Hormonal Contraception and Its Effects on Sports Performance and Injury Risk in Female Athletes: A Clinical Review
DOI:
https://doi.org/10.12775/QS.2026.70.74635Keywords
hormonal contraception, oral contraceptives, female athlete, sports performance, ACL injury, bone mineral density, menstrual cycle, sports medicine, training periodisationAbstract
Background. Hormonal contraception (HC) is used by 30–50% of women competing in sport, yet its influence on sporting performance and injury risk remains insufficiently understood.
Aim. To examine the available evidence on how HC affects aerobic capacity, muscular strength, ACL injury risk, and bone health in sportswomen, and to develop practical recommendations for sports medicine practice.
Material and methods. A narrative clinical review was conducted using PubMed, EMBASE, and Cochrane databases (2000–2024), including RCTs, systematic reviews, meta-analyses, and cohort studies.
Results. Combined oral contraceptives (COCs) attenuate maximal strength gains by 40–60% and blunt erythropoietin response by approximately 20%; evidence on VO₂max is equivocal. ACL injury risk shows a complex, phase-dependent relationship with oestrogen, while COC data are contradictory. Depot medroxyprogesterone acetate is associated with significant bone mineral density loss.
Conclusions. HC has meaningful, method-dependent effects on the sporting physiology of female athletes. Individualised prescribing and training periodisation aligned with the cycle are essential, and larger trials involving competitive athletes are still needed.
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