How does hormonal contraception affect the athlete?
We already have a few articles about how much the menstrual cycle can have on sports performance. However, there has always been a sentence that these articles apply only to those women who do not use hormonal contraception, and therefore their cycle is natural. This has definitely disappointed at least half of our readers. Recently, however, Lyle McDonald published a great e-book dedicated to (not only) women who play sports and use hormonal contraception. We took it to pieces together with other relevant sources and we bring you the first comprehensive article on this topic. In addition, we have done a small mini-study for you based on your answers from Instagram, which you will get in the Premium section. But let's get everything in order, this topic is extremely complex.
For example, you will learn:
What is contraception, how does it work, what types exist
What effect contraception has on training adaptations
Whether it gains weight after contraception or whether it prevents fat loss
What effect does it have on muscle growth or loss?
How it affects aerobic / endurance training
How it affects anaerobic / strength training
What is (hormonal) contraception?
Contraception is a term that includes all methods to prevent unwanted pregnancy. When we talk about hormonal contraception (HA), we most often encounter the form of tablets, patches, injections and intrauterine devices. In addition to hormonal contraception, of course, there are non-hormonal methods, such as the method of fertile and infertile days, a condom or a non-hormonal intrauterine device. But they simply do not have such an effect on the female body as the hormonal ones, so we will omit them in this article.
As the name suggests, all types of hormonal contraception are based on hormones, respectively. synthetic versions of estrogen and progesterone. Regardless of whether we are talking about pills or patches and other forms, hormonal contraception can generally be divided into two groups:
combined hormonal contraception (contains two hormones - estrogen (female sex hormone) and progestin (corpus luteum hormone)
gestagen hormonal contraceptives (contain only the hormone progestin)
How does such hormonal contraception work?
The combined function works mainly by blocking ovulation (ie the release of an egg from the ovary). This is achieved by giving the artificial hormone from contraception false information to certain brain centers that control the ovary. They then believe that they are in a different phase of the menstrual cycle and do not send a signal for ovulation.
Secondary mechanisms, thanks to which HA is more reliable, are e.g. effect on the mucus in the cervical canal, which becomes viscous (… different, is simply different), and thus impermeable to sperm. Another effect of HA is on the uterine mucosa, where it makes it difficult to potentially nest an egg, should theoretically occur during ovulation.
If we are talking about gestagen contraception, it is as follows: The main mechanism of action is the effect on mucus in the cervix. It is viscous (similar to the infertile phase of the normal cycle) and completely prevents sperm from entering the uterus. The additional effect is to prevent ovulation, ie the release of the egg. Gestagen contraception is usually the second option, in women whose bodies do not tolerate synthetic estrogen.
According to the dose of the hormone in individual phases, we divide the products of combined contraception into:
Monophasic (same dose of both hormones in all tablets)
Biphasic (same dose of estrogen in both phases of the preparation, in the second phase there is a higher dose of progestin)
Triphasic (progestin doses change every 7 days, estrogen, with some exceptions, remains at the same dose, but most tries to mimic a woman's natural menstrual cycle)
Combiphasic (in the second phase of the preparation there is a lower dose of estrogen and a higher dose of progestin)
If you are taking a pill form of contraception, you usually follow this pattern of use: for 21 days you take pills where the hormones are located, for 7 days you do not take any pill or placebo pill. During the first 21 days, HA suppresses your natural hormones, but during the 7-day break during menstruation (pseudomenstruation) they are no longer suppressed and the levels of natural hormones try to return. Pretty hormonal tornado. If you are using a contraceptive that uses the pattern of 24 tablets and 4 days off or 26 days and 2 days off, these are newer contraceptives that, by shortening this time, try to minimize the hormonal fluctuations that would normally occur.
What does HA contain?
Ever since the introduction of hormonal contraception (sometime in the 1960s), the form of estrogen found in contraception has been ethinyl estradiol (EE). In our mini-research, which we did based on your Instagram answers, we confirmed this, but also found that there are already exceptions. But about that later. Just to supplement: when a woman's body naturally produces estrogen, it is a form called 17-beta estradiol.
Interestingly, the first contraceptive pill contained 150 micrograms (0.15 mg) of this hormone, while current contraceptives most often contained 15-35 micrograms (0.015-0.035 mg). What has been achieved by reducing the estrogenic component? Some side effects have been significantly eliminated, but the effects on pregnancy prevention have been maintained. WIN-WIN.
What are the side effects? Estrogen is to blame for e.g. breast tenderness, water retention, increased risk of deep vein thrombosis. On the other hand, the less estrogen, the higher the risk of oily skin, acne, etc.
Do synthetic forms of hormones have the same effects as natural hormones produced by the female body? In the case of ethinyl estradiol, the answer seems to be "yes". It binds to the estrogen receptor and sends more or less the same signal as estrogen would do - just a little stronger than we said before.
On the other hand, with synthetic progesterone it is a thousand times more complicated. There are about 8 different progestins, which are divided into 4 different classes / generations according to when they were developed and what their chemical structure, resp. how much they chemically approach progesterone and how androgenic (ie how they act "masculine"). Accordingly, these progestins also have different effects on the female body. Third and fourth generation progestins were mostly present in your contraceptives, the second here and there, while the first was no longer present in them at all. The first and second generations of progestins are the most androgenic and carry with them more side / negative effects than e.g. third and fourth generation progestins.
Drospirenone has antimineralocorticoid effects in addition to its antiandrogenic effects, ie they block the effects of mineralocorticoids, e.g. aldosterone. Thus, such contraception blocks fluid retention, which can be caused by estrogens, e.g. swelling, weight gain (even a slight weight loss is shown), breast tenderness.
Here, the less androgenic / the more antiandrogenic progestin, the more pronounced the contraception affects oily skin, acne, unwanted hair or hair loss - so if you go to a gynecologist to improve your skin, you will get a fourth-generation progestin contraception. Different types of progestins do not affect the reliability of contraception.
It should be noted that although EE and progestins in the female body behave similarly to their natural counterparts (estrogen and progesterone), they do not behave identically. In addition, hormonal contraceptives provide much higher amounts of these hormones than the female body normally produces. At the same time, EE is in itself much more effective than female natural estrogen. To make matters worse, even progestins vary from generation to generation (especially in their androgenicity) and the way it is administered (orally / patch / body) may change the resulting effect. Can it be even more complicated?
How can hormonal contraception have a physiological effect on sports performance or long-term training adaptations
I may start too broadly to come to a fairly clear conclusion, but I feel the need and necessity to put all this information here.
A secondary effect of hormonal contraception is that the levels of natural estrogen and progesterone fall significantly, because synthetic ones (from hormonal contraception) seem to replace them.
Progesterone and synthetic progestins can bind to several different receptors, but we will focus on only two of them: the progesterone receptor and the androgen receptor, because these are the most relevant for our article in this case.
At the progesterone receptor, progestins behave like natural progesterone - they bind to and send a signal similar to progesterone. Of course, progestins of different generations will be slightly different, but in the end it is not so important now.
There are problems with the androgen receptor. In women, testosterone, which is commonly found in small amounts in the female body, binds to the androgen receptor. However, the progesterone that the female body naturally produces is anti-androgenic, which means that when it binds to this receptor, it prevents the effects of testosterone. Why is testosterone important in women? In this case, e.g. to grow muscle mass.
Along with the fact that progesterone blocks the positive effects of estrogen, this is part of the reason why progesterone generally has negative effects on muscle mass and potentially other aspects of physical performance or training in the second (luteal) phase of the menstrual cycle.
I will not go into other relatively complex details and summarize it as follows: Hormonal contraception, whether combined or gestagen, reduces the amount of total testosterone in the body, which has the potential to negatively affect performance, mood, muscle mass, sex drive and the like .
Will I gain weight when I start taking contraceptives?
I think this is one of the longest-running and at the same time the biggest concerns of women who are about to use hormonal contraception. But when we look at the available studies, they do not systematically support this idea. One study of combined contraception found little effect on increasing total body weight, but this depended on the type of HA used.
What should be noted, however, is that just as every natural menstrual cycle is different for each woman, so is the individual women's response to HA. There were huge differences between women in each study. While some women could gain 7 kg on HA, others could lose 14 kg. But when we look at the result of the study, aka the average, we find that it reports no difference.
However, Lyle McDonald noted one great thing in the book. One study compared women who took HA with those who had a non-hormonal intrauterine device. It works on a completely different principle and the essential information for us is that it does not contain any hormones and does not release them into the female body. Interestingly, both groups showed the same variation in weight change. The one with HA, and the one with no HA. So what is it that women gain on HA? Maybe not quite the contraceptive, huh? The fact that a woman says to herself: "She is gaining weight in hormonal contraception often plays a role, it is clear that I will gain weight!" And what will happen?
And does contraception prevent fat loss? No. As easy as that.
What about muscle gain?
We've bitten it up a bit already. (Combined) hormonal contraceptives with different androgenicity (ie with progestins of different generations) have different effects on the female body, even in the direction of muscle acquisition.
The worst thing in this respect is clearly HA with fourth-generation progestins, which are anti-androgenic. This means that it significantly reduces the amount of testosterone in the body and then blocks even the small amount that is left behind.
I will mention one study that tried to find out what happens to those muscles and hormonal contraception. In it, women were given combined HA, when:
one group had progestin gestodene (third generation, low androgenic effects)
second progestin norgestimate (also third generation with low androgenic effects)
the third group was control, women without HA
Although both progestins are from the same generation, gestodene is half less androgenic than norgestimate.
Protein synthesis in muscles at rest and during aerobic activity was measured. Resting protein synthesis was found to be reduced in both groups compared to the control group of women without hormonal contraception, but decreased significantly more in women with gestodene than in women with norgestimate.
Therefore: a progestin with higher androgenicity had the upper hand in this case. And we will make such a rule out of it. The more androgenic contraception, the less problem with muscle gain / loss. BUT also with a higher probability of acne, oily skin and other negative effects. I would probably like to point out that if you are not an elite athlete and you train just for fun, it is your hobby, you probably should not choose contraception according to how it affects muscle growth. There’s more to life than that.
There are still many subtopics to cover, but your attention is certainly not enough. That's why we've decided to split this article, and use it for your suggestions. In the second part you will learn in particular:
how HA affects aerobic / endurance training
how HA affects anaerobic / strength training
positive and negative HA
any scientifically based recommendations for HA
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