Female athletes should go on the Pill to prevent knee injuries

Female athletes should go on the Pill to prevent career-ending ACL injuries: Scientists discover hormones in the contraceptive stop the knee ligament becoming too ‘loose’ and tearing

  • Athletic women are up to 63% less likely to suffer a knee tear if they take the Pill
  • The Pill’s oestrogen and progesterone ‘downregulates hormones’
  • Knee-joint ligament contains oestrogen receptors, which make it ‘looser’ 

A single knee injury can stop an athlete’s career in its tracks.

But new research suggests sportswomen could avoid tears to the joint by taking the Pill.

Female athletes are up to 63 per cent less likely to have an anterior cruciate ligament (ACL) tear if they take the combined oral pill, a study found. 

The ACL connects the thighbone to the shin and helps stabilise the knee joint, and a tear can be career-ending.

Sportswomen could avoid knee injuries by taking the combined oral contraceptive pill (stock)

The Pill is often made up of a combination of oestrogen and progesterone, which ‘downregulates hormones, thus limiting hormonal fluctuations’, researchers wrote. 

Scientists say the ACL contains oestrogen receptors, which have been shown to increase ‘ligament laxity’, or looseness. 

The research was carried out by Brown University and led by Dr Steven DeFroda, of the department of orthopaedic surgery.  

ACL tears are common among young athletes, with 200,000 injuries occurring every year in the US. The injury’s prevalence in the UK is unknown.

More than half of cases occur in secondary-school students, with the risk increasing by 2.3 per cent every year for children between six and 18.

Of those who suffer an ACL injury, 45 per cent never compete again, 35 per cent do not meet their previous level of athleticism and up to half show signs of osteoarthritis just a decade later. 


An ACL injury is a tear or sprain in the anterior cruciate ligament (ACL).

The injury usually occurs during sport that involves sudden stops, change in direction, and jumping and landing, such as football or basketball.

ACL tears are common among young athletes, with 200,000 injuries occurring every year in the US, according to the journal The Physician and Sports medicine. 

The injury’s prevalence in the UK is unknown. 

Many people hear a ‘pop’ coming from their knee when the injury occurs.  

Other symptoms may include:

  • Severe pain and an inability to move the joint
  • Rapid swelling
  • Feeling of instability or ‘giving way’ with weight bearing 

ACL injuries are more common in women due to differences in anatomy, muscle strength and hormonal fluctuations.

Poor-fitting shoes; poorly maintained equipment, such as skis; and playing on artificial turf also increases the risk. 

ACL injuries raise a person’s risk of developing osteoarthritis of the knee, even if they have surgery to reconstruct the ligament. 

Depending on the severity of the injury, treatment may involve rest and rehabilitation exercises.

This includes:

  • Rest
  • Ice – every two hours for 20 minutes while the patient is awake
  • Compression – a wrap or band around the knee
  • Elevation – lay down with the knee propped up on pillows

In severe cases, surgery to replace the torn ligament with a segment of tendon may be required. 

Source: Mayo Clinic 

The researchers analysed 82,874 women aged 15-to-49 who took the Pill. Of which, 465 experienced an ACL tear that required surgery. 

These participants were compared against the same number of women not on the contraceptive, of which 569 suffered a severe ACL injury.  

Results published in the journal The Physician and Sportsmedicine revealed those taking the Pill were 18 per cent less likely overall to experience an ACL tear.

The greatest benefit was seen among the women aged 15-to-19, who were 63 per cent less likely to experience a tear if they took the contraceptive. 

‘It’s likely oral contraceptives help maintain lower and more consistent levels of estrogen and progesterone, which may lead to periodic increase in laxity and subsequent risk of tear,’ Dr DeFroda said.

The researchers believe teenage women may be more at risk of ACL tears due to them being less likely to take the Pill than older females, as well as students typically being more active at school than university.  

Due to these teenage years being the ‘time period in which most females will consider routine oral contraceptive use’, the Pill could be offered to these women as ‘early intervention in the hopes of preventing an ACL tear’.

‘Young athletes use oral contraceptives for a variety of reasons including regulating their menstrual cycle and/or preventing pregnancy,’ Dr DeFroda said. 

‘With careful assessment of the risks, injury risk reduction could be another way in which female athletes may benefit from their use.’

Hormonal fluctuations have been shown to influence a woman’s ACL injury risk due to ‘alterations in knee biomechanics’.

An increase in oestrogen levels while a woman is ovulating makes her knee joint looser. 

This causes an increase in ‘hamstring contracture’, which occurs when normally elastic tissue is replaced by less stretchy tissue. 

This affects the range of movement the joint has, which can lead to injury.

The researchers stress, however, the study’s participants and their controls were not matched according to their activity level.

They also only looked at the combined contraceptive pill and therefore it is unclear whether the single-hormone variety has the same effect. 

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