Effects of Oral Contraceptives on Body Composition and Physical Performance in Female Athletes

Abstract

Menstrual disturbances are common among female athletes, and oral contraceptives (OCs) are often recommended as estrogen substitution. However, there is little information about the effects of OC use in athletes, and there is great concern that OCs might impair physical performance. The aim of this study was to investigate the effects of OC use on body composition and physical performance in female athletes. Twentysix endurance athletes (13 with oligo-/amenorrhea and 13 regularly menstruating athletes) and 12 sedentary controls were examined before and after 10 months of treatment with a low dose, monophasic, combined OC. Significant changes in body composition were recorded in the athletes, but not in the controls. There was an increase in weight and fat mass only in athletes with oligo-/amenorrhea. These changes were associated with a decrease in ovarian androgens. OC treatment also increased bone mineral density, with the largest increase in athletes with a low bone mineral density at baseline. Despite significant changes in body composition, little impact on physical performance was recorded. We have demonstrated that OC treatment in female athletes has predominantly beneficial effects on body composition without adverse effects on physical performance and could be used for the prevention of osteoporosis in athletic amenorrhea. However, it cannot be excluded that a marked increase in fat mass might have unfavorable effects for athletic performance in individual women. (J Clin Endocrinol Metab 89: 4364 -4370, 2004)O RAL CONTRACEPTIVES (OC) are used by numerous women all over the world. Although the main purpose is birth control, OCs are also frequently used for medical treatment, e.g. in women with long-standing amenorrhea. Circulating estrogen levels are known to be important to maintain bone mass, and limited data suggest that modern low dose OCs prevent bone loss in premenopausal women (1-3). However, there are also studies reporting no beneficial effect (4 -6). OCs are generally well tolerated, but some women experience side effects, such as headache, nausea, breast tenderness, and weight gain (7,8). These side effects are of great clinical importance because they often lead to discontinuation of treatment. Young women may be especially concerned about weight gain (9). Despite extensive clinical experience, many metabolic effects of OC treatment remain to be explored. Changes in appetite and weight are known to occur in some women, but the association with treatment is unclear. There are only a few studies evaluating body composition during OC treatment, and these show no significant change in body weight or body fat (10 -12).The questions about weight gain and metabolic effects of OCs are of particular relevance to female athletes, because a change in body composition could have a negative impact on physical performance. Menstrual disturbances are common among female athletes, especially in endurance sports, and have been associated with insufficient dietary intake (13, 14). Long-standing amenorrhea and ...

Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review

“…Of the 10 studies of OC and other hormone replacement in this population, seven (two RCTs, 62 63 five cohort [64][65][66][67][68] ) showed a positive effect, two (one RCT, 69 one cohort 70 ) showed no effect, and one case report 71 showed a negative effect on BMD. In all studies that compared baseline BMDs with that of healthy controls or age matched reference values, baseline BMDs were significantly lower in the oligo/amenorrhoeic subjects.…”

“…In all studies that compared baseline BMDs with that of healthy controls or age matched reference values, baseline BMDs were significantly lower in the oligo/amenorrhoeic subjects. [65][66][67][68][69][70][71] Hergenroeder et al 62 showed an increase in total body and lumbar spine BMD with OCs, compared with medroxyprogesterone or placebo. Although well designed, this was a small study with only five subjects per treatment group, followed over a 12 month time span.…”

Peptide YY in adolescent athletes with amenorrhea, eumenorrheic athletes and non-athletic controls

“…Girls with AA or EA were endurance athletes with a self-reported history of one of the following for at least six months: (i) ≥ 4 hours of aerobic weight-bearing training of the legs weekly, (ii) ≥ 30 miles of running weekly or (iii) ≥ 4 hours of specific endurance training weekly [22]. Girls were considered amenorrheic if (i) they had no menses for at least three consecutive cycles immediately preceding study participation, and had either attained menarche and menstruated regularly for at least six months after menarche and before the period of amenorrhea [22], or (ii) had not attained menarche at 15.3 years of age (mean age at menarche + 2 SDs for girls in the United States) [23]. Athletes with eumenorrhea met criteria for endurance athletes but did not have menarchal delay or amenorrhea.…”

2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013

“…Pharmacological treatment that aims to restore regular menstrual cycles with COC does not normalise metabolic factors impairing bone health and will therefore likely not result in reversal of low BMD in the athlete with Triad disorders 2 159 172. The lack of efficacy of oral oestrogen in improving BMD in conditions of low-weight and possibly normal-weight exercise-induced amenorrhoea has been attributed to the suppressive effects of oral oestrogen on hepatic IGF-1 production 163 164 173.…”

“…It is also essential to consider contraceptive needs of the athlete. Before starting therapy, a thorough history and examination should be conducted to rule out contraindications for oestrogen therapy. COC therapy containing 20–35 μg of ethinyl oestradiol may maintain BMD in those with very low BMD measures, although data are not definitive 168 172. Most of the studies in adolescents and adults with anorexia nervosa and in amenorrhoeic athletes suggest that COC therapies are not effective in increasing BMD161 162 167 168 or in reducing stress fractures,161 although they are effective for contraceptive needs when used in recommended doses.…”