Research
Hormonal
Oral contraceptives (OCs) that maintain stable, moderate estrogen levels reduce the cyclic fluctuation in knee laxity and are associated with a lower risk of ACL injury compared to women with natural menstrual cycles.
If you are a female athlete concerned about ACL injuries, using oral contraceptives may help stabilize your ligament laxity throughout the month, potentially lowering your risk of injury compared to having natural hormonal cycles. Consult your doctor to see if this is appropriate for you.
GoodSupportsHIGH confidence
Together, these data suggest that ACL laxity changes through the cycle and eliminating the changes in estrogen using oral contraceptives decreases the risk of ACL rupture.
Why this rating
Supported by epidemiological data showing lower ACL injury rates in OC users.
Source
Effect of Estrogen on Musculoskeletal Performance and Injury Risk
Nkechinyere Chidi-Ogbolu et al. · Frontiers in Physiology · 2019
DOI 10.3389/fphys.2018.01834
narrative_reviewCited 358×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- High estrogen levels during the ovulatory phase of the menstrual cycle decrease ligament stiffness by inhibiting lysyl oxidase activity, leading to increased knee laxity and a significantly higher risk of anterior cruciate ligament (ACL) injury.Good
- Estrogen replacement therapy (ERT) in postmenopausal women improves muscle mass, strength, and power, and enhances the sensitivity of muscle to anabolic stimuli from exercise.Good
- High estrogen levels decrease tendon stiffness by inhibiting lysyl oxidase activity, which may protect muscles from eccentric injury but can negatively impact performance by reducing power output.Good
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