Real Talk: Your Period, Your Birth Control, And Your Bones

Did you know that there are more than 50 different kinds of birth control pills, and even more methods of birth control? So many options, so many factors to consider! But, along with all the different side effects of birth control, many women rarely consider the nutritional consequences of the various methods. Unfortunately, depending on the method, there may be bone health consequences (decreased bone density can lead to osteoporosis and fractures later in life), weight effects, or medication interactions. I wish that I could say with full confidence that of course your gyno would discuss all of these effects with you. But, doctors are busy and sometimes that discussion doesn’t happen in between them wielding the salad tongs (i.e. speculum).

So let’s talk bone health, your period, and birth control. No, don’t walk away because you know you don’t want to end up looking like the Hunchback of Notre Dame.

Body Fat and Estrogen

Your period is very closely linked to your body’s fat percentage, as the hormones are derived from lipids. Most periods start during the early pre-teen and teen years, which is the same age range when laying the foundation for strong bones is SO crucial (which is really ironic considering that most kids have a different kind of bone health at the forefront of their brain when hormones are raging). You might have heard that girls’ periods are starting earlier and earlier, and part of that is due to the high level of obesity in the pediatric population. By the same logic, kids that are leaner tend to start their periods later than their heavier counterparts.

We all have varying percentages of fat in our bodies, and we all NEED that fat in our bodies. Just not too much. Lipids are crucial for nervous system health, organ insulation, and so much more. Estrogen is derived from lipids, and estrogen stimulates bone growth. Fat gets a bad rap these days.

Low Weight and Overexercising

But, now that you know that your period, body fat, and bone health are closely linked—let’s think about the other side of body fat percentage when there’s not enough. When a woman’s body fat levels are too low, she will often stop menstruating (amenorrhea), which means that her estrogen levels are also too low. When that hormone level is plummeting, a woman’s bone health will also start to deteriorate. Amenorrhea often (but not always) occurs in cases of anorexia nervosa and in girls and women who exercise a lot.

Sidenote: When you don’t have enough body fat your sex drive will also decrease. Now I have your attention, amirite?

For example, my period didn’t start until I was 13 years old, but when my anorexia kicked off a year and a half later, my period quickly bowed out. I went at least two years without having my period because my body fat percentage was too low. My mom is a nurse and so she was always concerned about my bone health. When my weight showed no sign of increasing and my exercise showed no sign of decreasing, she dragged me into a gyno office to be put on the Pill. A lot of professionals at that time thought that forcing a period would help preserve bone health, but we know now that it actually doesn’t. Weight restoration is the only, and best, treatment. It is not uncommon for women with anorexia to have the bones of elderly women because of this situation.

Many people write off loss of periods in athletes as something normal that “just happens.” Well I’m here to tell you that it’s not. It means that your body fat stores are too low and you’re not producing enough estrogen which very negatively impacts your bone health. Taking birth control to mask the absence of menstruation is not the answer. You need to increase your body fat percentage. Period.

Long-Term Birth Control Methods That Take Away Your Period

The Mirena IUD and the implant cause some women’s periods to go away after the first 6 to 12 months. BUT, unlike amenorrhea from low body fat stores, when the period goes away on these methods there are no negative effects on your bone health. I’ve read the small print and read the research because I have an IUD, and you better believe it that I’m going to make sure my bones are in good shape. These methods are highly effective, remove human error because you don’t have to mess with it, are long-term options, and reduce menstrual flow and cramps.

The Pill

I’m using the term “the Pill” here to refer to both combination pills (estrogen and progestin) and progestin-only pills (often called mini-pills or POPs). According to the World Health Organization, the Pill has not been found to negatively impact bone health. You might see some of the media claiming it does damage your bone health, but there’s also almost an equal amount saying that it improves bone health—so let’s stick with the science authorities, shall we? So please, continue taking your birth control pills regularly, have lots of sex, and rejoice that you’re not going to get pregnant (if you take the pill on time and regularly).

Emergency contraceptives do not have any impact on bone health since they are not taken long-term. For more information about “morning after” emergency contraceptives, such as Plan B and Ella, please see our very informative article here.

Depo-Provera shot (often referred to as “the Depo shot”)

I am NOT a fan of the Depo shot, and here’s why.

Yes, it’s birth control for 3 months at a time, which is great because you don’t want to get pregnant! This method eliminates user-error because the doctor gives you the shot once every three months, instead of having to remember to take a pill every day. When taken regularly every three months, less than 1 out of 100 women will get pregnant. If not taken on time, 6 out of 100 women will get pregnant.


Use of the Depo shot over time can cause significant reductions in bone density, which can lead to osteoporosis later on in life. Thus, the FDA recommends that the Depo shot not be used for any longer than two years, unless there are no other plausible methods. In addition, this method is not recommended for use during teenage years since that is when bone growth is most crucial.

Another effect of the Depo shot is that it can lead to weight gain over time, as it can increase appetite. Women who used the Depo shot for one year gained, on average, about 5-6 pounds. Women who used the Depo shot or two years gained, on average, 8-10 pounds total. Some women decide to discontinue the Depo shot solely because of the weight gain issue.

It also can affect carbohydrate metabolism, in that your body cannot use the carbs as well, which would yield higher blood sugar levels. This might sound confusing, but take my word for it, it’s not a good thing.

Final Consensus

Please, don’t stop drinking your milk and taking your calcium pills. There are many factors that contribute to your bone health, and that is definitely a prominent one. Weight-bearing exercises (strength training, running, etc) help strengthen your bones. Having a healthy menstrual cycle is also crucial to maintaining good, strong bones.

The hormonal IUD and the implant are wicked awesome birth control methods, and we’re a fan of them. But, the Depo shot will always get the stink-eye from me. I will ask any woman that walks into my office, who is on the Depo shot, if there are any other options they would consider.

What are your thoughts on this topic? What’s your birth control method of choice? Comment below or tweet us @litdarling.

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