Hormonal contraceptives may decrease incidence of ACL injuries in women
Key takeaways:
- Use of hormonal contraceptives in women was associated with decreased incidences of ACL injuries vs. women not using contraceptives.
- Progestin-only oral contraceptive pills had the greatest positive effect.
Published results showed women who used systemic hormonal contraceptives, such as pills, patches, implants, injections and rings, had decreased incidences of ACL injuries vs. women who were not using contraceptives.
Among women aged 15 to 19 years, researchers found no differences in incidences of ACL injuries for patients using oral contraceptive pills (OCPs) vs. those who were not using contraceptives.
“Systemic hormonal contraceptive use is associated with a lower incidence of ACL injury requiring ACL reconstruction compared to no contraceptive use in females ages 15 to 35 [years], with a stronger association with progestin-only OCPs,” Sydney A. Fry, BS, medical student at the University of Colorado Anschutz Medical Campus, and colleagues wrote in the study. “It is postulated that decreasing ovulation through systemic hormonal contraceptives could decrease circulating relaxin levels and thus lower ACL injury incidence.”
Fry and colleagues used data from the Colorado Health Data Compass database between 2011 and 2024 to perform a prognostic retrospective comparative study of 14,886,766 female patients aged 15 to 35 years.
According to the study, 2,120,628 patients were using systemic hormonal contraceptives, such as implants, rings, injections, patches and OCPs. Selected based on previous reports, OCPs included norethindrone (NE) formulations, NE and ethinyl estradiol (NE+EE) formulations, norgestimate and EE (NG+EE) formulations, and drospirenone and EE (DS+EE) formulations. Fry and colleagues compared data with a cohort of 12,766,138 patients who were not using contraceptives.
Overall, ACL injury incidence was 0.079% (95% CI, 0.075-0.083) for patients who were using systemic hormonal contraceptives, 0.088% (95% CI, 0.081-0.095) for patients who were only using OCPs (n = 745,062) and 0.12% (95% CI, 0.118-0.121) for patients who were not using contraceptives.
Compared with patients who were not using contraceptives, the only group with no significant difference in injury incidences was female patients aged 15 to 19 years who were using OCPs (0.101%; 95% CI, 0.081-0.125). Fry and colleagues noted all other age groups of patients using OCPs had decreased injury incidences compared with patients who were not using contraceptives. In addition, they found all age groups of patients using systemic hormonal contraceptives had decreased injury incidences compared with patients who were not using contraceptives.
Fry and colleagues found ACL injury incidence was 0.03% (95% CI, 0.02-0.043) in the NE group, 0.093% (95% CI, 0.082-0.105) in the NG+EE group, 0.099% (95% CI, 0.088-0.112) in the NE+EE group and 0.096% (95% CI, 0.076-0.119) in the DS+EE group.
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