ABSTRACT
INTRODUCTION Ovarian steroids play key roles in bone metabolism and the accumulation and retention of normal bone mineral density (BMD). Therefore, the use of hormonal contraception may interfere with bone mineral density and metabolism in all periods of a woman’s life1. Estrogen deficiency is associated with a substantial decrease in bone density in adolescents and young women who develop estrogen-deficiency amenorrhea, as well as in the perimenopausal period1-3. Amenorrhea is a marker for conditions that have been associated with osteopenia, such as eating disorders, stress-induced hypothalamic hypogonadism, premature ovarian failure, hyperprolactinemia and gonadal dysgenesis. In functional hypothalamic amenorrhea (FHA), the marked reduction in estradiol production is related to a decreased BMD (Figure 1). BMD is further reduced in young amenorrheic women suffering from severe amenorrhea in addition to eating disorders such as anorexia nervosa (Figure 2).
