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. 2021 Nov;13(11):1207-1215.
doi: 10.1002/pmrj.12539. Epub 2021 Feb 3.

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

Jennifer Cheng  1 , Kristen A Santiago  1 , Zafir Abutalib  2 , Kate E Temme  3 , Ann Hulme  3 , Marci A Goolsby  4 , Carrie L Esopenko  5 , Ellen K Casey  1
Affiliations

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

Jennifer Cheng et al. PM R. 2021 Nov.

Abstract

Background: Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes.

Objective: To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States.

Design: Cross-sectional study.

Setting: Online survey.

Participants: 1020 U.S. female collegiate athletes (age ≥ 18 years).

Methods or interventions: Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one-time survey.

Main outcome measures: HC use, MI, history of stress fractures.

Results: Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004).

Conclusions: HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports-related injury are warranted.

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Figures

Figure 1.
Figure 1.. Prevalence of hormonal contraceptive (HC) use in National Collegiate Athletic Association (NCAA) female athletes by sport type.
The percentages of HC non-users (light gray) and users (dark gray) among 17 NCAA sports are shown. Percentages of HC users were 50% or greater for all sports, except for cross country, gymnastics, and golf.
Figure 2.
Figure 2.. Distribution of current HC use by type.
(A) The percentages of oral contraceptive pill, intra-uterine device, implant, injectable HC, NuvaRing, and patch users are shown. Percentages are relative to the total number of HC users.
Figure 3.
Figure 3.. Current HC use characteristics
(A) Primary reasons for HC use are presented. (B) Factors contributing to HC use are shown. Participants were allowed to select more than one factor.
See this image and copyright information in PMC

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