{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:04:29Z","timestamp":1789365869593,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Hormonal fluctuations may influence musculoskeletal stability in women, raising interest in whether hormonal modulation through contraceptive use alters susceptibility to lower-extremity injuries in sports-related settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>Systemic hormonal contraceptive use will be associated with lower rates of common lower-extremity injuries among female athletes with sports-related clinical encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level\u20093.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Data were obtained using the TriNetX United States Collaborative Network. Female athletes aged 18 to 65\u2009years who had encounters documented in sports or athletic environments were identified within a 20-year period. Cohort\u2009A included athletes with documented systemic hormonal contraceptive use while cohort\u2009B included athletes without contraceptive exposure. A 1:1 propensity score matching was used to balance the cohorts for demographic and medical factors such as hypertension, type 2 diabetes, and obesity. Outcomes were evaluated over 5\u2009years with injuries that included anterior cruciate ligament (ACL) sprain, meniscal tear, ankle sprain, patellofemoral disorders, lower extremity stress fractures, Achilles tendinopathy, iliotibial band syndrome, or greater trochanteric pain syndrome. Chi-square analysis, risk ratios (RRs), 95% CIs, and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009values were calculated to compare outcomes, with significance at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 8783 contraceptive users were matched to 32,499 nonusers, which resulted in 8358 patients in each balanced cohort. In 5\u2009years, contraceptive users demonstrated significantly lower risks of ACL sprain (1.7% vs 2.2%; RR 0.78, 95% CI 0.62-0.97;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.03), meniscal tear (2.0% vs 2.5%; RR 0.78, 95% CI 0.64-0.97;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.02), and stress fractures (0.2% vs 0.4%; RR 0.52, 95% CI 0.29-0.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Among women with sports-related encounters, systemic hormonal contraceptive use was associated with lower risk of ACL sprains, meniscal tears, and lower extremity stress fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Hormonal modulation through contraceptive use may play a protective role in ligamentous and bony injury risk in female athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19417381261479648","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:51:52Z","timestamp":1789123912000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Hormonal Contraceptives and Lower Extremity Injuries in Female Athletes With Sports-Related Clinical Encounters"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7725-8984","authenticated-orcid":false,"given":"Ahad A.","family":"Kesaria","sequence":"first","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2597-5290","authenticated-orcid":false,"given":"Alice","family":"Lee","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Goodsett","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A.","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0000000000000329"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.4183\/aeb.2022.355"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00001.2012"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.33.4.231"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.70082"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01281.2007"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/endo-91-4-1113"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200737070-00001"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12539"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e318074e532"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.2019.1600334"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511413378"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2025.02.012"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.2165\/00024677-200403030-00006"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000806"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.90933.2008"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/ar1978"},{"key":"e_1_3_2_19_2","volume-title":"Contraceptive Technology","author":"Hatcher RA.","year":"2007","unstructured":"Hatcher RA. 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