Contraception is essential for preventing pregnancy and allowing athletes to maintain control over their reproductive rights. However, it’s important to balance the potential impacts on athletic performance and training adaptations with the benefits of contraception, including its role in managing certain medical conditions.
Hormonal Contraception and Athletic Performance
Most hormonal contraception lowers oestrogen and contains synthetic progesterone. The pill also reduces growth hormone/IGF-1, which may not benefit athletic performance.
Combined Oral Contraceptive Pill (COCP)
The combined contraceptive pill (COCP) is the most studied form of contraception in athletes. Although studies are generally small and may not eliminate all confounding factors, data shows that the COCP can cause a minor decrease in Vo2 max. The impact on muscle strength and power varies depending on the type of pill and progestogen, but generally shows no difference or a slight negative impact. Choosing a low-dose pill with a more natural oestrogen (17-beta oestradiol) may reduce this impact, though more research is needed. A 2020 meta-analysis indicated a slight inferior impact on athletic performance from the COCP.
Other Hormonal Contraception Options
- Implanon: This high-dose progestogen implant stops ovulation and lowers oestrogen. There is limited data on its impact on performance, but it likely has a slight negative effect.
- Injection: High-dose progestogen injections are not recommended due to their negative impact on bone health and potential for weight gain.
- IUD: Increasingly recommended for athletes, the IUD does not lower oestrogen levels, which is beneficial for performance. It also allows for blood tests to diagnose functional hypothalamic amenorrhoea. However, it may not be suitable for everyone, especially younger athletes, highlighting the need for an individual approach.
Considerations for Amateur Athletes
For most amateur athletes, the impact of contraception on performance is likely trivial. However, it’s important to be aware of how contraception can mask Relative Energy Deficiency in Sport (RED-S) and amenorrhoea.