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

Review written by Dr Christina Le info

Key Points

  1. There is low certainty evidence that combined hormonal contraceptives (CHC) use may increase risk of future fracture and total knee arthroplasty.
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Women are more likely to experience musculoskeletal pain and conditions more than men (1). Many biological (e.g. anatomical predispositions) and sociocultural (e.g. access to healthcare) reasons could contribute to this discrepancy. Menstrual status is often thought to be a factor that increases risk of injury in females (2,3) and, subsequently, combined hormonal contraceptives (CHC) has been historically used to minimize this risk. However, CHC also has a negative impact on the ovulation cycle, bone mass, and bone mineral density (2,3).

So, is the use of CHC more of a help or a hindrance? This systematic review sought to determine the relationship between CHC use and musculoskeletal tissue pathophysiology, injuries, and conditions. A secondary objective was to examine the effects of CHC use in adolescents (≤18 years old) or adults (>18 years old).

Women are more likely to experience musculoskeletal pain and conditions more than men.
We do not have enough evidence to recommend Combined hormonal contraceptive use to protect musculoskeletal health.


  • Eligible studies reported primary data that looked at the association between CHC use and musculoskeletal tissue (i.e. bone, joint, ligament, muscle, tendon, and associated connective tissues), pathophysiology, injuries, or conditions in post-pubertal, pre-menopausal females with normal menstrual status.
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