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How oral contraceptive pills influence athletic performance

what the science says

Background

Oral contraceptive pills are taken by more than 100 million women around the world.  They are prescribed for various health reasons, among which heavy and painful periods predominate. Various other conditions such as endometriosis (when the endometrial tissue grows outside of the uterus), acne and the need for the contraception, reason taking the contraceptive pills. The contraceptive pill increases hormone levels in the follicular phase, blocking the ovulation and reduces the chance of conception. On the other hand, the body stops producing its own oestrogen and progesterone.

Combined contraceptive pills consist of synthetic oestrogen and progestin, the concentration of which varies based on the pill type. Some progestins, especially higher concentrations cause more androgen responses than others (insulin resistance, acne, weight gain, etc.). The pills are most often used in a 21/7 regime, where the active pills are taken for 21 days, with a 7-day break, before the new cycle. These phases, however, do not have much in common compared to a normal menstrual cycle and the bleeding in the 7-day phase is not the same as menstruation.

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Impact on performance

From our previous posts, we now know how oestrogen and progesterone affect our physical performance (i.e., study results are mostly inconclusive). Even less conclusive, inconsistent and weak are the studies conducted on the population using contraceptive pills. A concentration of the hormones in the pill plays an important role and to make the studies even more difficult to conduct, each brand has its own dosage of hormones as well as different forms of synthetic hormones. Overall, they can be divided into either high or low- dose contraceptive pills. The correct dosage will be assessed and prescribed by your gynaecologist depending on your weight and level of endogenous hormones etc.

A very revealing meta-analysis dealing with the effect of oral contraceptive pills came to the following conclusions:

  1. Performance in the early follicular phase- during menstruation vs. 7-day withdrawal phase
    The performance was superior in the early follicular phase as compared to the withdrawal phase.
  2. Performance in the follicular and luteal phase vs. active contraceptive pill phase
    Slightly better performance in the follicular and luteal phase as compared to the performance of those on the active contraceptive pill.
  3. Performance in the active pill phase vs.  7-day withdrawal phase
    Performance was superior in the active pill phase; however, the effect was rather minor.

The researchers assumed that oral contraceptive pills could, on average, have a slightly negative effect on the performance. Whereas, those who have a natural menstrual cycle showed slightly better performance. But. As some women suffer from severe menstrual symptoms such as cramps, heavy bleeding etc. Benefits of the oral contraceptives in managing the symptoms might outweigh the small adverse effect on performance.

Conclusion

Apparently, there seems to be a slightly negative influence of oral contraceptive pills on performance. Due to a high variability both between the contraceptive pills and between women, it is a great challenge to conduct studies on the effect of the oral contraceptive pill. Therefore, we cannot express the importance of working with each individual and monitoring their response to contraceptive pills and their progress in performance. Each individual athlete must be aware of the symptoms that contraceptive pill alleviates or create and how these affect the performance and emotional state. As with all drugs, taking contraceptive pills might bring some adverse effects such as weight gain, water retention, headaches, mood swings etc. also those must be taken into account. It should be noted that before making a decision to use or not use oral contraceptive pills, several factors (emotional, practical, financial, physical …) must be discussed with the doctor.

This article is not a medical advice.

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