Impact of Combined Oral Contraceptive Use on Exercise and Health in Female Athletes

Abstract

Nearly half of girls and women between the ages of 15 and 24 years use hormonal contraceptives. The overall health and well-being of girls and women of any age is benefited by routine exercise; however, the impact of hormonal contraceptive use on the capacity to exercise has yet to be conclusively addressed. Since the development of combined hormonal contraceptives, the concentration of the estrogen component (ethinyl estradiol; EE) has been decreased and further development of the progesterone component has occurred to reduce the side effects and increase the safety profile. There is currently no information available regarding the impact of transdermal or vaginal combined hormonal contraceptives on exercise performance variables; therefore, this review focuses on the impact of oral contraceptive (OC) preparations on factors influencing exercise performance. Current findings do not indicate consistent changes in substrate utilization during aerobic or anaerobic exercise in women using OC preparations. In addition, the influence of exogenous steroid concentrations used in monophasic and triphasic OC preparations on endurance performance variables of ventilation and oxygen uptake (VO2) is unclear. Short-term duration of OC use, as well as the androgenic activity of the progestin, appears to cause a decrease in VO2 and increased ventilatory response, with the observed effects of exogenous steroids dissipating with long-term use. It appears that modern OC formulations do not have enough androgenic potency across a cycle to influence muscular strength; however, these formulations may have the potential to increase anaerobic capacity. A negative impact on reactive strength has been documented with monophasic OC use. Long-term use of OCs can lead to an increase in body fat percentage and may compromise bone health in female athletes. Aerobic and anaerobic performance could be negatively impacted by these changes in body composition. Among female athletes, OCs may be prescribed to treat menstrual cycle disturbances, such as amenorrhea and oligomenorrhea, which occur as a result of an energy deficit. It must be emphasized that the use of OCs alone is not effective in treating these menstrual cycle disturbances and should be administered in combination with nonpharmacologic treatment when the latter treatment alone has not been effective.