# Hormonal Contraception, Menstrual Cycle Characteristics, and Lower Limb Injuries in Elite Female Team Sports—Identifying Factors Associated With Increased Injury Prevalence: A Cross‐Sectional Study

## TL;DR

This study explores how menstrual cycle characteristics and hormonal contraception relate to lower limb injuries in elite female athletes, finding unexpected links.

## Contribution

The study identifies menstrual dysfunction as unexpectedly associated with lower ACL injury rates and highlights the role of regular health exams in injury risk.

## Key findings

- 42% of athletes used hormonal contraceptives, with 19% of non-users experiencing menstrual dysfunction.
- 42% of athletes reported a lower limb injury in the past year, with knees being the most affected.
- Menstrual dysfunction was linked to lower ACL injury rates, while regular health exams correlated with higher injury rates.

## Abstract

This study aimed to examine the prevalence of menstrual cycle characteristics and lower limb injuries among elite female team sport athletes, and to identify factors influencing injury risk.

Data were collected from 301 female team athletes across the German 1st and 2nd division in basketball, field hockey, football, handball, and volleyball using an online questionnaire. Information was gathered on gynaecological health and lower extremity injuries in the past 12 months.

Forty‐two percent used hormonal contraceptives, while among non‐users, 81% were naturally menstruating and 19% had a menstrual dysfunction (MD). Of those naturally menstruating, 46% experienced dysmenorrhea in every menstrual cycle, and 18% took painkillers during each menstruation. Regarding injuries, 42% reported at least one lower limb injury in the past 12 months, with 44% classified as severe. The most commonly affected regions were the knee (44%), ankle (31%), and upper thigh (9%). MD was associated with lower anterior cruciate ligament (ACL) injury rates (p = 0.04, Cramer's V = 0.199, 95% CI: −∞ to −0.09), while regular periodic health examinations (PHE) were associated with higher injury rates (p = 0.05, Cramer's V = 0.121, 95% CI: −0.98 to −0.01), particularly knee cartilage injuries (p = 0.001, Cramer's V = 0.241, 95% CI: −3.19 to −0.59). No significant associations were found between injury rates and dysmenorrhea or premenstrual syndrome.

This study highlights the complex relationship between menstrual cycle characteristics and injury risk in female athletes, showing MD's unexpected association with lower ACL injury rates. Further, it emphasizes the need for targeted injury prevention programs, regular PHE, and enhanced medical support structures to reduce injury risks in elite female team sports.