Could Birth Control Pills Prevent Muscle Injuries?

Oral contraceptives may make you less prone to certain muscle and tendon injuries compared to those who aren’t on the pill, according to a recent study involving data from over 126,000 patients. 

The study published in Medicine & Science in Sports & Exercise found that female participants using birth control pills were 85% less likely than male participants to experience muscle sprains or tendon strains, which are the most common types of musculoskeletal injuries in sports.

“This discovery has the potential to advance preventative strategies and clinical interventions from musculotendinous injuries for various female populations,” Luis Rodriguez, lead author of the study and PhD candidate in the Joint Biomedical Engineering Graduate Program between UT Dallas and UT Southwestern, told Verywell in an email.

Here’s what else you need to know about the study, how birth control pills might protect you from muscle injuries, and expert-recommended strategies for preventing such injuries.

People on the Pill Had Significantly Fewer Muscle and Tendon Injuries Than Others 

Rodriguez and his colleagues used a national healthcare database called PearlDiver to look into an orthopedic injury dataset. They looked at the proportion of muscle and tendon injuries in the lower parts of the body compared to the total number of orthopedic injuries in different groups, including males, females who had been using oral contraceptives for at least a year before their injury and continued using them afterward, and females who had never used oral contraceptives.

The study focused on patients aged 18 to 39 with body mass indexes (BMIs) ranging from normal to overweight. Each cohort had 42,267 patients.

The study included monophasic, biphasic, triphasic, and quadriphasic oral contraceptive pills, which are different formulations designed to provide varying levels of hormones throughout the menstrual cycle. 

Rodriguez some examples of lower-body strain injuries featured in the study database include: 

• Pulling the adductor muscle, fascia, and tendon of the right thigh for the first time
• Straining the muscle group, fascia, and tendon at the back of the left thigh
• Overstretching the muscles and tendons in the lower leg on the right side for the first time

After considering factors like age, BMI, and geographic location, the researchers found that female participants using oral contraceptives had fewer muscle and tendon injuries compared to female participants who didn’t use them, and compared to male participants. Specifically, only 0.55% of orthopedic injuries were muscle and tendon injuries in those on birth control, compared to 2.55% for those without a history of using oral contraceptives and 3.49% for males.

Rodriguez added that these findings could also provide insight into injury risk among women impacted by conditions involving hormone imbalances and altered hormonal environments, such as “women with polycystic ovary syndrome (PCOS), menstrual cycle irregularities, and hormonal shifts post-menopause.”

Why Might Birth Control Pills Prevent Muscle and Tendon Injuries? 

Rodriguez said that we still need more research to understand how birth control pills might affect muscle and tendon injuries, but he thinks it might have something to do with hormone levels.

“At this point, we don’t know, but research indicates that women with low estrogen levels, such as after menopause, have poorer musculoskeletal health compared to women with normal levels,” Rodriguez said.

Other experts suggest that birth control pills might help prevent muscle and tendon injuries because of how they affect estrogen, a hormone necessary for maintaining reproductive and sexual health.

Preliminary and controversial data show that muscle and tendon injuries in female athletes occur more frequently during certain phases of the menstrual cycle when estrogen levels are high and progesterone levels are low, Mary Jacobson, MD, an OB-GYN and Chief Medical Officer at Hello Alpha, told Verywell in an email.

However, estrogen, found in birth control pills can help improve muscle mass and strength while also increasing the collagen content of connective tissues, Jacobson said. But too much estrogen can make tendons and ligaments less stiff, which raises the chance of injury. 

Birth control pills with a mix of estrogen and progestin might help by keeping estrogen levels from spiking too high, which would lower the risk of injuries, she added.

“We know that permanently low levels of female sex hormones, leading to an absence of menstrual periods in athletes (called the female athlete triad), are detrimental for bone health and increase the risk for stress fractures,” Jacobson said. However, taking hormonal medication can help avoid these risks by balancing hormone levels.

Other Potential Benefits of Birth Control Pills 

Besides protecting against pregnancy, birth control pills offer many other benefits, Jacobson said. They may make your period more regular, lighter, and shorter, help reduce or ease menstrual cramps, and decrease the risk of cancer of the uterus, ovary, and colon.

In addition, birth control pills may improve acne and unwanted hair growth and treat certain disorders that cause heavy bleeding and menstrual pain, such as fibroids and endometriosis, Jacobson said.

If used continuously, birth control pills may also reduce the frequency of migraines associated with menstruation, “although they should not be used if you have migraines with aura,” said Jacobson. “They can also be used to treat heavy bleeding and pain by stopping the menstrual period.” 

Some studies have indicated that women using oral contraceptive pills may experience lower incidences of anterior cruciate ligament injuries, Rodriguez said. However, he emphasized that “this field is still young, so there are still a lot of unanswered questions” regarding the lesser-known benefits of birth control usage.

What Are the Risks of Taking Birth Control Pills? 

Although there are benefits to using oral contraceptives, there are some risks to be aware of, Jacobson said. These include a small increased risk of deep vein thrombosis (DVT) or blood clots, heart attack, stroke, and liver tumors.

Some individuals may experience digestive issues like bloating, increases in appetite, abdominal discomfort, and nausea, Myra Trivellas, MD, an orthopedic surgeon who specializes in the treatment of shoulder, knee, and hip conditions and injuries at Hoag Orthopedic Institute, told Verywell in an email. 

Trivellas added that oral contraceptives may also cause hormonal side effects, such as mood changes, depression, mental changes, and headaches. They can also interact with certain medications, “potentially reducing their effectiveness or causing adverse effects.”

Other Ways to Prevent Muscle Injuries 

According to Trivellas and Jacobson, there are many things you can do to prevent muscle injuries and strains.

1. Warm-up and Cool-down. Before physical activity, engaging in dynamic stretching, static stretching, and light exercises can help prepare muscles and tendons for movement, reducing the risk of injury, Trivellas said. Cooling down with gentle stretching after activity helps with muscle recovery.
2. Gradual Exercise Progression. Avoid sudden increases in intensity or duration of exercise to help prevent overuse injuries to muscles and tendons. Gradually ramp up the intensity and duration of workouts to allow the body to adapt and strengthen safely, said Trivellas.
3. Maintain Proper Form: Use correct body mechanics and technique during exercise and daily activities to lower the strain on muscles and tendons, lowering the risk of injury, Trivellas said. Seeking guidance from a coach, fitness instructor, or physical therapist can be very helpful. 
4. Cross-Training: Include a variety of exercises and activities into a fitness routine to help prevent overuse injuries by reducing stress across different muscle groups and reducing repetitive strain on specific tendons or muscles, Trivellas said.
5. Rest and Recovery: Ensure adequate rest between workouts to give the body time to repair and rebuild muscle tissue, reducing the risk of overuse injuries, Trivellas said. It’s important to prioritize sleep and incorporate rest days into a training schedule.
6. Take Breaks Regularly. Try to take frequent breaks throughout the day and aim to change any sustained posture every 20 to 30 minutes to prevent muscle strain and stiffness, said Jacobson. Be sure to stretch any stiff muscles as well.
7. Nutrition and Hydration: Maintain a balanced diet and stay hydrated to support overall muscle and tendon health. Adequate intake of protein, vitamins, and minerals, along with staying hydrated, can aid in muscle repair and recovery, said Trivellas.
8. Listen to Your Body: Pay attention to signs of muscle fatigue, discomfort, or pain during exercise. Ignoring these signals can increase the risk of injury, Trivellas said. It’s important to modify activities or seek medical advice if persistent pain or discomfort occurs.