Prevalence, patterns and motives for hormonal contraceptive use among German servicewomen: results from a nationwide survey.

Hormonal contraceptive (HC) use is common among servicewomen and has been discussed in relation to health, performance, and operational readiness. No systematic data exist on HC prevalence among German servicewomen. This study analyzes contraceptive practices and motivations for contraceptive choice in German servicewomen. A nationwide, cross-sectional online survey was conducted among female members of the German Armed Forces. Recruitment occurred via military institutions and a digital flyer. The anonymous questionnaire (40 items, 10-15 min) assessed demographic characteristics and contraceptive use. Data were cleaned and analyzed using R. Inferential analyses comprised pairwise adjacent comparisons using Fisher's exact test with Holm correction. A total of 2818 servicewomen completed the survey (response rate 11.2%; mean age 33.9 years). Overall, 38.1% reported current HC use. Combined oral contraceptive pills (COCP) were the most common method (18.5%), followed by hormonal intrauterine devices (8.9%) and progestin-only pills (8.4%). HC use declined with increasing age, primarily due to decreasing pill use, although 8% of women ≥40 years still reported COCP use. Systemic long-acting reversible contraceptives (LARC) (implants and injections) were virtually absent. Contraceptive use differed significantly across age- and length-of-service categories, but not BMI categories. Pregnancy prevention was the primary reason for HC use (82%), followed by management of menstrual pain and bleeding. A small proportion reported HC use for performance-related cycle control (13%) or masking of amenorrhea (2%). Deployment-related switching to HC was uncommon. HC use among German servicewomen appears low compared with reports from British and U.S. militaries. Given evidence linking certain systemic LARC formulations to potential effects on bone metabolism, the low prevalence warrants further investigation in the context on musculoskeletal health and injury risk in a population exposed to high mechanical loading. Preventive efforts in the German military should consider a broader range of modifiable risk factors, including nutrition and training load. The findings may indicate potential gaps in military-specific education and counseling regarding informed contraceptive choice, occupational implications of different methods, and age-related hormonal management. The response rate and the limited scope of certain questionnaire items should be considered when interpreting the results.