Background of hormonal contraceptive
The use of hormonal contraceptives in sport and wider society.
Multiple hormones are involved in regulating bodily functions, such as growth and development, metabolism, electrolyte balance, and reproduction. In females, sex hormones fluctuate in a regular cycle which can cause a range of symptoms, including abdominal cramps, fatigue, bloating, and changes in mood. Aside from preventing pregnancy, hormonal contraceptives are frequently used to reduce or alleviate symptoms. In the broader community, the use of hormonal contraceptives have been associated with unintended consequences for some individuals. Such symptoms include an increased risk of depression, negative mood changes, significantly reduced general well-being, and lower bone health. Do any of these sounds familiar to you?
Also, the use of hormonal contraceptives provides an option to control or stop bleeding (eg, manipulating the timing of a bleed for a sport competition) with a means of offsetting any negative impact on female athlete performance. This may be beneficial for female athletes where menstrual-related symptoms have been shown to negatively affect training and sport performance.
A recent review further highlighted that hormonal contraceptive use may impair performance in some sportswomen. Within athletes, hormonal contraceptive use may delay recovery and/or cause muscle damage along with other potential negative effects on training and performance.
With an increasing popularity and growth in participation of women’s rugby, there is a need to understand the potential impact hormonal contraceptive use may have, which should be a priority to understanding both the health and performance of players.
From 1598 women rugby players, 606 used hormonal contraceptives (38%). The frequency of use varied globally, highest reported use was in South America (49%). The most common type of hormonal contraceptive was the combined oral contraceptive pill (44%). Over 10% of players use contraceptives just to control the timing or stop periods for the purpose of rugby, yet up to 15% reported hormonal contraceptives to negatively affect rugby performance and over 20% of players required the use of medication to manage hormonal contraceptive-related symptoms.
During my week off of birth control I feel bloated, slow and cramps. All of these affect my physical performanceBrown et al., 2023
Results found that associated contraceptive symptoms varied in severity, in some cases causing altered performance, use of medication for management or even not taking part.
Recommendations for women’s rugby
- Annual menstrual cycle profiling to include hormonal contraceptive use, type and symptoms
- Regular monitoring of symptomology to help optimise health and performance
- Point of Contact within the sport for players to talk to
- Training and education programs including types of hormonal contraceptives available and management of symptoms
- Communication between players, coaches and support staff to improve health and performance