Oral contraceptive pills are utilized by women worldwide, including elite athletes. In the United Kingdom, they are the most commonly used hormonal contraceptive among elite sportswomen. While oral contraceptives are primarily designed for pregnancy prevention, some athletes employ them to manipulate their menstrual cycle, either by controlling the timing of their periods or eliminating them altogether. This is motivated by the inconvenience and additional concerns associated with menstruation during training or competition, as well as the negative side effects experienced by some athletes, which could potentially hinder their performance.

The mechanism of action of oral contraceptives

The most common type of oral contraceptive follows a 28-day cycle, with a routine of 21 days of active pill consumption followed by 7 days of pill-free intake. Throughout the cycle, oral contraceptives have two primary physiological effects. Firstly, they reduce the natural levels of estrogen and progesterone in the body, and secondly, they introduce synthetic estrogen and progestin during the active pill-taking phase.

Effects of Oral Contraceptives on Performance

To assess the effects of oral contraceptives on exercise performance, previous studies in this area were analyzed. The investigation focused on comparing the performance of individuals during pill-taking days versus pill-free days, as well as comparing oral contraceptive users to naturally menstruating women. Additionally, the quality of the identified studies was evaluated to gauge the reliability of the evidence. The majority of the 42 relevant studies, involving a total of 590 participants, were categorized as moderate, low, or very low quality, with only 17% considered high-quality studies.

Practical Implications

The results indicated that, on average, oral contraceptives may have a slight negative impact on exercise performance compared to naturally menstruating women who do not use oral contraceptives. However, it is important to note that this effect is likely to be negligible when applied to a group of female athletes. The effect size of oral contraceptives on exercise performance falls below the small category on the grading scale. Therefore, there is no need to establish specific exercise guidelines for female athletes using oral contraceptives.

An Individualized Approach

Instead, it is recommended to adopt an individualized approach to oral contraceptive pill usage. Monitoring each athlete's response to their oral contraceptive is crucial, as the effects can vary among individuals. Furthermore, the investigation revealed that exercise performance remains consistent between pill-taking and pill-free days. Consequently, female athletes need not be concerned about the specific day of their oral contraceptive pill cycle in relation to their performance.

Confidence in the Findings

To strengthen the confidence in the findings, the analyses were repeated using only the moderate and high-quality studies, and the results remained consistent. This confirms the reliability of the results and conclusions.

Key Takeaways

In summary, our main takeaways are as follows: Some female athletes using oral contraceptives may experience a minimal decline in performance compared to naturally menstruating athletes who do not use oral contraceptives. However, this should be considered on an individual basis rather than applying it to groups of female athletes. Furthermore, there is currently no performance-related evidence to support general guidance on distinguishing between pill-taking and pill-free days when using oral contraceptives.

‍

If you have any further questions about the topic, then just drop us online by clicking here

‍

Scientific References

1. Elliott-Sale, K.J., McNulty, K.L., Ansdell, P. _et al._ The Effects of Oral Contraceptives on Exercise Performance in Women: A Systematic Review and Meta-analysis. _Sports Med_ (2020). https://doi.org/10.1007/s40279-020-01317-5
2. Martin D, Sale C, Cooper SB, Elliott-Sale KJ. Period prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes. Int J Sports Physiol Perform. 2018;13(7):926–32.
3. Schaumberg MA, Emmerton LM, Jenkins DG, Burton NW, de Jonge XAJ, Skinner TL. Oral contraceptive use for manipulation of menstruation in young, physically-active women. Int J Sports Physiol Perform. 2017;16(1):e68–e6969.