The Pill & The Female Athlete

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

contraceptive pill pack

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.”

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