Hormonal contraceptive use.

Hormonal contraceptive use is important to understand in regards to the female athlete. There is a growing body of literature on the negative side effects of hormonal contraceptives such as mood disturbances, depression, poorer bone health, greater inflammation and oxidative stress. Hormonal contraceptives also have a masking effect meaning you are unable to use the menstrual cycle as a marker of health, which can result in underlying health problems being missed.

Previous research on elite athletes has reported high use of hormonal contraceptives in the range of 33-72%. However this study, which surveyed 76 World Cup and World Championship mountain bikers in both XCO and DH, had much lower numbers. Twenty-five percent of riders were current hormonal contraceptive users, 25% were previous users and 50% had never used hormonal contraceptives of any kind.

There were also differences observed in types of hormonal contraceptives used in this research compared to previous research on elite athletes in other sports. Combined oral contraceptives, “the pill”, was the most common making up 53% of hormonal contraceptive use. This is much lower than in previous research. Combined oral contraceptives provide exogenous estrogen and progestin which down-regulates or suppresses endogenous estrogen and progesterone. Women will experience a “withdrawal bleed”, not a period. Twenty-four percent of riders reported using a hormonal intra-uterine device (IUD), which is higher than previously reported in the literature on elite female athletes in other sports. A hormonal IUD provides progestin only and is localised to the uterus.

Reasons for use, in this study, were: contraception 66%, to enhance period regularity 34%, to reduce period pain 24%, period manipulation 16% and to reduce acne 16%. Five percent of riders were either unsure of their reasons/prescribed it by a Doctor.

Unfortunately most riders experienced negative side effects from hormonal contraceptives. The most common self-reported side effects being: weight gain 40%, mood disturbance 37% and a performance deficit 21%.

Findings from my research Riding with Flow: Menstrual Health in World cup and World Championship Mountain Bikers.