Abstract

CASTRO, Juliana Silva; TAVARES, Bruna  and  GUEDES, Marta. Effects of ethinylestradiol contraception in bone mineral density in adolescent women: what is the evidence?. Rev Port Med Geral Fam [online]. 2019, vol.35, n.4, pp.299-304. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i4.12184.

Objective: Combined hormonal contraceptives (CHC) are the most used hormonal contraception method in adolescence. They lead to lower levels of estradiol than physiological ones, which may influence the acquisition of peak bone mineral density (BMD). The objective of this study was to determine the impact of CHC with 30-35 µg of ethinyl estradiol (EE) on BMD when compared to placebo or lower doses of EE in healthy female adolescents between 10-19 years old. Sources: National Guideline Clearinghouse, National Institute for Health and Care Excellence Guidelines Finder, Canadian Medical Practice Guidelines Infobase, The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, Bandolier, Evidence-Based Medicine Online, and MEDLINE. Methods: We searched clinical guidelines, randomized controlled trials, systematic reviews and meta-analysis, published between March 2007 and March 2017 in Portuguese, Spanish, English or French. The MESH terms used were: 'adolescent', 'ethinyl estradiol' and 'bone density'. To stratify the level of evidence and the strength of recommendation the Strenght of Recommendation Taxonomy, of the American Academy of Family Physicians was used. Results: Seventy-six publications were identified, of which five were included: two randomized controlled trials, one systematic review, one cohort study, and one guideline. The first showed that non-CHC users’ adolescents have higher BMD than those who use CHC, regardless of drug dosage. The BMD of adolescents using a higher dosage of ethinyl estradiol (30-35 µg) appeared to be less affected than those with a lower dosage (<30 µg). In the included systematic review discordant data were found, with one of the studies reporting no differences between the various doses of EE. The included cohort study revealed an increase in the BMD when prescribed 30-35µg EE, at 24 months’ mark. Between 24 and 36 months the BMD acquisition was lower in the 30-35µg EE group compared with placebo or lower dose. The Faculty of Sexual and Reproductive Healthcare’s guideline reports that dosage does not appear to affect BMD. Conclusion: In teenagers, the use of ethinyl estradiol at a dosage equal or higher to 30ug, for a lower impact on BMD, has received a Grade B Recommendation.

Keywords : Adolescent; Ethinyl estradiol; Bone mineral density.

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