Hormonal Birth Control and Athletes
There’s a lot of info floating around recently about how damaging birth control can be for women. It seems like it’s become more of a lifestyle drug, as opposed to just a way to control your reproductive system. In this article, I’m going to lay out my case as to why you should think twice about using hormonal birth control as an athlete.
A Brief History of Hormonal Birth Control
Hormonal birth control has been around for a little over 60 years now. Back in June of 1960, the Food and Drug Administration approved the first hormonal contraception pill for use in the United States. This medication was called Envoid, and it was manufactured by G.D. Searle and Company who had been financing research done by a man named Gregory Pincus for years.
Envoid consisted of mestranol and norethindrone. Norethindrone is classified as a progestogen, whereas mestranol is an estrogen hormone. When combined they make it harder for sperm to reach the egg/uterus, and make it more difficult for a fertilized egg to attach to the uterus. It’s substantially more complex than this, but this is the gist of how hormonal birth control can work to prevent pregnancy.
Within the first year of the pill being available to women in the United States, there were roughly 1.2 million women taking advantage of the benefits of being able to plan their own pregnancy. By the time women hit menopause, roughly 80% of them had used oral contraception for an average of 5 years.
It’s undeniable that oral contraception has led to more women being able to chase their dream work lives, and has been a socioeconomic net positive for women in many ways. However, we’ve now started to understand that hormonal contraception isn’t without cost.
How Does Hormonal Birth Control Work?
Most hormonal birth control is what’s called a combination birth control. It’s a combination of progesterone and estrogen and it has a few direct effects on your body.
They prevent ovulation
They increase the thickness of the cervical mucus making it more difficult for sperm to reach the egg
They can change the lining of the womb making it less likely that a fertilized egg will implant
Hormonal birth control essentially “tricks” your body into believing it’s pregnant. When you’re pregnant your body won’t ovulate, due to the fact that you can’t get pregnant while you’re pregnant. This process is great for preventing pregnancy 93% of the time, however, there are some side effects of combination birth control and we’re going to go over that now.
What Are The Side Effects of Combination Hormonal Birth Control?
While preventing pregnancy is the right choice for many women and hormonal birth control works fairly well for this, it’s not without negative side effects. Have you ever read the insert of your birth control? It’s riddled with potential side effects. Here are some of the side effects of hormonal birth control:
Blood clots
Headaches
Nausea
Breast tenderness
Breakthrough bleeding
Stroke
Heart attack
Vaginal discharge
Weight gain
Lowered libido
Mood swings
Depression/Anxiety
Acne
Increases in blood pressure
Gallbladder disease
Liver cancer
Death
Seems like a lot of unwanted side effects honestly, and it would be disingenuous of me to sit here and say that you’ll suffer from all of them. However, it’s not all that uncommon to suffer from at least some of these while on hormonal birth control. 51% of women report having some kind of unwanted side effect while using birth control.
There are also a lot of anecdotal stories of hormonal birth control changing women’s preferences in partners. It’s wild, but there’s some data to suggest that when women are on birth control, they seek out less masculine men opting for more feminine features in men. I had a buddy get married to the love of his life, a happy relationship and they decided they wanted to have kids. His wife went off her hormonal birth control and started finding my friend less attractive fairly quickly. Instead of having kids, they ended up divorced. This isn’t an isolated case either, this happens to many couples.
Whatever your feelings on hormonal birth control, you’ve got to admit that there’s got to be some downsides to essentially fooling your body into believing that it is pregnant, 365 days out of the year. You’re not designed to live in that state. It can affect everything from your physical health to your mental and emotional health.
While these side effects seem unwanted on the surface, many women will push that all to the side because of the purported benefits of birth control. We’re going to go over that next.
Why is Hormonal Birth Control Prescribed Beyond Pregnancy Prevention?
While pregnancy prevention is the number one reason for hormonal birth control prescription, doctors also prescribe them for other reasons. Here’s a list of the reasons doctors will prescribe birth control:
Having regular periods
Lessen the severity of cramps, PMS, and anemia
Relieve endometriosis symptoms and prevent ovarian cysts
Can lessen the severity of acne experienced by some teens
Prevents unwanted hair growth
Can help with Polycystic Ovarian Syndrome
PCOS is when the ovaries create too much extra testosterone and can cause some unwanted effects in women
Can lower the risk of some cancers
Ovarian cancer in particular. The longer you’re on the pill the better your odds of not developing ovarian cancer
As a young high school-aged athlete, chances are (hopefully) you’re not being prescribed birth control in an effort to prevent pregnancy. You’ve probably been sold on some of the other benefits, but if that’s the case I would implore you to find other ways to combat those issues. From diet, to sleep, and exercise there are many other ways to control the craziness your body goes through in your teens. Birth control should be an absolute last resort when it comes to your health.
Androgens In Women?
When it comes to sports, we have all kinds of rules dealing with exogenous hormone use. There’s a reason for this: they work.
Testosterone is the most prevalent androgen in the body. And while women have significantly lower levels than men, they still need testosterone to perform, grow, recover, and function. Testosterone is important in strength development, muscle mass development, recovery, and aggression (your compete level). Many women who are successful in sports have a genetic predisposition to having higher androgen levels. This is one of the many reasons transwomen should be banned from competing against men. In the book Principles of Sports Training, the author Dietrich Harre speaks about the old Eastern Bloc communist countries selecting girls at a young age who had darker/coarser arm hair for sports like weightlifting and throwing. The reason? They had higher androgen levels.
Hormonal birth control lowers testosterone and sex binding hormone globulin (SBHG). This can and will absolutely affect your performance and recovery. It can decrease your level of compete, and believe it or not lower your confidence. Lower testosterone can cause:
Slower speeds
Less muscular control (higher incidence of injury)
Slower recovery times
Less power
Lowered levels of conditioning
Higher body fat levels
Lower pain/exhaustion thresholds
Hormonal birth control can (and does) cause a decrease in your ability to perform at the highest levels of competition. It lowers your androgen levels as well as sex binding hormone globulin. If the goal is performance, take a hard look at the overall efficacy of your birth control plan and find if there are other ways to gain the benefits without the pill.
Benefits of Hormonal Birth Control in Women Athletes
There are some benefits to hormonal birth control when it comes to athletes. A 2018 study of 430 elite female athletes from 24 different sports found that about half of these athletes used hormonal birth control. Of those athletes, 12.7% said they liked the regularity of their menstruation, and 12.2% said they liked being able to reduce the amount of bleeds they experienced every month.
While on birth control, you have a fairly regular 28-day cycle. This can be beneficial when planning training and competition. Push aside the fact that understanding when you are going to experience bleeding can be beneficial, there are some benefits to ensuring you’re not competing during this time.
There is definitely some benefit to being able to control when you’ll go through menses, and as an athlete being able to plan can be a game changer. Ensuring you’re not menstruating during a competition or a hard block of training can yield game-changing benefits. We’re going to talk about one of those next.
ACL Tears and Hormonal Birth Control
A study in 2002 found that there is a higher incidence of ACL tears during menses, specifically during days 1 and 2. The reason for this is the change in your hormone levels (often called hormone balance). Higher levels of estrogen lead to more laxity (less stability) in the joints. Your tendons and ligaments have estrogen receptors, and this estrogen plays a role in the function of these structures. Estrogen causes ligaments and tendons to become more lax. This means they’ll have a higher stretch capacity. It sounds like it could be a good thing, however, this increased laxity causes instability in the structures they support. The incidence of ACL tears and patellar tendonitis increases during menses. It isn’t quite understood yet, but the general consensus is that higher levels of estrogen allow for more laxity in ligaments specifically for the pubic symphysis. This is the ligament that connects the hip bones together, and laxity is needed to give birth without damaging these structures.
Having the ability to stop or shorten menses can ensure you stay healthy during competition. It can also ensure a good hormone balance that will allow you to recover and excel both on and off the field.
So What’s the Answer?
As with everything you put into your body, there are trade-offs. I think it was Thomas Sowell who said “There are no solutions, only compromises”. He was talking about politics, but your health is pretty much the same. You can increase your strength, but it might cost you some conditioning. You can lose fat, but you’re going to lose some muscle mass along with it.
In this scenario, you can increase your overall control of your menstruation which can have huge benefits, but it might cost you some performance and recovery benefits. You have to weigh the pros and cons of your specific situation, and I can’t tell you what’s best. Every situation is different, and every body is different. My hope with this article is to give you the information on both sides of the equation, so you can make an informed decision as to what is best for you. Hopefully, this article gave you some insight into how these hormones can affect not just your performance, but your overall emotional and physical health.
