What is your background?
First, I would like to thank the Women’s Health Research Institute for this opportunity to talk about an important issue in young women’s health.
I am a physician by training. I got my MPH and PhD in reproductive health from Tehran University of Medical Sciences in Tehran, Iran. I have been teaching and doing research on various reproductive and sexual health topics since then. I used to check and use the CeMCOR (Centre for Menstrual Cycle and Ovulation Research) website and its articles when I was In Iran, and after moving to Canada in 2014, I had the honour to know and work with Dr. Prior.
Dr. Prior and I had access to CaMos (Canadian Multicentre Osteoporosis Study) data and were able to use this data to study the association between reproductive hormones and events with bone health both in younger women and post menopausal women.
You recently conducted a meta-analysis looking at the relationship between combined hormonal contraception and bone mineral density in adolescent women. Can you tell us a bit about what this meta-analysis revealed?
Yes, we did publish our meta-analysis (an examination of several separate but similar studies in order to test the pooled data for statistical significance) of five studies that reported on the change in bone mineral density in adolescent women using combined hormonal contraceptives (CHC) over two years. Our analysis showed those teens using CHC gained less bone mass compared with those who did not use CHC.
We pooled together the data of 885 young women ages 12-19 years from China, Brazil, the USA and Canada, and then we compared the change in BMD between CHC user and non-CHC user teens. We found that after two years, teens taking CHC (n = 558) gained significantly less spinal bone than the young women who did not take CHC (n = 327).
Why is this important?
Most people think that osteoporosis is the disease of post menopausal women. However, we know that to prevent osteoporosis and fragility fractures later in life, women need to first, reach their highest peak bone mass and second, prevent losing bone afterwards.
Adolescence is an important period for bone health as girls are rapidly gaining bone mass to reach a peak at the hip bone during the teen years and a peak in the spine bones during their 20s or 30s. So, anything that interferes with gaining bone during adolescence would put the person at a higher risk for future osteoporosis and fragility fracture.
We already know that estrogen is useful for preventing bone loss in adult women. However, adult bone change is different than teenage bone change and estrogen, especially in a high dose, prevents bone growth. We did not know about this different effect of estrogen on teen’s bone because during the eighties and nineties, CHCs were only given to married women as a contraceptive method. For the past few decades, not only are more and more women –especially younger women — using CHC, but it’s also been prescribed by physicians for other medical reasons other than contraception (e.g., to regulate their periods, to reduce menstrual cramps, etc.). Therefore, all the previous studies were done on older women and very few studies looked into the effect of hormonal contraceptives on adolescent bone.
What call-to-action would you share with the research community or healthcare professionals based off your findings?
As I said before, few studies evaluated the effect of CHC on young women’s bone. We need scientific evidence to fully understand this relationship and provide strong scientific evidence that help physicians and other health practitioners to offer the best care to adolescent and young women.
I would also like physicians to think about the bone effects of medications when treating common conditions such as acne and painful periods.
November is Osteoporosis Month. What should younger women know about maintaining good bone health?
There is a lot that young women need to know about bone health. They should educate themselves about bone health using reliable sources. Have a balanced diet, avoid drinking and smoking as much as possible, and stay physically active. They should also talk to their family physician about other contraceptive and treatment options when possible. And, they can talk to their pharmacist about the effects of prescribed and over-the-counter drugs on bone health and in short, be aware that prevention of osteoporosis starts in childhood!
For more information, they can refer to the ABC’s of Osteoporosis Prevention for Teenaged Women from the Centre for Menstrual Cycle and Ovulation Research.
Where can young women go to learn more about bone health?
It is very important to use sources that are reliable and present scientific information. Osteoporosis Canada is a good place to start. The CeMCOR website is also a popular website and they can find lots of short videos and articles about bone health and menstrual cycles and other topics related to women’s health.
Is there anything else we should know?
We just published a short article on CeMCOR about our meta-analysis that can check out. CeMCOR has also published a paper on the prevalence and reasons for CHC use among a Canadian sample of 16-24 year old women. It detailed that more than 50 percent of young women started using CHC for non-contraceptive reasons.
There is also an article titled ABCs of Osteoporosis that I found very useful.
Thank you again for this opportunity.