The use of combined hormonal contraceptives may not protect against musculoskeletal pathologies

1. In this systematic review, there was limited data to support the use of combined hormonal contraceptives (CHC) to prevent musculoskeletal conditions and injuries.

2. There was also low-certainty evidence to suggest that CHC use was associated with higher risks of future fracture and total knee arthroplasty.

Evidence Rating Level: 1 (Excellent)

It is known that women typically experience more musculoskeletal (MSK) pain and chronic MSK conditions compared to men. Some have postulated that these sex differences may be related to their menstrual status. Given that combined hormonal contraceptives (CHC) can stabilize menstruation, some have suggested that it may aid in alleviating MSK pathologies. Contrary to this, CHC use is often associated with reductions in peak bone mass and mineral density. Given that little is known on this subject, the objective of the present study was to assess the association between CHC use and various MSK pathologies.

Of 5,438 identified records, 50 (n=5,695,908 patients from 48 unique cohorts) studies were included from various databases from inception to April 2022. Studies were included if they assessed the association between CHC use and MSK pathology. Studies were excluded if participants had an underlying condition that could affect reproductive hormone levels, if only MSK performance was assessed, or if the study evaluated intrauterine devices or contraceptive methods that were estrogen-only or progestin-only. The study quality and risk of bias were assessed using the Downs and Black Quality Assessment Tool (DBQAT). The review was conducted in accordance with PRISMA guidelines. The primary outcome was the effect of CHC use on MSK pathology.

The results demonstrated that there was insufficient high-quality evidence to support the use of CHCs in the prevention of various soft tissue-related MSK pathologies. In addition, low-certainty evidence suggested that the use of CHCs may lead to higher future fractures and knee arthroplasties. Despite these results, the study was limited by the presence of missing data from some of the included studies, which may have affected the analysis. Nonetheless, the present study provided an update on the lack of evidence pertaining to the use of CHCs in various musculoskeletal pathologies.

Click to read the study in British Journal of Sports Medicine

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