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The Pill & The Female Athlete

How birth-control pills can affect your body and your pursuit of fitness.

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You’re a serious athlete, maybe even a fitness competitor. Because your body is a temple, you work out religiously and consider very carefully everything that goes in your mouth, whether it’s food, supplements or prescription medication. Enjoying sex with the right partner may be an important part of your life as well, but do you worry about how one of the easiest, most reliable methods of contraception — the birth-control pill — will affect your workouts and your body? As you’ve probably heard, many of the health-related pros and cons to taking oral contraceptives extend well beyond the original intent to prevent pregnancy.

When determining if the Pill is right for you, your doctor (preferably a reputable ob/gyn who has some knowledge and experience with female athletes) should be the ultimate judge after thoroughly reviewing your medical history, lifestyle indicators and other factors. Being an informed consumer of health-care services is important, but remember that every woman is different. Marching into a physician’s office and demanding to be put on a certain brand of Pill just because your fitness-minded friend is on it, or because you saw an appealing advertisement for it, isn’t such a hot idea.

Another question you should consider is whether you want reversible contraception. All birth-control pills are reversible, meaning you can stop taking them and, theoretically, get pregnant fairly easily. A method such as tubal ligation, on the other hand, is considered permanent. Of course, keep in mind that birth-control pills won’t prevent the spread of HIV or other sexually transmitted diseases.

Regulating your cycles
Outside of preventing conception, one of the most important benefits of an oral contraceptive for the highly athletic woman may be its ability to treat amenorrhea, a condition where menstrual periods cease. Sharon Winer, MD, clinical professor of obstetrics and gynecology at the University of Southern California (Los Angeles), explains that amenorrhea is most commonly associated with women with one or more of these variables: 1) They exercise strenuously; 2) they experience physical and/or emotional stress; and 3) they have dietary and weight changes, frequently resulting in a decrease in bodyfat.

“Women with amenorrhea are at a greater risk of developing osteoporosis, due to the loss of estrogen,” Winer states. “Prescribing oral contraceptives [all of which contain estrogen] is one of the most common ways we can replace the estrogen, and restore and regulate the periods while reducing the risk of developing osteoporosis.”

Winer also points out that oral contraceptives are gaining new popularity for their role in menstrual manipulation. This is the concept of not taking the week’s worth of placebo pills and immediately starting a new pack of active pills to avoid having your period at an inconvenient time (during a vacation, special event or athletic competition, for example) and delaying it until later, sometimes as long as several months. Indeed, while published reports indicate that medals have been won and world records have been set in all phases of the menstrual cycle, and by women taking oral contraceptives, this does appear to be an intriguing prospect for female athletes who are concerned about cramps, headaches and other ills often attributed to PMS.

This perceived boon to womankind is echoed by Michael Randell, MD, an Atlanta-based ob/gyn affiliated with Northside Hospital. “There’s no medical benefit to having a period every 28 days,” he notes. “Most women [on the Pill] choose to have it just as a reassurance they aren’t pregnant, but it really isn’t imperative that it come at that interval. In fact, Barr Laboratories has launched a large clinical trial to test its product called Seasonale, which gives women the option of ‘seasonal’ periods — one every three months. A woman takes a pill daily for 81 days, then is off them for seven days, resulting in a period.”

To review the myriad noncontraceptive health benefits and side effects commonly associated with oral contraceptives, see “The Pill: Common Pros & Cons.”

A plethora of pills
All birth-control pills are basically alike in that they use progestin (a synthetic derivative of the female hormone progesterone) to suppress ovulation, and estrogen to promote endometrial health and support to the uterus, thus resulting in cycle control. Pills vary in their amounts of progestin and estrogen, as well as the type of progestin. Third-generation progestin-containing pills (for example, Desogen, Mircette, Ortho Tri-Cyclen) are the newest. They’re generally better tolerated than first-generation pills, which had more androgenic (malelike) side effects such as acne, weight gain, extra facial hair, etc.

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