Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States.
Jennifer Cheng, Kristen A Santiago, Zafir Abutalib and 5 others
PMID 33340255WHAT IT FOUND
Most female collegiate athletes use hormonal contraceptives, often to mask irregular periods rather than treat underlying energy deficits.
Injectable contraceptives were associated with higher odds of stress fractures compared to oral pills, while past menstrual irregularity alone showed no such link.
Key findings
01Current hormonal contraceptive use was reported by 65% of athletes, with oral contraceptives being the most common type (71% of users).
02Athletes with a history of menstrual irregularity were significantly more likely to use hormonal contraceptives to regulate cycle consistency rather than for birth control or symptom reduction.
03Use of injectable hormonal contraceptives was associated with greater odds of having a history of stress fractures compared to oral contraceptive use, but past menstrual irregularity was not associated with stress fractures.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The cross-sectional design prevents establishing cause-and-effect relationships between contraceptive use, menstrual irregularity, and stress fractures. Self-reported data introduces potential recall bias regarding past menstrual history and stress fracture diagnoses. The study could not analyze estrogenicity or androgenicity for 16% of combined oral contraceptive users due to missing dose information. The sample was recruited from Big 10 and Ivy League schools, which may limit generalizability to all U.S. collegiate athletes, particularly those on the West Coast. Athletes using hormonal contraceptives may have been more motivated to participate, potentially biasing prevalence estimates.
Declared interests
The study was part of a larger project approved by an Institutional Review Board. No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret the association between injectable contraceptives and stress fractures as proof that the drug caused the fracture. The study is cross-sectional, so it cannot determine if the injectable use preceded the injury or if athletes with pre-existing bone health issues were prescribed different contraceptives. Also, past menstrual irregularity itself was not associated with stress fractures in this sample, likely because current contraceptive use masks the irregularity in many athletes.