Oral contraceptives, widely used by women, including elite athletes, serve not only as a means of pregnancy prevention but also as a tool to manipulate the menstrual cycle. Athletes find this manipulation convenient, as it eliminates concerns associated with menstruation during training or competition, along with its potential negative impact on performance.
Mechanism of Action
The mechanism of action of oral contraceptives involves a 28-day cycle, with 21 days of active pill consumption followed by 7 days of pill-free intake. This hormonal contraception reduces natural hormone levels and introduces synthetic hormones during the active pill phase.
Effects of Oral Contraceptives on Exercise Performance
An analysis of previous studies explored the effects of oral contraceptives on exercise performance, comparing performance during pill-taking and pill-free days, as well as comparing oral contraceptive users to naturally menstruating women. The majority of these studies were of moderate to low quality, with only a small percentage considered high-quality.
Evaluating the reliability of the evidence
Findings indicated a slight decline in exercise performance among oral contraceptive users compared to naturally menstruating women. However, this effect was deemed negligible when applied to groups of female athletes. Individualized approaches are recommended, as responses to oral contraceptives vary among athletes.
Notably, exercise performance remained consistent across pill-taking and pill-free days, alleviating concerns about specific days within the pill cycle. Confidence in the findings was reinforced through the repetition of analyses using high-quality studies.
Key takeaways emphasize that while some athletes using oral contraceptives may experience minimal performance declines, this must be considered on an individual basis rather than applying it universally. No evidence supports the need for specific guidance regarding pill-taking versus pill-free days when using oral contraceptives.
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- 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
- 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.
- 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.