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  • Title: Rational use of oral contraceptives in the perimenopausal woman.
    Author: Connell EB.
    Journal: J Reprod Med; 1993 Dec; 38(12 Suppl):1036-40. PubMed ID: 8120861.
    Abstract:
    Oral contraceptives have undergone extensive revision in their labeling over the past 10 years to remove warnings about cardiovascular and other risks and to highlight their noncontraceptive benefits. While these changes are becoming better known, the potential bone-sparing effects of oral contraceptives in the premenopausal and perimenopausal woman remain under-appreciated. Osteoporosis is a major health care problem worldwide in terms of both its associated morbidity and mortality and its economic impact. Although the benefits of postmenopausal hormone replacement therapy for the prevention and treatment of osteoporosis are generally recognized, little attention has been paid to strategies that might be used to maintain bone mass up to the time of menopause, at which time bone loss accelerates. An additional noncontraceptive benefit of oral contraceptives may be to maintain and build bone mass up to the time of menopause. Few family planning specialists are examining the potential bone-protective effects of oral contraceptives (OCs) in premenopausal and perimenopausal women. Osteoporosis is a major public health problem worldwide, as reflected in its associated morbidity and mortality and economic impact. For example, more than 25 million people in the US have osteoporosis, which costs society $7-10 billion each year. These costs are largely due to the more than 1.3 million fractures each year. The 250,000 hip fractures are responsible for the highest personal and societal cost. 12-20% of women with a hip fracture die within 2-3 months of the fracture. At least 50% need assistance with daily activities. Clinicians and public health specialists are not putting their energy into developing strategies that may preserve bone density in the premenopausal and perimenopausal years. More emphasis is needed on such strategies, since menopause is the time when bone loss accelerates. Clinicians do stress hormone replacement as a preventive therapy, but this is restricted to postmenopausal women. Extensive research and development of lower-dose OCs and data on appropriate screening of women with risk factors (e.g., smoking, obesity, and hypertension) demonstrate that healthy, nonsmoking women can use OCs safely and effectively throughout most of their reproductive years. Perhaps OC use can provide women the noncontraceptive benefit of maintenance and build up of bone mass up to menopause.
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