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Hormonal Contraception and Its Effects on Sports Performance and Injury Risk in Female Athletes: A Clinical Review

Jan Kabat · Quality in Sport · 2026

This narrative review pulled together studies from 2000-2024 on how hormonal contraception affects female athletes' endurance, strength, ACL injury risk, and bone health. It reports that combined oral contraceptives may blunt maximal strength gains by 40-60% and reduce the erythropoietin response by around 20%, that VO2max evidence is mixed, that ACL risk data are contradictory, and that the injectable contraceptive depot medroxyprogesterone acetate is linked to meaningful bone mineral density loss.
Takeaway: Discuss your contraceptive method with a sports-savvy clinician if strength gains or bone health are training priorities, since effects differ by method.
Abstract (source)

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.

Systematic review / meta-analysisOpen accessResistance Training & HypertrophySports Nutrition & Supplements
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