Oral Contraceptives may not be the answer for women with amenorrhea

Posted July 19, 2007 at 04:30 PM by Katie Drummond

Section: Her Fitness, Her Health, Body Image, Eating Disorders, Injury & Rehab, Her Nutrition, Healthy Eating, Her News, Special Features

It’s a sad fact that anorexia nervosa is a common problem among young women, particularly female athletes. Not only does undernourishment compromise the athletic abilities of these young competitors, but, more importantly, malnourishment means the risk for early-onset osteoporosis, thanks to the secondary amenorrhea that tends to accompany low body weight. For years, medical experts believed that by addressing the loss of estrogen in anorexic or over exercising athletes, bone loss could be staved off until effective physical and psychological treatment took hold. As a result, thousands of women were prescribed birth control pills not for contraceptive reasons, but to boost estrogen levels that would trigger menses and potentially save their bones. Now, however, new evidence has emerged to disprove the theory that contraceptives can prevent osteoporosis, and it seems women who relied on birth control rather than boosting their body weight may not have been protected after all.

Secondary amenorrhea, caused by over exercise, stress, and anorexic behavior, is typically not thought of as an illness – but a symptom of a bigger, usually psychological, problem. However, doctors who were pushed to provide temporary, “band aid” solutions often doled out drugs instead of addressing underlying issues that caused the loss of periods in the first place. Much like post-menopausal women are given estrogen therapy to prevent osteoporosis, doctors thought that young women could benefit in the same way. However, two recent studies done by researchers at Harvard and Oxford found that while estrogen is effective in older women, it made next to no difference in the bone density of younger women with amenorrhea.  In fact, the studies found that the decreased androgen levels caused by birth control pills made bone loss even worse, putting those on birth control in an even more dire position. Both studies cite one, and only one, permanent solution to bone loss – the cessation of oral contraceptives and the restoration of a healthy body weight in underweight women.

Another problem associated with using oral contraceptives to restore bone health is that the pills won’t do anything to address both the nutritional deficiencies of athletes and women with anorexia, or the psychology behind the disorder. While low estrogen levels will leech essential nutrients from the bones, so will a lack of calcium, protein, and fat – not to mention the energy loss associated with insufficient calorie intakes. When low estrogen levels, malnourishment, and the loss of androgens associated with birth control pills combine, women are faced with a triple-threat to their bones, one that can only be solved by gaining weight or increasing body fat levels and getting healthy. And that health means more than just physical wellness –understanding why the amenorrhea occurred in the first place will help prevent it from recurring, and both studies suggest psychological counseling for women struggling with secondary amenorrhea.

But will a healthy body weight undo the damage already done to your bones? Not likely. Recent research has also found that while young women with sustained amenorrhea (around two years without a menses) do recover some bone mass with a healthy weight, bone density is still significantly lower than that of women who have never suffered from the ailment. Unfortunately, anyone who has ever struggled with amenorrhea has sustained some bone loss, and the sooner a healthy weight is restored, the better. Furthermore, recovered women can take preventative measures by following the standard advice to anyone for preventing osteoporosis – adequate calcium intake (around 1,200 mg a day) and weight bearing exercise will both help fend off further losses.

Study after study has shown that once you lose bone mass, it’s gone for good. Aside from brittle bones and the daily risk of injury, young athletes face the possibility of stress fractures, diminished performance, and, eventually, the inability to participate in high impact sports at all. While many women rely on the birth control pill to have their periods, contraception won’t address the problems associated with low body mass – physical and emotional wellness are the only solutions.