agreement that in adolescents, combination pills with higher levels of ethinyl estradiol lead to lower gains in bone mineral density (BMD) during use, and even after discontinuing use, when compared to female adolescents who were not using oral contraception. The largest differences in BMD are in the lumbar spine, although hip, distal radius, and total body also declined.
Progestin only pills and injections have mixed results in the research in terms of BMD and fracture risk, and the World Health Organization states the progestin only birth control options are safe for long term use when it comes to BMD and fracture risk in women. Research is ongoing in this area.
The Nuts and Bolts
Birth control options need to be discussed with your health care provider when it comes to risk-benefit concerns. If you have a family history of osteoporosis, consider progestin-only birth control options, or other forms of birth control. Starting oral birth control later (i.e. not in adolescent years), may allow for healthy BMD that can be maintained into perimenopause and postmenopause years.
Know your reasons for birth control. If indeed it is for birth control, it may be the best option. If it is for hormone dysfunction (acne, painful periods, irregular cycles, heavy periods etc.), speak with your naturopathic doctor to determine the root cause, and to ensure healthy hormones, skin, and menstrual cycles.
When it comes to healthy bone development, foods with plenty of vitamins and minerals support building the bone matrix. Some of these foods include:
- Dark green leafy vegetables (bok choy, broccoli, kale, chard, etc.)
- yams with the skin on
- Citrus fruits
- Nuts and seeds
- Canned salmon with the bones in
Get your vitamin D levels tested to ensure adequate levels (and adequate supplementation), along with eating grass-fed butter for high amounts of vitamin K2 (aiding in calcium and vitamin D absorption). Making resistance-based or weight-bearing exercise part of your daily routine is essential for growing bone and maintaining bone density.
Take advantage of your bone-growing and maintaining years!
- Curtis, Kathryn M., and Summer L. Martins. “Progestogen-only contraception and bone mineral density: a systematic review.” Contraception 73.5 (2006): 470-487.
- Scholes, Delia, et al. “Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation.” The Journal of Clinical Endocrinology & Metabolism 96.9 (2011): E1380-E1387.
- Berenson, Abbey B., et al. “Effects of Depot Medroxyprogesterone Acetate and 20 μg Oral Contraceptives on Bone Mineral Density.” Obstetrics and gynecology 112.4 (2008): 788.
- Cibula, David, et al. “Low dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence.” European journal of endocrinology (2012): EJE-11.
- Moretto, M. R., et al. “Bone mineral density in healthy female adolescents according to age, bone age and pubertal breast stage.” The open orthopaedics journal 5 (2011): 324.
- Boot, Annemieke M., et al. “Peak bone mineral density, lean body mass and fractures.” Bone 46.2 (2010): 336-341.
- Imai, Yuuki, et al. “Estrogens maintain bone mass by regulating expression of genes controlling function and life span in mature osteoclasts.” Annals of the New York Academy of Sciences 1173 (2009): E31-E39.
Hi, I’m Dr. Jenny Schmidt-White. My practice focuses on family health and wellness, healthy aging for men and women and optimizing fertility & hormone function. I work with you, within realistic and sustainable parameters, to find the root cause of dysfunction in your body and address it.