Strong Bones for Life: What to Know About Hormones, Birth Control, and Menopause Therapy

Bones are not static – they are constantly growing, repairing, and breaking down. Bones are living tissue that remodel throughout life. When bone density or quality drops, bones become easier to break. This condition is known as osteoporosis, and it greatly increases your risk of having a fracture (broken bone).

Hormones play an important role in bone strength and health. Estrogen is a key hormone that not only regulates the menstrual cycle but also helps protect bones. Around menopause, estrogen levels fall. In the first years after a person’s final period, bone loss happens faster.

At any age, establishing healthy habits supports bone health throughout life; good nutrition, regular movement, not smoking, and limiting alcohol helps maintain bone strength.

Build and Protect: Everyday Bone Health Habits

Calcium and vitamin D work together: calcium builds and strengthens bone, while vitamin D helps the body absorb calcium. Teens need around 1,300 mg of calcium daily, and adults require about 1,000 mg. Adults should aim for 800-1,000 IU of vitamin D every day. Food is the best source, but supplements can help if needed.

Participate in weight-bearing exercises like walking or running, muscle-strengthening workouts like push-ups or squats, and balance training. Even movements like climbing stairs and gardening can support bone density. The only exercises that don’t count as weight-bearing are one where something else is holding up your body weight, like swimming in a pool or riding a bicycle.

A bone density screening (known as DXA or DEXA) measures bone strength. It is used to diagnose osteopenia and osteoporosis. Clinicians recommend a DXA screening for all women age 65 and older and younger postmenopausal women with risk factors.

Hormonal Birth Control and Bone Health: What We Know

Most hormonal birth control options such as the pill, patch, ring, or implant are “bone-neutral”, meaning that they have no clinically meaningful impacts on bone health. Hormonal birth control is sometimes also used to reduce or stop periods. These options do not harm future fertility or the ability to conceive. The best birth control depends on the individual’s health, preferences, and goals.

However, one type of hormonal birth control, the depot medroxyprogesterone acetate (DMPA) injection — more commonly called the Depo shot — can lower bone mineral density while you use it. After stopping the injection, bone density usually recovers. However, it’s unknown if there is any long-term increase in fracture risk. Decisions about using the Depo shot should include a discussion between a patient and provider about all the benefits and possible risks. This is especially important in teens, who are still building up to their peak bone mass. For all teens, balanced nutrition and regular exercise are important. If a teen uses the Depo shot long-term, those habits become even more crucial.

Menopause Hormone Therapy (MHT): Symptoms, Bones, and Safety

Menopause hormone therapy (MHT) uses estrogen, and sometimes progesterone/progestin, to help with common but pesky menopause symptoms. MHT can help treat hot flashes, night sweats, and vaginal and urinary symptoms. You can take MHT in the form of a pill, patch, gel, or local vaginal product.

MHT also prevents bone loss and reduces fracture risk by supplementing estrogen that is lost during menopause. It raises bone mineral density in the spine and the rest of the skeleton. For that reason, it is sometimes prescribed around the time of menopause to protect bone health and prevent osteoporosis. However, depending on a person’s health history and the type, dose, and route of the medication, MHT may include certain risks. These risks can include blood clots, stroke, and, for combined estrogen-progestin medications, breast cancer. People with certain medical conditions like previous hormone-sensitive cancer, active liver disease, or unexplained vaginal bleeding may be advised against taking systemic MHT.

The position statements published by The Menopause Society (formerly NAMS) may give you a better understanding of the benefits and risks associated with MHT.

Choosing What’s Right for You

To figure out what’s right for you, here are some things to consider:

  • Goals: What is your goal for using this medication? Birth control, period management, menopause symptom relief, bone protection? The best fit may be a combination of lifestyle changes, birth control choices, and/or MHT.
  • Timing, dose, and route: How often do you want to take medication? Would you prefer something that you can “set and forget”? Discuss type, dose, and delivery route (for example, oral, like a pill, or under the skin, like an implant) with your clinical team. Your healthcare provider can help guide your decision by considering your medical history, too.
  • Bone checks over time: If you have risk factors or are on medication that affects bone, your healthcare provider may recommend getting DEXA scans to track bone mineral density. 

Quick Guides

If you’re using DMPA (Depo shot): Prioritize getting enough calcium and vitamin D and engage in weight-bearing exercise. Review how long you plan to use DMPA and whether other options might fit your needs.

If you’re considering a pill/patch/ring/implant: Most people will not see meaningful bone changes. Choose contraception based on your birth control needs, medical history, and personal preferences.

If you’re entering menopause with bothersome symptoms and bone concerns: Ask your healthcare provider about the benefits of MHT for hot flashes, vaginal/urinary symptoms, and bone health. Discuss your personal risks and non-hormonal options if MHT isn’t right for you.

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