Candice MacMillan provides athletes, coaches, and sports medicine practitioners with important information about oral contraceptives.
Injury rates in gender-comparable sports are higher among female athletes participating at different levels of play(1). In addition to anatomical and biomechanical differences, sex hormone (estrogen/estradiol, progesterone, and relaxin) profiles contribute to this sex disparity in musculoskeletal (MSK) injuries(2,3). Continuous hormonal fluctuations throughout the menstrual cycle (MC) affect the material structure and mechanical properties of muscle, tendon, bone, and ligaments(2,4-6). The influence of hormonal contraception (HC) on athletic injury risk and performance is a contentious topic, and research findings are conflicting(3,7).
In a recent investigation of 430 elite female athletes, almost 50% of athletes used HC, indicating that half of the surveyed population did not have eumenorrheic (normal) MCs(8). Most (68%) of these athletes reported taking oral contraceptive pills (OCPs), making them the most commonly used hormonal contraceptives(9). Aside from birth control, athletes strategically use OCPs to alleviate symptoms associated with dysmenorrhea, menorrhagia, and premenstrual syndrome and to manipulate the timing of inconvenient withdrawal bleed(7,9).
Oral contraceptives (OC) are exogenous hormones that inhibit ovulation and result in consistently low endogenous sex hormone concentrations. The various OCPs have different compositions and potencies (see table 1)(8,9).
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