4 What does the research say?

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The image shows a female in a lab coat holding packets of pills.

The use of hormonal contraception provides practical benefits, such as the manipulation of menstrual cycles to prevent bleeding or symptoms at times when the athlete needs to be at peak performance. Also, hormonal contraception pills can be taken ‘back to back’ which means eliminating the 7-day withdrawal bleed. However, because the menstrual cycle is being disrupted the hormonal environment in athletes using contraception is different to those with naturally occurring menstrual cycles. This difference may have an impact on performance and is explored in Activity 3.

Activity 3 Hormonal contraceptives and athletic performance

Timing: Allow about 15 minutes

Watch the video where Dr Emma Ross discusses the research conducted into the impact of hormonal contraception on athletic performance. Then answer the following questions:

1. What does the research say about athletic performance and hormonal contraception use?
2. Why do you think it is so difficult to produce valid research about hormonal contraception use and performance?

Download this video clip.Video player: boc_sfps_1_session3_activity3.mp4

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Transcript

EMMA ROSS

Now we understand that things like strength, power, endurance are not impacted by the hormonal fluctuations across a natural menstrual cycle. And actually largely, the same can be said for women who are using hormonal contraception. Their strength and their power isn't impacted by using hormonal contraception.

With one exception, though that there is some well controlled research which shows that aerobic endurance measured by VO2 max can be decreased in those women using the pill. And the reason that was great research is because it used women as their own controls, they had women who weren't using the pill and they measured their VO2 max.

And then those women started taking the pill and they found that their aerobic endurance was decreased by up to 11%. And I think the important thing to remember here is that using hormonal contraception is a very individual choice. And what's important is to find the right solution and the right strategy that suits you.

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Discussion

1. Emma explains how research has shown that while measures of strength do not seem to be impacted by the synthetic hormones, aerobic endurance may be. Controlled research under laboratory conditions has shown that aerobic endurance can be decreased by as much as 11%. Although it should be said that not all studies support this finding, and no study has shown how this impact translates into endurance performance in competition.
2. Emma explains how the research she quotes was well controlled meaning that the researchers had attempted to control significant variables (things that can change). However, as we identified before, there are many different types of hormonal contraceptive pills and methods, so research design needs to ensure all subjects are using the same method and brand to be valid. This also means that there may be slightly different outcomes for the different hormonal contraceptives.

In summary, the relationship between hormonal contraceptive use and performance is not completely clear; however, an analysis of 42 studies showed that oral contraception users might have a slightly poorer endurance performance compared to those with a natural menstrual cycle (Elliott-Sale et al., 2020). The recommendation from Emma Ross was that an individual approach needs to be taken and active females need to find the approach that works best for them.