Linking menstrual irregularity, contraceptives, and bone health in collegiate athletes

May 16, 2021; Los Angeles, California, USA; A general overall view of the start of the women’s 5,000m during the Pac-12 Conference Chapionships at Cromwell Field. Credit: Kirby Lee-USA TODAY Sports 

Paper Title: Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States.

Publication: PM&R

Publication date: Published online ahead of print on 2020 Dec 19.doi: 10.1002/pmrj.12539.


For many women, the symptoms of menstruation or menstrual irregularity (MI) can get in the way of athletic performance. Therefore, some choose to manage these issues with hormonal contraceptives(HC). College-level athletes are among the population most likely to use HCs. Yet, little is known about the prevalence and implications of HC use among these women athletes. Therefore, the purpose of this study was not only to learn how many college-aged female athletes used HCs but also to analyze the implications of HC use on bone stress injuries (BSIs) and MI.


Researchers conducted this cross-sectional study via an online survey administered to and completed by 1366 NCAA collegiate female athletes across the United States from September 2018 to January 2019. The survey questioned the athletes on their menstrual history, HC use, and history of BSIs.


The survey found that 63% of the respondents currently used OCs. The two most common reasons for HC use were birth control and regulation of menstrual cycles and symptoms. The athletes reported using oral contraceptives more than injections or patches. Those with a history of MIs were more likely to use HCs.

Nearly half of the athletes (47%) reported they experienced MI either historically or currently. Thirty-two percent of those not using HCs relayed they currently experience MIs. The type of sport, (those that emphasize leanness and aesthetic presentation like gymnastics and diving or those that don’t like soccer or basketball) didn’t appear to impact the incidence of  MIs.

One-quarter of those surveyed reported a past BSI. Of those, 21% also had primary amenorrhea (delayed menarche >15-years-old). The researchers found that those who used oral contraceptives were less likely to suffer a BSI, while those using injectable HCs were more likely to have a history of a BSI. Interestingly, those who participated in lean/aesthetic sports were also more likely to have suffered a BSI and were less likely to use HCs.

The study didn’t tease out the length of contraceptive use and the time of the BSIs. However, oral HC use doesn’t appear to be associated with BSIs, while it appears that injectable HCs might. This study’s limitations included a predominance of white athletes from the New England area, potential recall bias, and selection bias from the pre-survey consent information.

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