Arthroscopy - 2026-04-26 - Journal Article
Systemic Hormonal Contraceptive Use Is Associated With Greater Odds of Rotator Cuff Tears, Shoulder Instability, Dislocation, and Other Shoulder Pathologies: A Propensity Matched Epidemiological Study.
Omurzakov A, Omurzakov AM, Burkhart RJ, Shah AK, Abid R, Voos JE, Calcei JG, Apostolakos JM
Topics
Key Takeaway
Systemic hormonal contraceptive use is associated with up to 2.0× greater odds of rotator cuff tears and 1.8× greater odds of superior labral tears compared to matched controls over 5 years.
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Summary
This propensity-matched retrospective cohort study used the TriNetX database to determine whether estrogen-only, progestin-only, or combined hormonal contraceptives increase risk of 10 shoulder pathologies in females aged 13–50. All three formulations were associated with significantly increased odds of rotator cuff tears (OR 1.6–2.0), shoulder instability (OR 1.5–1.6), bursitis (OR 1.5–2.0), superior labral tears (OR 1.4–1.8), and impingement (OR 1.6–1.8). Estrogen-only users showed no significant increase in dislocation/subluxation or AC joint pathology, while progestin-only and combined users had elevated odds across all 10 pathologies.
Key Limitation
The database design cannot establish causality or account for confounders such as physical activity level, sport participation, or indication for contraceptive use, all of which independently influence shoulder injury risk.
Original Abstract
PURPOSE
To evaluate whether systemic estrogen-only, progestin-only, or combined hormonal contraceptives (HCs) are associated with increased risk of shoulder pathologies in reproductive-age females.
METHODS
A retrospective cohort study of female patients presenting to clinic from 2013 to 2020 and aged 13-50 with 5 years of follow-up was conducted using the TriNetX database. Patients prescribed estrogen-only, progestin-only, or combined HCs were matched 1:1 to controls using propensity score matching. Odds ratios (ORs) 95% confidence intervals (CIs), and P values were calculated after 5 years for 10 shoulder pathologies.
RESULTS
Estrogen-only (n = 95,109) users had increased odds of rotator cuff tears (RCT; OR: 2.0, P < .001), shoulder instability (SI; OR: 1.5, P < .001), bursitis (B; OR: 2.0, P < .001), superior glenoid labral tears (SLT; OR: 1.8, P < .001), impingement (IMP; OR: 1.8, P < .001), and calcific tendinitis (CT; OR: 1.8, P < .001), with no difference in rotator cuff capsule sprains (CS; OR: 1.3, P = .117), dislocation or subluxations (DS; OR: 1.3, P = .069), acromioclavicular (AC) joint sprains (AC-S; OR: 1.3, P = .272), or AC joint dislocations (AC-D; OR: 1.2, P = .486). Progestin (n = 766,264) and combined (n = 625,809) users had increased odds for all pathologies (all P < .05), with ORs for RCT, SI, CS, DS, B, SLT, IMP, CT, AC-S, and AC-D of 1.6, 1.6, 1.3, 1.5, 1.5, 1.4, 1.6, 1.5, 1.6, and 1.2 for progestin, and 1.6, 1.6, 1.7, 1.4, 1.7, 1.6, 1.8, 1.6, 1.8, and 1.3 for combined HC users.
CONCLUSIONS
The HC formulations studied were associated with increased odds of all 10 shoulder pathologies. Surgeons should be aware of these potentially increased risks when treating patients on HCs.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.