Hormonal Contraception, Menstrual Cycle Characteristics, and Lower Limb Injuries in Elite Female Team Sports—Identifying Factors Associated With Increased Injury Prevalence: A Cross‐Sectional Study

ABSTRACT Background and Aims This study aimed to examine the prevalence of menstrual cycle characteristics and lower limb injuries among elite female team sport athletes, and to identify factors influencing injury risk. Methods Data were collected from 301 female team athletes across the German 1st and 2nd division in basketball, field hockey, football, handball, and volleyball using an online questionnaire. Information was gathered on gynaecological health and lower extremity injuries in the past 12 months. Results Forty‐two percent used hormonal contraceptives, while among non‐users, 81% were naturally menstruating and 19% had a menstrual dysfunction (MD). Of those naturally menstruating, 46% experienced dysmenorrhea in every menstrual cycle, and 18% took painkillers during each menstruation. Regarding injuries, 42% reported at least one lower limb injury in the past 12 months, with 44% classified as severe. The most commonly affected regions were the knee (44%), ankle (31%), and upper thigh (9%). MD was associated with lower anterior cruciate ligament (ACL) injury rates ( p = 0.04, Cramer's V = 0.199, 95% CI: −∞ to −0.09), while regular periodic health examinations (PHE) were associated with higher injury rates ( p = 0.05, Cramer's V = 0.121, 95% CI: −0.98 to −0.01), particularly knee cartilage injuries ( p = 0.001, Cramer's V = 0.241, 95% CI: −3.19 to −0.59). No significant associations were found between injury rates and dysmenorrhea or premenstrual syndrome. Conclusion This study highlights the complex relationship between menstrual cycle characteristics and injury risk in female athletes, showing MD's unexpected association with lower ACL injury rates. Further, it emphasizes the need for targeted injury prevention programs, regular PHE, and enhanced medical support structures to reduce injury risks in elite female team sports.