Systemic Hormonal Contraceptive Use Is Associated With Greater Odds of Rotator Cuff Tears, Shoulder Instability, Dislocation, and Other Shoulder Pathologies: A Propensity Matched Epidemiological Study

PURPOSE: To evaluate whether systemic estrogen-only, progestin-only, or combined hormonal contraceptives (HCs) are associated with increased risk of shoulder pathologies in reproductive-age females. METHODS: A retrospective cohort study of female patients presenting to clinic from 2013 to 2020 and aged 13-50 with 5 years of follow-up was conducted using the TriNetX database. Patients prescribed estrogen-only, progestin-only, or combined HCs were matched 1:1 to controls using propensity score matching. Odds ratios (ORs) 95% confidence intervals (CIs), and P values were calculated after 5 years for 10 shoulder pathologies. RESULTS: Estrogen-only (n = 95,109) users had increased odds of rotator cuff tears (RCT; OR: 2.0, P < .001), shoulder instability (SI; OR: 1.5, P < .001), bursitis (B; OR: 2.0, P < .001), superior glenoid labral tears (SLT; OR: 1.8, P < .001), impingement (IMP; OR: 1.8, P < .001), and calcific tendinitis (CT; OR: 1.8, P < .001), with no difference in rotator cuff capsule sprains (CS; OR: 1.3, P = .117), dislocation or subluxations (DS; OR: 1.3, P = .069), acromioclavicular (AC) joint sprains (AC-S; OR: 1.3, P = .272), or AC joint dislocations (AC-D; OR: 1.2, P = .486). Progestin (n = 766,264) and combined (n = 625,809) users had increased odds for all pathologies (all P < .05), with ORs for RCT, SI, CS, DS, B, SLT, IMP, CT, AC-S, and AC-D of 1.6, 1.6, 1.3, 1.5, 1.5, 1.4, 1.6, 1.5, 1.6, and 1.2 for progestin, and 1.6, 1.6, 1.7, 1.4, 1.7, 1.6, 1.8, 1.6, 1.8, and 1.3 for combined HC users. CONCLUSIONS: The HC formulations studied were associated with increased odds of all 10 shoulder pathologies. Surgeons should be aware of these potentially increased risks when treating patients on HCs. LEVEL OF EVIDENCE: Level III, retrospective cohort study.