Oral Contraceptive Use Has Protective Effect Against Ankle Sprains in Women

Ankle sprain (AS) is among the most common musculoskeletal injury, particularly in women. Hormonal fluctuations during the menstrual cycle may contribute to this sex disparity by affecting ligamentous laxity and muscle stiffness. While oral contraceptive pills (OCPs) modulate hormone levels and have been linked to reduced anterior cruciate ligament (ACL) injuries, there is limited evidence on the correlation of OCPs with AS.

OCP use is associated with decreased odds of AS in a large national cohort.

Case-control study.

Level 4.

The 2010-2023 PearlDiver database was queried for female patients aged 15 years to 50 years old with and without AS, identified from orthopaedic and control populations, respectively. Controls were subsequently matched 1:1 to AS patients. Each cohort was stratified by OCP use, defined as OCP prescription within 1 year before AS, and subcategorized by OCP formulation. Multivariate analysis was used to investigate independent predictors of AS, including OCP use, with secondary analysis for OCP type.

In total, 1,836,163 patients with ASs and 108,761 controls met inclusion criteria. On average, the AS cohort was older (30.3 vs 27.5 years; P < 0.001), had a higher comorbidity index (1.9 vs 1.0; P < 0.001), and had a higher proportion of patients with severe obesity (5.4% vs 2.2%; P < 0.001). Postmatch multivariate analysis showed OCP use to be associated with decreased odds of ASs (odds ratio [OR], 0.47; 95% CI, 0.46-0.49; P < 0.001). Nonestrogen formulations had a greater protective effect (OR, 0.20; 95% CI, 0.18-0.22; P < 0.001) compared with estrogen-progesterone OCPs (OR, 0.47; 95% CI, 0.46-0.48; P < 0.001).

Patients using OCP were found to have significantly decreased odds of AS compared with non-OCP patients.

These findings may guide future treatment and injury prevention plans, particularly for at-risk female athletes.