Birth Control and Athletic Performance

In this country, 62% of women are using some form of contraceptive. Of those, almost 50% are using a type of hormonal method such as the patch, an injectable or, the most popular form, the pill. While many women use the pill as an oral contraceptive, it is also frequently prescribed for irregular menstrual cycles, acne, severe PMS or other hormonal imbalances.

Many potential side effects for women on the pill include blood clots, weight gain or breakthrough bleeding. While these are often taken into consideration before use, many athletes are woefully ignorant of other detrimental effects that can be brought about by prolonged pill usage.  As strength and conditioning coaches, this presents us with some unique challenges regarding our female athlete population.

Oral contraceptives cause deficiencies in:

  • Vitamin: B6, Folate, B12
  • Mineral: Zinc, Selenium, Magnesium, Phosphorus
  • Antioxidants

This can lead to performance losses in several ways. B vitamins are utilized in the body to convert carbohydrates to energy, produce red blood cells, synthesize DNA, and repair tissue and cells. More specifically, B12 deficiencies cause significant fatigue. So instead of chasing PR’s, your athletes will just want to chase Zzz’s.

Magnesium is utilized in over 300 reactions in the body including ATP production in the mitochondria. Yes, over 300 reactions.  Low levels of magnesium is like watching the movie “300” without any Spartans--ain’t nothing badass going to happen anytime soon.  And speaking of mitochondria, those little cellular powerhouses are not invincible. They rely heavily on antioxidants to neutralize any free radicals within the body whether they came from the good stuff (exercise) or the bad stuff (pollutants, pesticides). Only problem is, hormonal birth control depletes those antioxidants so there’s less (wo)manpower to fight off the junk and protect those cells!

The brutal results from this multitude of contraceptive driven deficiencies are increased fatigue, lowered motivation and impaired recovery. We all know that recovery is more important than training itself, so that combo can be truly devastating to the female athlete.

Now, one could assume that aggressive supplementation of these deficient nutrients MIGHT neutralize the negative effects mentioned so far. However, there’s one major influence that the pill has on the body that cannot be fixed with supplementation. And this effect might just be the most detrimental to athletic performance of all: the increased production of sex hormone binding globulin (SHBG).

SHBG is a special kind of protein that binds to testosterone and renders it inactive. If you read that sentence and dropped to your knees screaming “No! Dear God, NOOOOO!!!!”, pat yourself on the back because that was the appropriate response. The reduction of excess testosterone is precisely one of the reasons the pill is prescribed for acne. This might be good news for your skin, but bad news for your muscles and a lot of other things! You see, female athletes already have naturally lower levels of testosterone than their male counterparts.

With testosterone’s role in increasing muscle mass, bone mass, competitive drive, and sex drive one could see how an increased binding of this small amount of testosterone could cause serious problems for female athletes, especially those whose sport has a very large strength, power or weightlifting bias. I’m looking at you Power Athletes!

Even worse, women using oral contraceptives also tend to have lower levels of the hormone DHEA (a testosterone pre-cursor) and higher levels of the stress hormone cortisol which is very catabolic in nature. That’s a triple whammy! And excessive cortisol production can often lead us down the slippery slope of  HPA-axis dysfunction (commonly referred to as adrenal fatigue) You see your brain is responsible for talking to your adrenals and signaling them to produce hormones on a regulated basis. This constant introduction of estrogen from birth control dysregulates that communication creating an environment of chronic cortisol production and inflammation which is seriously bad news for any athletes that are looking to compete at the highest level (think CF Games!).

So where does this leave us with empowering our female power athletes? The solution to this problem is going to be different for each individual. There are a lot of low hanging fruits that need to be examined before diving down this rabbit hole.

For many Power Athlete Ladies the stress of possible unwanted pregnancy, irregularity, PMS etc is enough to warrant keeping the hormonal birth control that they are using. If that’s the case, I’d highly suggest making sure their sleep is ON POINT! Next up, I’d examine their nutrition and make sure they’re getting optimal levels of flesh building nutrients. Then I’d really work on optimizing rest and recovery techniques. Lastly, they’d benefit from some targeted supplementation to minimize the common deficiencies discusses above.

But, if you are coaching a seasoned female athlete (or are one) who is seeing a slow, unexplained drop in performance and have already optimized their low-hanging fruit, a change could be in order whether that be switching to a non-hormonal birth control method or ditching it all together. It’s a choice nobody can make for them, but, hopefully, now they’ve got a little more knowledge to make that decision.

Sources

Guttmacher Institute (2015, October) Contraceptive Use in the United States. Retrieved August 22, 2016, from https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states

Lee, C.W., M.A. Newman, and S.E. Riechman. 2009. Oral Contraceptive Use Impairs Muscle Gains in Young Women (Abst. 955.25). Experimental Biology 2009, New Orleans (April 21).

Panzer C., et al.  Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med 2006 Jan; 3(1): 104-13.

Zal F, et al. Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives. Contraception. 2012 Jul;86(1):62-6.

Akinloye O, et al. Effects of contraceptives on serum trace elements, calcium and phosphorous levels. West Indian Med J. 2011 Jun;60(3):308-15.

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Leah Kay

RN, BSN; Nutrition Coach at Power Athlete at Power Athlete
Former collegiate volleyball player and 7 year competitive CrossFitter. 6x CF regional qualifier and 1x CF Games qualifier. Began coaching CrossFit in 2009 while working towards a Bachelor's in Nursing. Studied functional medicine through the American Academy of Anti-Aging in 2013 with specific emphasis on nutrition and hormone regulation. Continues to blend love of coaching and wellness as Head Trainer and Co-Owner of CrossFit Katy and Functional Nutritionist at Specialty Healthcare and Wellness in Houston, TX.
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