Oral Contraceptive Cycle Research Articles

Current oral contraceptive use affects explicit and implicit measures of depression in women

Some data suggest that increased depressive symptoms may occur in women using combined oral contraceptives (OCs). However, this idea is controversial and the existing evidence is conflicting. The present study compared negative affect in 53 healthy women (Mage = 19.9 years) during intervals of active daily OC hormone intake and during the washout week of the contraceptive cycle when no exogenous estrogens or progestins are used. A prospective counterbalanced repeated-measures study design was employed. Depressive affect was evaluated using standard psychometric tests of explicit (self-perceived) and implicit negative affect. Implicit measures are considered less subject to bias related to social expectations, self-awareness, or willingness to disclose. Other than their usual OCs, participants were medication-free and had been using OCs for a median of 12 mo. We found that measures of implicit affect (e.g., Affect Misattribution Procedure, Emotional Stroop Test) displayed a more depressive-like pattern of performance during active hormone intake, particularly among a subgroup of OC users who reported experiencing high levels of depressive affect more generally. In contrast, participants’ self-perceptions suggested that they perceived their negative symptoms to be greater during the ‘off’ phase of the OC cycle, when OC steroids are withdrawn and menses occurs. The present findings reinforce the possibility of depressive mood effects associated with OC usage, and highlight the utility of including implicit measures, but also illustrate the complexity of mood assessment in OC users.

Influence of Menstrual Cycle and Oral Contraceptive Phases on Bone (re)modelling Markers in Response to Interval Running

To explore how sex hormone fluctuations may affect bone metabolism, this study aimed to examine P1NP and β-CTX-1 concentrations across the menstrual and oral contraceptive (OC) cycle phases in response to running. 17β-oestradiol, progesterone, P1NP and β-CTX-1 were analysed pre- and post-exercise in eight eumenorrheic females in the early-follicular, late-follicular, and mid-luteal phases, while 8 OC users were evaluated during the withdrawal and active pill-taking phases. The running protocol consisted of 8 × 3min treadmill runs at 85% of maximal aerobic speed. 17β-oestradiol concentrations (pg·ml−1) were lower in early-follicular (47.22 ± 39.75) compared to late-follicular (304.95 ± 235.85;p = < 0.001) and mid-luteal phase (165.56 ± 80.6;p = 0.003) and higher in withdrawal (46.51 ± 44.09) compared to active pill-taking phase (10.88 ± 11.24;p < 0.001). Progesterone (ng·ml−1) was higher in mid-luteal (13.214 ± 4.926) compared to early-follicular (0.521 ± 0.365; p < 0.001) and late-follicular phase (1.677 ± 2.586;p < 0.001). In eumenorrheic females, P1NP concentrations (ng·ml−1) were higher in late-follicular (69.97 ± 17.84) compared to early-follicular (60.96 ± 16.64;p = 0.006;) and mid-luteal phase (59.122 ± 11.77;p = 0.002). β-CTX-1 concentrations (ng·ml−1) were lower in mid-luteal (0.376 ± 0.098) compared to late-follicular (0.496 ± 0.166; p = 0.001) and early-follicular phase (0.452 ± 0.148; p = 0.039). OC users showed higher post-exercise P1NP concentrations in withdrawal phase (61.75 ± 8.32) compared to post-exercise in active pill-taking phase (45.45 ± 6;p < 0.001). Comparing hormonal profiles, post-exercise P1NP concentrations were higher in early-follicular (66.91 ± 16.26;p < 0.001), late-follicular (80.66 ± 16.35;p < 0.001) and mid-luteal phases (64.57 ± 9.68;p = 0.002) to active pill-taking phase. These findings underscore the importance of studying exercising females with different ovarian hormone profiles, as changes in sex hormone concentrations affect bone metabolism in response to running, showing a higher post-exercise P1NP concentrations in all menstrual cycle phases compared with active pill-taking phase of the OC cycle.

Impact of Menstrual and Oral Contraceptive Cycle Phases on Nutrition Intake and Metabolic Flexibility in Sportswomen

Impact of Menstrual and Oral Contraceptive Cycle Phases on Nutrition Intake and Metabolic Flexibility in Sportswomen

Effects of In-Exercise Carbohydrate Supplementation on Prolonged High-Intensity Exercise Performance in Oral Contraceptive Users.

To examine the impact of oral contraceptive (OC) phases on performance, physiological, and subjective responses to prolonged, intensive exercise when carbohydrate (CHO) stores are reduced. Ten well-trained female cyclists using monophasic OC completed 4 identical trials (>150min) under conditions of in-trial 60-g·h-1 CHO supplementation (CHO+) or placebo (CHO-) during the sugar- (SUG) and active-pill (ACT) phases of their OC cycle. Each trial comprised two 400-kcal time trials (TT) separated by 1hour of submaximal cycling at first ventilatory threshold. Change in completion time from TT1 to TT2 was minimized in CHO+ compared with CHO- (4.06 [2.55] vs 6.08 [5.33]min; P = .019, effect size = -0.36). An interaction effect of OC and CHO was observed for time to complete TT (P = .006), mean TT power (P = .002), mean TT heart rate (P = .002), and posttrial emotional balance (P = .020) and negative emotional state (P = .033). In ACT, mean TT power and heart rate were higher in CHO+ when compared with CHO-, resulting in faster TTs in CHO+ and improved posttrial emotional well-being. When CHO was not supplemented, TT power and heart rate were higher in SUG when compared with ACT, resulting in faster TTs in SUG and improved posttrial emotional balance. CHO depletion during ACT negatively influenced TT performance and emotional well-being when compared with SUG. Irrespective of OC pill phase, CHO supplementation should be prioritized to sustain performance and improve postexercise recovery-stress balance.

The oral contraceptive cycle and its influences on maximal and submaximal endurance parameters in elite handball players.

The usage of the oral contraceptive pill is widespread among athletes of various levels. However, there is limited knowledge on how the intake of the pill alters the submaximal and maximal endurance parameters between the oral contraceptive phases. Therefore, the aim of this study was to examine potential differences between the pill intake and withdrawal phase on endurance-related parameters in first-division handball players. In total, 15 female team handball players performed two graded exercise tests until volitional exhaustion on a motorized treadmill. Tests were performed during the pill intake (days 16-17) and withdrawal phase (day 2-3). Throughout the test, respiratory gases were measured breath-by-breath, and the heart rate was measured continuously. Before and after the graded exercise test, blood samples were obtained in order to assess the blood lactate concentration. Before each test, venous blood samples were taken to determine endogenous sex hormone levels. Ventilatory parameters (O2, CO2, and E, and respiratory equivalents for O2 and CO2) were measured, and the oxidation of fat and carbohydrates was calculated. A paired-sample t-test was used to assess differences between the two time points, and the significance was accepted as p < 0.050. Significant differences with lower values during the consumption phase were found for absolute (mean difference ± SD: 88 ± 131mL∙min-1; p = 0.021) and relative O2peak (mean difference ± SD: 1 ± 2mL∙min-1∙kg-1; p = 0.012). Higher values during the consumption phase were found for submaximal respiratory equivalents for O2 (mean difference ± SD: -1.1 ± 1.7; p = 0.028) and CO2 (mean difference ± SD: -0.9 ± 1.5; p = 0.032). No differences were found for all other parameters, including differences for endogenous sex hormones (p > 0.050). The results of the current study suggest only marginal and physiologically insignificant differences in endurance-related parameters between oral contraceptive phases.

Influence of menstrual cycle phase and oral contraceptive phase on exercise performance in endurance-trained females.

Limited data exists on the influence of menstrual cycle (MC) phase and oral contraceptive (OC) phase on physical performance in endurance-trained females due to poor control regarding MC verification and differentiation. We aimed to evaluate exercise performance and the respiratory response to exercise in three distinct phases of the MC and OC cycle in endurance-trained females. Using a prospective cohort study design, we recruited trained females (Vo<inf>2max</inf> 52±4 mL O<inf>2</inf>/min/kg) who were either not using oral contraceptives (NOC) or using monophasic OCs. NOC were tested in the early and late follicular phase (FP) and the mid-luteal phase (LP). OC-users were tested in the withdrawal phase (WP) and two times in the active OC phase (OCP). The test battery included DXA scans, blood sampling, a submaximal bike test, a maximal isometric knee-extensor strength test, 4 and 20-second bike sprints, and a 6 min time trial on a bike. MC phases were verified by the use of ovulation kits and circulating sex hormone levels. After the exclusion of four NOCs due to inadequate sex hormone levels, 11 NOC and 13 OC users were included in the final analysis. 6 min time trial performance, sprint performance, and most submaximal exercise intensity variables did not differ between MC phases and OC cycle phases. However, in NOC, ventilation (L/min) during exercise at 30% of aerobic peak power was 7.6% lower in the late FP compared to the LP (P<0.05). In OC users, muscle strength was 3.9% higher in the early OCP compared to WP (P<0.05), whereas body mass was higher in the late OCP compared to WP (P<0.05). Collectively, our study suggests that MC phase and OCP influence exercise performance to a limited extent in endurance-trained females.

Impact of Dienogest Alone or in Combination with Ethinylestradiol on the Quality of Life of Women with Endometriosis: A Prospective Cohort Study

OBJECTIVE: We aim to compare the effectiveness of oral contraceptives and dienogest, primarily by considering the quality of life scale. We also aim to compare the Cancer Antigen-125 and Anti-mullerian Hormone values. STUDY DESIGN: Gynecological examination findings evaluated based on ESHRE and ASRM Guideline criteria are compatible with endometriosis, or a previous surgery pathology result is consistent with endometriosis, and patients whose imaging report was compatible with endometriosis were selected. Among the patients who were recommended medical treatment, patients selected as Dionegest 2mg+Ethinylestradiol 0.03 mg (Dienelle) treatment were considered Group 1, and patients deemed suitable for treatment with treatment 2mg Dionegest (Visanne) were considered Group 2. Pre-treatment Cancer Antigen-125/Anti-mullerian Hormone values and SF-36 were recorded. RESULTS: There was no significant difference between drug groups in terms of education status, body mass index, family history, smoking, alcohol consumption, age, age at menarche, menstruation pattern, duration of menstruation, infertility, gestational status, job loss due to pain complaints, operation, and MRI findings (p&gt;0.05). There was no significant difference between the drug groups regarding the quality of life before and after treatment (p&gt;0.05). There was no significant difference between drug groups regarding endometrioma size, Cancer Antigen-125, and anti-mullerian hormone findings (p&gt;0.05). CONCLUSION: Evaluating our data, the efficacy and success of the two treatment protocols were the same. It seems more logical to prefer cost-effective oral contraceptive treatments with a low side-effect profile than high-cost Dionegest. Following the guidelines accepted step therapy in treating mild or moderate endometriosis, cyclic oral contraceptives may be recommended as first-line therapy.

Health Effects of Oral Contraceptives on Periodontal Disease and Gingivitis: A Cross-Sectional Questionnaire-Based Study Among Saudi Women in Jeddah.

Sex hormones strongly influence the health and ailment of the oral cavity. For instance, a woman's oral health is influenced by her menstrual cycle, menopause, pregnancy, and usage of oral contraceptives. The use of various therapeutic medication results in intraoral alterations. Oral contraceptive pills (OCPs) are among the drugs that produce intraoral alterations. The study's objective was to evaluate attitudes and oral health conditions of Saudi women's utilizing OCPs in Jeddah, Saudi Arabia. A cross-sectional questionnaire-based study was conducted among Saudi women in Jeddah, Saudi Arabia. The self-administered questionnaire was made and sent to women to evaluate the attitude and oral health condition of women utilizing OCPs. The women using OCPs were asked to self-administer 17 questions to evaluate attitudes and oral health conditions. The questionnaire had multiple-choice questions and was consisted of four sections. The number of participants who used contraceptives was 125 (35.9%) women; of them, only 94 (75.2%) used oral contraceptives. The duration of using oral contraceptives mainly was 1-5 years (39.4%), then > 5 years (34.0%), and <1 year (26.6%). Of the 94 women, 34 (36.2%) had gingival diseases, 23 (24.5%) treated their gums; and 13 (13.8%) cleaned their gums at a dental clinic regularly. Times of teeth brushing per day were one time in 32 women (34%), twice in 47 women (50.0%), and three times in 15 (16.0%). Of the 94 women, 4 (4.3%) were smoking, 24 (25.5%) took medication other than OCPs, and 16 (17.02%) had chronic diseases. Common oral complications noticed by participants were gum bleeding after brushing (51.6%), dental caries (25.5%), and oral ulcers (10.6%). Females on OCPs had a high rate of gingival bleeding, dental caries, and oral ulcers. OCPs users had poor periodontal and gingival health. Establishing an oral hygiene program was necessary to treat gingival and periodontal inflammation that exacerbated by OCPs.

Five years later: Can women in Los Angeles County, California, get adequate pill supplies?

ObjectivesThis study sought to determine if pharmacies in Los Angeles County had implemented 2017 legislation requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. Study designWe conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly 5 years after the legislation went into effect. We chose the categorical state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County’s eight service planning areas in proportion to the number of women living in each area. We asked pharmacies if they would fill a prescription for a year’s supply of contraception all at once for a patient enrolled in Family PACT. ResultsWe contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a 1-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. ConclusionsOnly 3.2% of surveyed pharmacies in Los Angeles County said they would comply with current legislation, which requires dispensing 1-year supply of pills at once. ImplicationsCollaboration among physicians, pharmacies, and patients along with enhanced insurance company oversight will be needed to improve dispensing practices to achieve the lower unintended pregnancy rates associated with providing adequate contraceptive supplies.

Influence of menstrual cycle and hormonal contraceptive use on MS symptom fluctuations: A pilot study.

In clinical practice, females with MS often report menstrually-related symptom fluctuations. Hypothetically, use of oral contraceptives (OCs) could reduce these fluctuations, particularly continuous OCs (11+ weeks of consistent exogenous hormones followed by 1 week placebo). To prospectively capture (1) whether neurologic and generalized symptoms vary with menstrual cycle phase and (2) whether type of contraception impacts symptom fluctuations. In this two-center pilot study, females with MS and a regular menstrual cycle prospectively tracked their menstrual cycles and completed symptom surveys for up to 6 months. Participants were categorized as 1) users of oral contraceptives, either a) cyclic or b) continuous, or 2) endogenously cycling, either c) hormonal intrauterine device (IUD) users or d) "none users" (e.g. no hormonal contraception; included condoms, copper IUD, tubal ligation, "fertility awareness methods"). There was no correction for multiple analyses. Altogether, 47/70 participants (67%) provided >4 weeks of data and were included in the analyses. Mean (SD) age was 35.0 (0.9) years, median (IQR) EDSS was 1.5 (1-2) and mean (SD) SymptoMScreen score was 10.4 (9.6). For endogenously cycling patients (IUD and none users), fatigue (MFIS) was lower in the perimenstrual period than in the luteal period (p<0.05). For continuous OC users, variability in symptoms was lower than for endogenously cycling females (MFIS: p<0.01; Daily Hassles, from Uplift & Hassles Survey: p<0.05) or cyclic OC users (MFIS: p<0.001). In this pilot study, symptom severity did not definitively fluctuate in relationship to the menstrual cycle in endogenously cycling participants. However, fatigue and daily hassles were less variable for participants using continuous OC than for cyclic OC users or no-OC users. Future confirmatory studies are warranted to further examine whether contraceptive choice can be leveraged to manage symptom fluctuation in cycling females with MS. Such studies could enroll larger cohorts over fewer cycles or employ incentivization and hormonal measurements to enhance participant retention and statistical power.

Oral contraceptive use and menstrual cycle influence acute cerebrovascular response to standing.

To determine if the menstrual cycle and oral contraceptives (OC) influence responses to acute orthostatic stress and if these factors are clinically relevant to the diagnosis of initial orthostatic hypotension (iOH). Young, healthy women were recruited, including OC users (n=12) and non-users (NOC; n=9). Women were tested during the low hormone (LH; placebo pills; days 2-5 natural cycle) and high hormone (HH; active dose; days 18-24 natural cycle) menstrual phases. Changes in mean arterial pressure, cardiac output, heart rate, the 30:15 heart rate ratio and cerebrovascular resistance indices within 30s of standing were examined. There were no effects of OC or menstrual cycle on hemodynamic responses during standing (all p>0.05). In the LH phase, OC users had a greater fall in mean middle cerebral artery blood velocity (MCAV) compared to NOC (p<0.05). However, this was reversed in the HH phase, where OC users had a reduced fall in mean MCAV (p<0.05). Interestingly, 8 women (OC and NOC) had drops in systolic/diastolic blood pressure meeting the criteria for iOH, and 7 of those 8 women displayed this drop in a single phase of the menstrual cycle. Our results indicate that chronic versus acute OC use (i.e., long-term use observed via LH phase versus short-term use observed via HH phase) have opposing effects on cerebral blood velocity during standing. Further, our results highlight that multiple assessments across the cycle may be necessary to accurately diagnose iOH, as most women met the diagnostic criteria during a single menstrual phase.

Hormonal Cycling And Substrate Oxidation At Rest And During Exercise: A Systematic Review And Meta-analysis

Fluctuations of endogenous and exogenous sex hormones across the menstrual cycle (MC) and oral contraceptive (OC) cycle have been suggested to influence rest and exercise substrate metabolism in females. However, there is no clear consensus on the relationship between substrate oxidation and MC or OC phase in females. PURPOSE: This systematic review and meta-analysis aimed to examine the impact of MC and OC cycle phase on substrate oxidation in females at rest and during moderate-intensity continuous exercise. METHODS: Five databases were searched to identify studies including female participants assessed during ≥2 hormonal cycle phases and substrate oxidation determined at rest and/or during moderate-intensity continuous exercise via indirect calorimetry. Data were excluded if substrate metabolism was experimentally manipulated, collected earlier than 5 min into exercise, or if a physiological “steady-state" could not be achieved during exercise. Pairwise meta-analyses examined the effect of MC phase, follicular versus luteal, and OC phase, inactive versus active, on the standardized mean difference (SMD) of each substrate oxidation measurement. Study quality was assessed using a modified Downs and Black checklist, and certainty of the evidence was determined using GRADE criteria. RESULTS: 51 eligible trials were identified for analysis. Analysis of MC phases from 24 studies for resting trials (n = 487) and 23 studies for exercise trials (n = 441) observed that RER was unaffected in the luteal versus follicular phase at rest (SMD = 0.03, 95% CI = -0.16, 0.21, P = 0.78; very low certainty) or during exercise (SMD = -0.01, 95% CI = -0.20, 0.19, P = 0.95; very low certainty). Analysis of OC phase from 7 studies (n = 122) found that RER was lower in the active versus inactive OC phase during exercise (SMD = -0.40, 95% CI = -0.77, -0.03, P = 0.03; low certainty). CONCLUSIONS: We found no effect of MC phase on substrate oxidation at rest or during moderate-intensity continuous exercise. The active OC phase may be associated with greater lipid oxidation during moderate-intensity continuous exercise than the inactive OC phase, indicating a possible effect of exogenous rather than endogenous hormones on substrate oxidation during exercise.

Bleeding Patterns of Oral Contraceptives with a Cyclic Dosing Regimen: An Overview.

Bleeding irregularities are one of the major reasons for discontinuation of oral contraceptives (OCs), and therefore clinicians need to set expectations during consultations. In this review we provide an overview of bleeding data of recently marketed cyclic combined OCs (COCs) and one progestin-only pill (POP). We evaluated data from phase 3 trials (≥12 months) used to gain regulatory approval. Overall, each type of OC has its own specific bleeding pattern. These patterns however were assessed by using different bleeding definitions, which hampers comparisons between products. In COCs, the estrogen balances the effects of the progestin on the endometrium, resulting in a regular bleeding pattern. However, this balance seems lost if a too low dose of ethinylestradiol (EE) (e.g., 10 µg in EE/norethindrone acetate 1 mg) is used in an attempt to lower the risk of venous thromboembolism. Replacement of EE by 17β-estradiol (E2) or E2 valerate could lead to suboptimal bleeding profile due to destabilization of the endometrium. Replacement of EE with estetrol (E4) 15 mg in the combination with drospirenone (DRSP) 3 mg is associated with a predictable and regular scheduled bleeding profile, while the POP containing DRSP 4 mg in a 24/4 regimen is associated with a higher rate of unscheduled and absence of scheduled bleeding than combined products.

Influence of oral contraceptive phase on cardiorespiratory response to exercise in endurance-trained athletes

Objective The aim of the study was to analyse the cardiorespiratory response to exercise during an oral contraceptive (OC) cycle in endurance-trained women. Methods Sixteen low-dose monophasic OC pill (OCP) users performed an interval-running protocol. The protocol consisted of eight 3 min bouts at 85% of participants’ maximal aerobic speed (vV̇ o 2peak) with a 90s recovery at 30% vV̇ o 2peak in two OC phases: a withdrawal phase (WP) and an active pill phase (APP). The non-parametric Wilcoxon test was applied to analyse differences (p < 0.05) in performance variables between OC cycle phases. Results Throughout the high-intensity intervals, higher ventilation (WP 80.90 ± 11.49 L/min, APP 83.10 ± 13.33 L/min; p < 0.001) and relative perceived exertion (WP 14.51 ± 2.58, APP 15.11 ± 3.11; p = 0.001) during the APP were found, whereas carbon dioxide production (WP 2040.92 ± 262.93 mL/min, APP 2010.25 ± 305.68 mL/min; p = 0.003) was higher in the WP. During the active recovery intervals, ventilation (WP 65.78 ± 9.90 L/min, APP 67.88 ± 12.66 L/min; p < 0.001) was higher in the APP, while heart rate (WP 159.93 ± 10.26 bpm, APP 159.74 ± 12.83 bpm; p = 0.029) was higher in the WP. Conclusion An increase in ventilation occurs during the APP, which is accompanied by higher perceived exertion. Therefore, coaches and athletes should be aware of these variations, especially perceived exertion, in regard to women’s training programmes, in order to improve their performance, wellness and adherence to physical activity.

Efficacy of Post-Operative Medication to Prevent Recurrence of Endometrioma: Cyclic Oral Contraceptive (OC) After Gonadotropin-Releasing Hormone (GnRH) Agonist Versus Dienogest.

BackgroundThere are several medical treatment options for endometrioma. Progestin, especially dienogest, is an effective drug for preventing recurrence of endometrioma after surgery. Additionally, oral contraceptive (OC) use after conservative surgery has been reported to reduce significantly the risk of endometrioma recurrence. The aim of this study was to compare the long-term effects of gonadotropin-releasing hormone (GnRH) agonist followed by OC to those of dienogest alone to prevent recurrence of endometrioma after laparoscopic surgery.MethodsA retrospective cohort study was performed on patients who underwent conservative laparoscopic surgery for endometrioma between January 2000 and December 2020, in the Endometriosis Clinic, Department of Gynecology, Samsung Medical Center. A total of 624 patients who received medical treatment at least six months after laparoscopic conservative surgery for endometrioma was included. Among them, 372 patients used OC after GnRH agonist therapy, and 252 patients used dienogest. Within the OC group, 148 used a 21/7 regiment and 224 used a 24/4 regimen. A cumulative endometrioma recurrence curve was presented using the Kaplan-Meier method to compare the recurrence of those groups.ResultsThe cumulative recurrence rate of endometrioma for 60 months was 2.08% (n = 4) in the OC after GnRH agonist group and 0.40% (n = 1) in the dienogest group. There was no statistical difference in cumulative recurrence of endometrioma between the two groups. In subgroup analysis, the cumulative recurrence rate of endometrioma over 60 months was 4.21% (n = 2) in the 21/7 OC group and 1.09% (n = 2) in the 24/4 OC group and showed no significant difference.ConclusionLong-term use of OC after GnRH agonist as well as that of dienogest treatment are effective postoperative medical therapies for preventing endometrioma recurrence. Thus, the choice of regimen can be individualized or used interchangeably depending on patient condition, need for contraception, and compliance with drug therapy.

Serum iron availability, but not iron stores, is lower in naturally menstruating than in oral contraceptive athletes

ABSTRACT This study measured serum markers of iron status in naturally menstruating and oral contraceptive (OC) athletes during the main hormonal milieus of these two profiles to identify potential differences confounding the diagnosis of iron deficiency in female athletes. Resting blood samples were collected from 36 naturally menstruating athletes during the early-follicular phase (EFP), mid- late-follicular phase (MLFP) and mid-luteal phase (MLP) of the menstrual cycle. Simultaneously, blood samples were collected from 24 OC athletes during the withdrawal and active-pill phase of the OC cycle. Serum iron, ferritin, transferrin, transferrin saturation (TSAT), C-reactive protein (CRP), interleukin-6 and sex hormones were analyzed. Naturally menstruating athletes showed lower levels of TSAT, iron and transferrin than OC athletes when comparing the bleeding phase of both profiles (p<0.05) as well as when comparing all analyzed phases of the menstrual cycle to the active pill phase of the OC cycle (p<0.05). Interestingly, only lower transferrin was found during MLFP and MLP compared to the withdrawal phase of the OC cycle (p>0.05), with all other iron markers showing no differences (p>0.05). Intracycle variations were also found within both types of cycle, presenting reduced TSAT and iron during menstrual bleeding phases (p<0.05). In conclusion, in OC athletes, serum iron availability, but not serum ferritin, seems higher than in naturally menstruating ones. However, such differences are lost when comparing the MLFP and MLP of the menstrual cycle with the withdrawal phase of the OC cycle. This should be considered in the assessment of iron status in female athletes. Highlights Naturally menstruating athletes present lower TSAT, iron and transferrin in all analyzed phases of the menstrual cycle compared to OC athletes during their active pill phase. However, both the mid-late follicular and mid-luteal phases of the menstrual cycle do not differ from the withdrawal phase of the oral contraceptive cycle. Intracycle variations are found for TSAT and iron in both naturally menstruating and oral contraceptive athletes, which are mainly driven by a reduction in TSAT and iron during menstrual bleeding phases. As serum iron availability changes significantly as a function of the athlete's hormonal status, it should be considered in the assessment of the athlete’s iron status as well as standardise the phase of the menstrual cycle in which to assess iron markers to avoid misdiagnosis or misleading results. In contrast, the assessment of iron stores through serum ferritin is substantially stable and the athlete’s hormonal status does not seem to be of relevance for this purpose.

The Effect of the Menstrual Cycle and Oral Contraceptive Cycle on Muscle Performance and Perceptual Measures.

Most reproductive-aged women are exposed to fluctuating female steroid hormones due to the menstrual cycle or oral contraceptive use. This study investigated the potential effect of the menstrual cycle and combined monophasic oral contraceptive cycle on various aspects of muscle performance. Thirty active females (12 with a natural menstrual cycle, 10 taking a high-androgenicity oral contraceptive and 8 taking a low-androgenicity oral contraceptive), aged 18 to 30 years, were tested three times throughout one menstrual or oral contraceptive cycle. Counter-movement jumps, bilateral hop jumps, handgrip strength, isometric knee extensor strength and isokinetic knee flexion and extension were assessed. Perceptual ratings of fatigue, muscle soreness, pain and mood were recorded. Most variables showed no significant changes over the menstrual or oral contraceptive cycle. However, for the menstrual cycle group, isokinetic knee flexion at 240° s−1, and time of flight in bilateral hopping and counter movement jumps showed better results during the mid-luteal phase compared with the late follicular phase. For the high-androgenicity oral contraceptive group, isokinetic knee flexion at 240° s−1 was significantly higher in the late hormone phase compared with the early hormone phase. For the low-androgenicity oral contraceptive group, time of flight for the counter-movement jumps was lower in the late hormone phase compared with the early hormone phase. The findings indicate that faster and explosive aspects of muscle performance may be influenced by endogenous and exogenous female hormones.

The acute effect of the menstrual cycle and oral contraceptive cycle on measures of body composition.

This study aimed to investigate the effect of fluctuating female hormones during the menstrual cycle (MC) and oral contraceptive (OC) cycle on different measures of body composition. Twenty-two women with a natural MC and thirty women currently taking combined monophasic OC were assessed over three phases of the menstrual or oral contraceptive cycle. Body weight, skinfolds, bioelectric impedance analysis (BIA), ultrasound, dual-energy X-ray absorptiometry (DXA), and peripheral quantitative computed tomography (pQCT) measurements were performed to assess body composition. Urine specific gravity (USG) was measured as an indication of hydration, and serum oestradiol and progesterone were measured to confirm cycle phases. Five participants with a natural MC were excluded based on the hormone analysis. For the remaining participants, no significant changes over the MC and OC cycle were found for body weight, USG, skinfolds, BIA, ultrasound and pQCT measures. However, DXA body fat percentage and fat mass were lower in the late follicular phase compared to the mid-luteal phase of the MC, while for the OC cycle, DXA body fat percentage was higher and lean mass lower in the early hormone phase compared with the late hormone phase. Our findings suggest that assessment of body fat percentage through BIA and skinfolds may be performed without considering the MC or OC cycle. Body adiposity assessment via DXA, however, may be affected by female hormone fluctuations and therefore, it may be advisable to perform repeat testing using DXA during the same phase of the MC or OC cycle.

Strength Performance Across the Oral Contraceptive Cycle of Team Sport Athletes: A Cross-Sectional Study.

Oral contraceptive pills (OCP) are very popular in female athletes not only for contraceptive effects but also due to the possibility of cycle manipulation. Moreover, it is debatable whether the manipulation of the menstrual cycle has a beneficial effect on exercise performance. Therefore, the aim of this study was to investigate potential differences in knee-extensor and flexor strength performance of first division team sport athletes between phases of the oral contraceptive cycle. Sixteen female handball players (age: 23.3 ± 3.1 years; body mass: 67.0 ± 8.52 kg; body stature: 1.68 ± 0.05 m) using a monophasic OCP participated in strength performance tests, once during OCP consumption (CONS) and once during withdrawal (WITH). Tests were performed on a dynamometer to measure knee-extensor and flexor maximal voluntary isokinetic and isometric torque. Prior to each test, body mass was assessed, and venous blood samples were collected. Wilcoxon signed-rank test and magnitude-based inferences have been conducted to analyze differences between WITH and CONS. Significance was accepted at P < 0.05. No significant differences between oral contraceptive cycle phases of knee-extensor and flexor strength parameters and body mass have been indicated (all at P > 0.05). Follicle-stimulating hormone (FSH) (P = 0.001) and luteinizing hormone (P = 0.013) were significantly higher in WITH, whereby estradiol and progesterone showed no significant difference between phases (both at P > 0.05). These results support the notion that knee-extensor and flexor isokinetic and isometric strength performance does not differ between phases of oral contraceptive cycle in well-trained team sport athletes. OCP intake is suggested to cause a stable but downregulated hormone cycle, which has no effect on knee-extensor and flexor strength when comparing oral contraceptive cycle phases. Therefore, manipulation of the female cycle using OCP in order to achieve a higher knee-extensor and flexor strength performance does not seem to be justified; however, it is currently unclear if cycle manipulation might affect other physiological systems.

178 Sleep Disparities in Adolescent Women: Role of Pubertal Development, Menstrual Cycle and Premenstrual Symptoms

Abstract Introduction About 20-30% of children experience sleep difficulties and about 50-60% of those persist into adolescence. Sex differences in sleep become more apparent after the onset of puberty, suggesting a role for maturational changes in the sleep of males and females. In addition, adolescent females experience greater sleep difficulties with the advancement of pubertal stages and around the time of menstruation. Although adult studies have shown sex differences in sleep continuity and architecture, there is a large gap of knowledge in adolescents. Methods We analyzed data from the Penn State Child Cohort, a random, population-based sample of 421 adolescents (16.5±2.3y, 53.9% male) who underwent one-night in-lab polysomnography (PSG) and seven-night at-home actigraphy (ACT) as well as a thorough physical exam and clinical history, including self-reports of Tanner staging, menstrual cycle and use of oral contraceptives (OC). Results Upon PSG, females had a longer sleep latency (p&amp;lt;0.05), while males a greater number of awakenings (p&amp;lt;0.05), longer wake after sleep onset (p&amp;lt;0.01) and greater stage N1 (p&amp;lt;0.05). Per ACT, females had longer total sleep time and greater sleep efficiency (p&amp;lt;0.01). Sex differences in PSG and ACT parameters were more prominent among adolescents reporting Tanner stages 4-5, including females having greater stage N3 than males (p&amp;lt;0.01) and females reporting premenstrual symptoms (PMS) having a longer sleep latency than males or than those not reporting PMS (P&amp;lt;0.05). Among females, those who had their last period 8-14 days prior to the PSG had a shorter sleep latency than those who had their period within the previous 7 days (p&amp;lt;0.01) or 15-25 days before (p&amp;lt;0.05). Females using OC (n=38) did not show significantly different PSG or ACT parameters than those not using OC (n=156). Conclusion Our study provides evidence for sex-related health disparities in objective sleep arising in adolescence. Females sleep objectively better than males from a sleep continuity and sleep architecture perspective, particularly when examined at the same pubertal stage. Additionally, sleep onset is significantly impacted by the menstrual cycle and associated symptoms but females preserve greater levels of deep sleep, a sign of sleep resilience. Support (if any) NIH Awards Number R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127