An Athlete's Guide To Birth Control
Choosing the right birth control is such a personal decision, and as an athlete, it can help to think about how it may affect your health and performance. Some methods can mask issues like irregular periods, a key indicator of your body’s health. Understanding your options will help you make informed decisions that support both your well-being and athletic goals.
Why Menstrual Cycles Matter
A natural, regular menstrual cycle is a crucial sign that your body is functioning properly. Changes or irregularities in your menstrual cycle, such as periods becoming inconsistent or stopping altogether, often signal underlying health issues. Because some contraceptives can hide this vital health indicator, it’s important to understand your options and their potential impacts.
Note:
A menstrual cycle is considered regular when it occurs every 21-35 days, with periods lasting 2-7 days.
Hormonal Contraceptives
1. Combined Oral Contraceptive Pills (OCPs)
What They Are: Daily pills containing synthetic estrogen and progestin to suppress the natural menstrual cycle
Pros: Highly effective at preventing pregnancy and may ease premenstrual symptoms
Cons: Potential side effects include nausea, headaches, or mood changes. Some athletes report reduced aerobic capacity, though evidence varies.
Considerations: During the placebo week of most OCP regimens, you’ll experience a withdrawal bleed (not the same as a true period) which can hide menstrual dysfunction
2. Progestin-Only Pills (Mini Pills)
What They Are: Daily pills containing only progestin
Pros: Suitable for those sensitive to estrogen or breastfeeding; fewer estrogen-related side effects
Cons: Requires strict timing for effectiveness and may cause irregular bleeding
Considerations: Mini pills are less likely than combined OCPs to disrupt training adaptations and are easy to stop if needed
3. Hormonal IUDs (hIUDs)
What They Are: Small devices placed in the uterus, releasing progestin locally rather than throughout the body
Pros: Low-maintenance, long-term (3-7 years), and may reduce or eliminate menstrual bleeding and cramps
Cons: Insertion can be uncomfortable, and irregular bleeding is common initially
Considerations: hIUDs are popular among endurance athletes for their minimal systemic impact and positive effects on symptoms like heavy bleeding
4. Injectable Contraceptives (e.g., Depo-Provera)
What They Are: Progestin injections given every three months to stop ovulation
Pros: Highly effective and doesn’t require daily attention
Cons: Side effects may include weight gain and irregular bleeding. Effects can linger after stopping
Considerations: There’s limited research on injectables and athletic performance, but their systemic impact is thought to be similar to OCPs
Non-Hormonal Contraceptives
1. Copper IUDs
What They Are: Non-hormonal devices that prevent pregnancy by releasing copper ions toxic to sperm
Pros: Long-lasting (up to 10 years), hormone-free, and allows for natural menstrual cycle tracking
Cons: May increase menstrual bleeding and cramping temporarily after insertion
Considerations: Copper IUDs provide reliable contraception without masking period-related health signals, though insertion can be uncomfortable for some
2. Barrier Methods
What They Are: Condoms, diaphragms, or cervical caps
Pros: Hormone-free, easily accessible, and condoms protect against STIs.
Cons: Less effective than other methods and require consistent, correct use
Considerations: Best for those needing occasional contraception or dual protection against pregnancy and STIs
3. Fertility Awareness Methods
What It Is: Tracking ovulation to avoid intercourse during fertile windows
Pros: Hormone-free, device-free, and increases body awareness
Cons: Less reliable and requires meticulous tracking; stress can disrupt cycle regularity
Considerations: Apps like Natural Cycles simplify tracking, but this method demands daily effort and works best with regular cycles
Important Considerations
Doctors often prescribe OCPs to “regulate” menstrual cycles or protect bone health in athletes with amenorrhea (no periods). However, the synthetic estrogen in OCPs doesn’t offer the same bone-protective benefits as natural estrogen. In cases of REDs (Relative Energy Deficiency in Sport), OCPs can mask underlying issues like under-fueling, delaying effective treatment and recovery.
Low energy availability (the cause of REDs) is typically accompanied by a reduction in estrogen levels, which increases the risk of stress fractures, especially in high-impact sports like running. If this state is maintained, it can contribute to a wide range of other problems, including low immunity, depression, infertility, and damage to your cardiovascular health.
Key Takeaways for Athletes
Consult a specialist: Choose a gynecologist or sports doctor familiar with female athletes to guide your decision
Monitor and adapt: Pay attention to how your body responds and adjust contraception as needed to support both health and performance
Know Your options: Contraceptives can also manage medical conditions like endometriosis, heavy bleeding, or PCOS
Key Takeaways for Supporters
Consult experts: Encourage athletes to seek guidance from a gynecologist or sports doctor with expertise in female athletes' health to make informed decisions about contraception
Understand the impact: Help athletes recognize how certain contraceptives can mask important health signs, such as menstrual irregularities, which may be linked to REDs or other health concerns
Encourage body awareness: Promote understanding of how contraceptive choices interact with the body, especially regarding menstrual health and long-term athletic well-being