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.

Many women complain of the bloating and weight gain that can accompany the use of oral contraceptives, and should work with their doctors to find the brand that’s the least problematic. Lisa Lowe, 35, an IFBB pro fitness competitor from Northern California who was on the Pill for 19 years straight, recently stopped and says she has noticed an “unbelievable difference” in the amount of water she was holding in her body.

Brandy Maddron, another pro fitness competitor and wife of pro bodybuilder Aaron Maddron, stopped taking the Pill because of how it affected her moods. “It made me feel more emotional; Aaron noticed it, too,” she explains. “Weight gain wasn’t a big issue for me on the different pills I tried, but they made my moods inconsistent, which is the last thing you need on top of the demands of dieting and training for competition.”

A clinical study in the March 2000 journal Contraception compared three pills: Ortho Tri-Cyclen, Alesse and Mircette. Billed as the first large, controlled clinical trial to directly compare 20-mcg estrogen and 35-mcg estrogen pills, the study showed that common side effects such as bloating, breast tenderness and nausea were more common in women using the 35-mcg pill (Ortho Tri-Cyclen) than in those on the 20-mcg pills (Alesse and Mircette). Cycle control — bleeding and spotting between periods, a side effect more commonly associated with low-dosage pills — was similar in all pills studied after the end of six cycles, with Mircette and Ortho Tri-Cyclen causing fewer such problems in the first two cycles among first-time birth-control pill users. In addition, self-reported acne decreased in 43% of the Mircette first-timers and 19% of the Alesse first-timers, while 22% of the Ortho Tri-Cyclen first-time users experienced an increase in acne.

Randell adds that when a woman on the Pill complains of a diminished libido, the theory goes that the culprit is a natural substance called sex hormone-binding globulin (SHBG) that’s increased in women’s bodies when they take pharmacologic doses of estrogen. (A pharmacologic dose is the amount contained in birth-control pills, as opposed to physiologic doses, which are in hormone-replacement therapy for menopausal patients.) SHBG binds up and neutralizes the “male” hormone testosterone, which is present in much smaller amounts in females and is believed to give humans their sex drive.

With regard to specific concerns of serious female athletes, particularly fitness competitors and others who fear that taking oral contraceptives could impede their ability to build muscle mass, the verdict is still out. Researchers affiliated with the Sports Medicine Centre, University of Ottawa, Canada, report in Clinical Sports Medicine (April 2000): “Athletes taking [oral contraceptives, or OCs] for contraception or menstrual-cycle control may be able to minimize any potential side effects and performance influences by taking the lower-dose triphasic pills and the newer progestins. For women with menstrual dysfunction, OCs may provide a predictable hormonal milieu for training and competition.”

Finally, research at the Cincinnati Sportsmedicine Research and Education Foundation, Deaconess Hospital, published in Sports Medicine (May 2000), indicates that oral contraceptives could play a beneficial role in the tendency of female athletes to be more prone to knee injuries than their male counterparts. Monthly fluctuations in female sex hormones may make the nerves less efficient at controlling muscles and ligaments used to stabilize the knee, but by stabilizing hormone levels, oral contraceptives may actually reduce the chance of knee injuries. Yet more research needs to be done before this subject can be considered settled.

All this being said, is any one particular Pill the female athlete’s brand of choice? While Randell slightly favors Mircette in a theoretical sense, due to the aforementioned study indicating reduced breast tenderness and bloating, as well as excellent cycle control, he does prescribe many other pills as well, depending on the circumstances.

Concurs Winer: “I’m not committed to any one particular pill . . . I don’t think the athletic component is the overriding component. Women tolerate pills differently. You are a woman first and an athlete second.”