Combined hormonal contraception is a highly effective method that is used by millions of women worldwide. It works by inhibiting the hypothalamo-pituitary ovarian axis, thus preventing ovulation, and in so doing, it also suppresses endogenous estrogen production. Bone is a metabolically active tissue, in which collagen is the major structural protein and this has been shown to be sensitive to estrogen. The latter is also true for other collagen-containing organs such as muscles. There is growing concern that the very low dose estrogen-containing pills may be associated with failure to attain the peak bone mass in adolescents. Conversely, in older peri-menopausal females, where there is an age-related decline in bone mass, the estrogen in combined hormonal contraception may help to decrease this rate of decline, hence having a beneficial effect on bone density. This review explores the current evidence base around the effect of combined hormonal contraception on bone density and muscle. The evidence seems to be still unclear as to whether this has a beneficial, harmful or no effect on bone density, bone turnover markers, or muscle with studies reporting no effects or small effects in different directions. The studies available seem to be quite heterogeneous as to make it very difficult to make any meaningful comparisons. Higher quality studies are needed to evaluate the long-term effect of different doses of estrogen in different combined hormonal contraception regimens on bone health in adolescents, particularly those under 20, that would not have yet reached their peak bone mass.