The Association Between Hormonal Contraceptives and Lower Extremity Injuries in Female Athletes With Sports-Related Clinical Encounters

Background: Hormonal fluctuations may influence musculoskeletal stability in women, raising interest in whether hormonal modulation through contraceptive use alters susceptibility to lower-extremity injuries in sports-related settings. Hypothesis: Systemic hormonal contraceptive use will be associated with lower rates of common lower-extremity injuries among female athletes with sports-related clinical encounters. Study Design: Cohort study. Level of Evidence: Level 3. Methods: Data were obtained using the TriNetX United States Collaborative Network. Female athletes aged 18 to 65 years who had encounters documented in sports or athletic environments were identified within a 20-year period. Cohort A included athletes with documented systemic hormonal contraceptive use while cohort B included athletes without contraceptive exposure. A 1:1 propensity score matching was used to balance the cohorts for demographic and medical factors such as hypertension, type 2 diabetes, and obesity. Outcomes were evaluated over 5 years with injuries that included anterior cruciate ligament (ACL) sprain, meniscal tear, ankle sprain, patellofemoral disorders, lower extremity stress fractures, Achilles tendinopathy, iliotibial band syndrome, or greater trochanteric pain syndrome. Chi-square analysis, risk ratios (RRs), 95% CIs, and P values were calculated to compare outcomes, with significance at P < 0.05. Results: A total of 8783 contraceptive users were matched to 32,499 nonusers, which resulted in 8358 patients in each balanced cohort. In 5 years, contraceptive users demonstrated significantly lower risks of ACL sprain (1.7% vs 2.2%; RR 0.78, 95% CI 0.62-0.97; P = 0.03), meniscal tear (2.0% vs 2.5%; RR 0.78, 95% CI 0.64-0.97; P = 0.02), and stress fractures (0.2% vs 0.4%; RR 0.52, 95% CI 0.29-0.93; P = 0.02). Conclusion: Among women with sports-related encounters, systemic hormonal contraceptive use was associated with lower risk of ACL sprains, meniscal tears, and lower extremity stress fractures. Clinical Relevance: Hormonal modulation through contraceptive use may play a protective role in ligamentous and bony injury risk in female athletes.