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Healio
ByMax R. Wursta
Fact checked byGina Brockenbrough, MA

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February 19, 2025
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Hormonal contraceptives may decrease incidence of ACL injuries in women

ByMax R. Wursta
Fact checked byGina Brockenbrough, MA

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.

“Through our years of research from the cellular level to NCAA athlete studies to this epidemiological study, it appears that the hormone relaxin is implicated, at least in part, in the increased ACL tear rate in female athletes,” Jason L. Dragoo, MD, endowed chair of regenerative medicine at the University of Colorado, told Healio.

Dragoo 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. Dragoo 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). Dragoo 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.

Dragoo 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.

“Next step is a prospective trial following female ACL tear rates in athletes using certain oral contraceptive pills or medicated [intrauterine devices] IUDs vs. a control group,” Dragoo said.

Sources/Disclosures

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Source:

Fry SA, et al. Arthroscopy. 2025;doi:10.1016/j.arthro.2025.02.012.

Disclosures: Dragoo reports receiving funding or support from Zimmer Biomet Holdings Inc., Averitas, Moximed, ConMed Corporation, Apex Biologiz and Arthrex Inc.; and being a board or committee member of the American Academy of Orthopaedic Surgeons. Please see the study for all other authors’ relevant financial disclosures.

Read more about

contraceptives
acl injury
university of colorado anschutz medical campus
 

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