Hormonal contraceptives and sport performance

Hormonal contraceptives have been first introduced to public six decades ago. Predominantly, its main purpose was to help women prevent an unwanted pregnancy. In the beginning, these pills were perceived as a great revolution with the immense interest from women. However, over the years, their main purpose of used changed along with its different forms.

On the one hand, hormonal contraceptives have been prescribed for treatment and alleviation of number of medical conditions (e.g., functional ovarian cysts and benign breast disease) as well as those associated with the menstrual cycle irregularities (e.g., dysmenorrhoea and menorrhagia) (British National Formulary). While on the other hand, HC has been widely used by athletic populations to manipulate the timing of or complete omitting of the menstrual cycle (Sims, 2016). Due to the possibility to relieve MC symptoms across the menstrual cycle (e.g., cramps, pain, bloating and headaches) as well as the ability to eliminate unpredictable menstruation, HC has become a desirable option for many athletes. In this instance, however, it is important to realise that such behaviour is extremely dangerous as the menstruation is one of the most important signs of females’ health and therefore should not be overlooked. 

Furthermore, it is important to be aware of differences that comes along with HC intake. While being on the pill, the menstrual bleeding experienced is not a real period. Rather it is a withdrawal bleed experienced as a part of usual 7 pill free days with the 21 first days of contraception intake (21-7days) (Martin et al., 2018; Schaumberg et al., 2018). The bleed associated with the HC is only a withdrawal bleed during which there is no occurrence of ovulation. 

Nevertheless, ovulation is the main event of the menstrual cycle during which the oestrogen levels peak. Oestrogen is one of the main female sex hormones which is needed for puberty, menstrual cycle, pregnancy, bone strength and other functions of the body. Moreover, ovulation is also important for sufficient production of progesterone. Progesterone does not only support pregnancy, but also the general health. Therefore, by suppressing natural occurrence of ovulation, the real health problems (amenorrhoea, RED-s syndrome or other health related problems) can be easily masked as well (Briden, 2021).

However, there are still other options to prevent pregnancy which do not interfere with the endogenous hormonal profile in the females’ body. Non-hormonal contraceptives, unlike the hormonal contraceptives, do not suspend the process of ovulation (and fertility). 

The forms of non-hormonal contraception are:

Overall, despite the prevalence of HC use in athletic populations (Martin et al., 2018), its effects on exercise performance are still unclear. Although many research fields and studies have addressed this topic (Joyce et al., 2013; Lebrun, 1993; Minahan et al., 2018; Burrows & Peters, 2007), the outcomes are still ambiguous. Research has shown conflicting findings on the pivotal effects of HCs on muscle function (Rechichi & Dawson, 2009; Sarwar et al., 1996), aerobic and anaerobic (Casazza et al., 2002; Giacomoni et al., 2000) capacity and performance-based tests (Frankovich and Lebrun, 2000). Therefore, it is not possible to provide useful guidance to either the sporting or research community on how to work with athletes or participants using HCs, at the moment. Therefore, for the time being, use of non-hormonal contraceptives seems as the most feasible option, given the positive pregnancy prevention and no interference to natural menstrual cycle and hormonal fluctuation. 

Written by Tereza Hybská

Reviewed by Jaylene Pratt

Reference 

1. Briden, L. (2021). Ovulation is the main event of the menstrual cycle. Lara Briden – The period revolutionary. Available at: https://larabriden.com/3-signs-your-period-is-notreally-a-period/.
2. British National Formulary. Hormonal contraceptives. Available at: https ://bnf.nice.org.uk/.
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9. Martin, D., Sale, C., Cooper, S.B. and Elliott-Sale, K.J. (2018). Period Prevalence and Perceived Side Effects of Hormonal Contraceptive Use and the Menstrual Cycle in Elite Athletes. International Journal of Sports Physiology and Performance, 13(7), pp.926–932. 
10. Minahan, C., O’Neill, H., Sikkema, N., Joyce, S., Larsen, B. and Sabapathy, S. (2018). Oral contraceptives augment the exercise pressor reflex during isometric handgrip exercise. Physiological Reports, 6(5), p.e13629. 
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12. Sarwar, R., Niclos, B.B. and Rutherford, O.M. (1996). Changes in muscle strength, relaxation rate and fatiguability during the human menstrual cycle. The Journal of Physiology, 493(1), pp.267–272. 
13. Schaumberg, M.A., Emmerton, L.M., Jenkins, D.G., Burton, N.W., Janse de Jonge, X.A.K. and Skinner, T.L. (2018). Use of Oral Contraceptives to Manipulate Menstruation in Young, Physically Active Women. International Journal of Sports Physiology and Performance, 13(1), pp.82–87. 
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