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ARTICLE TYPE : RESEARCH ARTICLE

Published on :   12 Dec 2025, Volume - 1
Journal Title :   WebLog Journal of Orthopaedics | WebLog J Orthop
Source URL:   weblog iconhttps://weblogoa.com/articles/wjor.2025.l1201
Permanent Identifier (DOI) :  doi iconhttps://doi.org/10.5281/zenodo.17993710

Impact of Oral Contraceptive and Hormone Replacement Therapy Use Resulting in Increased Risk of Meniscal Degeneration in Female Athletes

Amari Eubanks 1
Kiana Allen 1
Dy’Quan Kearney 1
Diwane Mills 1
Damon Ross 1
Madison Burnard 2
Elizabeth Beyene 4
Mekdem Bisrat 4 *
Syed Fahad Gillani 3
Miriam Michael 3,4
1College of Medicine, Howard University, Washington, DC, USA
2Department of Anesthesiology, Howard University, Washington, DC, USA
3Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, USA
4Department of Internal Medicine, Howard University College of Medicine, Washington, USA

Abstract

Background: Meniscus degeneration is the gradual breakdown of cartilage in the knee that could lead to osteoarthritis. Female athletes in high-impact sports are at an increased risk, but the underlying reason for this is unknown. The deficiency of sex hormones (i.e, Estrogen) is known to influence connective tissue and joint health. Still, the impact of elevated hormones, such as those from oral contraceptives and hormone replacement therapy, is unknown. The study aims to evaluate elevated hormone levels in female athletes with the risk of meniscus injuries.

Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Two cohorts were defined: female athletes aged 15-45 on oral contraceptive or hormone replacement therapy (n=61,888), and a control group of female athletes not on hormonal therapy (n=205,175). The primary outcome was the development of meniscus injuries, including meniscus tears or meniscus derangements. Patients with meniscus-related knee injuries and osteoarthritis before hormonal therapy were excluded. Statistical analyses included risk analysis, Kaplan-Meier survival analysis, and frequency analysis (i.e., the number of instances). Key metrics included risk ratio, hazard ratio, and survival probability over a 5-year follow-up period.

Results: Oral Contraceptive Pills (OCP) and Hormone Replacement Therapy (HRT) in female athletes after matching (n=58,265, 50%) were positively associated with meniscus degeneration compared to female athletes who were not on hormone therapy (n=58,265, 50%). OCP and HRT athletes had a risk ratio of 1.369. Kaplan-Meier Analysis showed similar time-related meniscus injuries with OCP and HRT use (97.59% vs. 97.63%). Users demonstrated a minor increase in the average number of instances post-outcome (3.54 vs. 3.42). This difference was not statistically significant (p = 0.666).

Conclusions: Hormonal therapy slightly increases the number of meniscus-related injuries for female athletes. These findings suggest that oral contraception and hormone therapy may impact joint health and should be considered for future risk assessments.

Keywords: Hormone Replacement Therapy; Meniscal Degeneration; Meniscus Tear; Oral Contraceptives

Citation

Eubanks A, Allen K, Kearney D, Mills D, Ross D, Burnard M, et al. Impact of Oral Contraceptive and Hormone Replacement Therapy Use Resulting in Increased Risk of Meniscal Degeneration in Female Athletes. WebLog J Orthop. wjor.2025.l1201. https://doi.org/10.5281/zenodo.17993710
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