Background: Sex hormones regulate musculoskeletal tissue properties, influencing bone and muscle health, and injury risk and recovery in female athletes. Hormonal fluctuations during the menstrual cycle, pregnancy, and menopause affect tissue homeostasis and injury susceptibility.
Purpose: This narrative review synthesizes current evidence on the effects of oestrogens, androgens and progestogens on musculoskeletal health, injury risk, and prevention strategies in female athletes. It also examines the impact of hormonal modulation, including oral contraceptive use.
Methods: A literature search was conducted across peer-reviewed databases, focusing on studies from the past two dec-ades. Both preclinical and clinical studies were included, addressing the physiological effects of sex hormones on bone and muscle, injury mechanisms, focusing in particular on anterior cruciate ligament (ACL) and Achilles tendon injuries, and
preventive strategies.
Results: Oestrogens are crucial for bone density and turnover; their deficiency increases fracture risk. Androgens promote cortical bone formation, while progesterone supports the action of oestrogens. In skeletal muscle, oestrogens improve con-tractility, reduce inflammation, and aid repair; while progestogens—via their active form, progesterone—enhance protein synthesis and endurance. Low oestrogen states are linked to higher injury risk. Oral contraceptives, by stabilizing hormone
levels, may reduce ACL injury risk but have been associated with increased Achilles tendinopathy. Exercise-based, multi-component prevention programmes tailored to female physiology significantly reduce injury incidence in women.
Conclusions: Sex hormones are central to musculoskeletal health and injury risk in female athletes. Preventive and training strategies should take hormonal status into account to optimize performance and reduce injuries. Further research is need-ed to better understand the effects of hormonal modulation and to refine preventive approaches.
