You are here

  • Home
  • Online First
  • Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females

Article Text

Article menu
Download PDFPDF
Systematic review
Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females
  1. Lynita White1,
  2. Justin M Losciale2,3,
  3. Kipling Squier3,4,
  4. Sarah Guy5,
  5. Alex Scott3,4,
  6. Jerilynn C Prior6,7,
  7. Jackie L Whittaker2,3
  1. 1 Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
  2. 2 Arthritis Research Canada, Vancouver, British Columbia, Canada
  3. 3 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
  5. 5 City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
  6. 6 Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
  7. 7 Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Jackie L Whittaker, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; jackie.whittaker{at}ubc.ca

Abstract

Objective Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions.

Design Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach.

Data Sources MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022.

Eligibility Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females.

Results Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02–1.20) and total knee arthroplasty (risk ratio 1.00–1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited.

Conclusion Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes.

PROSPERO registration number This review was registered on PROSPERO CRD42021224582 on 8 January 2021.

  • Preventive Medicine
  • Female
  • Women

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

http://dx.doi.org/10.1136/bjsports-2022-106519

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

    View Full Text

    Footnotes

    • Twitter @JayLos18, @jwhittak_physio

    • Contributors LW and JLW designed the systematic review. JLW coordinated the study. LW, JML, KS, SG, AS and JLW screened titles and abstracts as well as full-text records. LW, JML, KS, SG, AS and JLW performed data extraction and risk of bias assessment. LW, JML and JLW performed semiquantitative synthesis. LW, JML and JLW wrote the first draft of the manuscript. JCP provided perspectives on CHC and bone variables. All authors contributed to reviewing, editing and revising the manuscript and approved the final submitted version. JLW is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JLW is an associate editor of the British Journal of Sports Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.