Combined Hormonal Contraceptives Lack Protection Against Musculoskeletal Conditions, Injuries

The use of combined hormonal contraceptives for non-contraceptive reasons is common among young women, including its use to “control” their menstrual cycle to prevent injuries.

A recent study examined the association between combined hormonal contraceptive use and musculoskeletal tissue pathophysiology, injuries, or conditions. The researchers found that there was insufficient evidence to recommend the use of combined hormonal contraceptives to protect against musculoskeletal pathophysiology, injury, or conditions.

“It is premature and inappropriate to prescribe [combined hormonal contraceptives] for these purposes,” the researchers wrote.

In their systematic review, the researchers looked at the data from 5 million women across 50 different studies. Data was pulled from five databases and data was used from studies spanning from 2004 to 2022.

The researchers assessed the use of combined hormonal contraceptives on 30 distinctive outcomes, 75% being bone-related. Upon analysis and based on semi-quantitative synthesis, the researchers found a “low certainty of evidence that combined hormonal contraceptive use is associated with higher future fracture risk (RR = 1.02–1.20), and total knee arthroplasty (RR = 1.00–1.36).”

Further, there was a very low certainty of evidence “of unclear relationships between [combined hormonal contraceptive] use and a wide range of bone health outcomes,” the researchers wrote.

There is limited evidence on the effect of combined hormonal contraceptive use on musculoskeletal tissues beyond bone, and its use in adolescence compared with adulthood.

Reference:

Losciale JM, White L, Squier K, et al. 26 combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5-million women. BMJ Open Sport Exerc. Published online January 25, 2023. doi:10.1136/bmjsem-2023-sportskongres2023.12