Let me start by saying, of course this is a complicated issue with no black and white solution. I honestly think it will take me a number of posts to say what I would like to.
Both the pro and anti oral contraception crowds have some data to backup their claims. It’s easy to find female athletes across the spectrum: from those who are able to perform fine on the pill; to those who recognized that they couldn’t achieve their athletic potential while taking the hormones; to women who simply couldn’t function on any form of oral contraception.
The truth is that the studies are extremely limited, and the ones using actual athletes are even more so. Like many issues in women’s health, the lack of data is extremely frustrating.
Though some distance runners begin taking the pill for other reasons – such as acne, birth control, ovarian cysts, etc. – many are urged to start taking it because they are amenorrheic, meaning their menstrual cycles have stopped. There is documented evidence that women who are amenorrheic in young adulthood fail to build the optimal amount of bone and may suffer from low bone density later in life. There is even some data to suggest that a certain extent of this loss may be irreversible.
While the link between estrogen and bone density seems to be established, the logic that birth control pills will protect bone density has not been thoroughly tested. This approach to amenorrhea in young women is actually based on the treatment of post-menopausal women with low bone density using hormone replacement therapy.
There are many reasons that a woman can experience amenorrhea, and by extension thought to be low estrogen. My theory is that our bodies can only handle so much stress and that they need a certain level of homeostasis to function properly. Our stress levels are affected by our diet, activity level, emotional health, and environmental pollutants. Any combination of these assaults can contribute to a stress load that is too much for our system to function normally. When this happens the body goes into crisis mode and decides to stop menstruating.
The reality is that there are a number of highly trained, extremely lean competitive athletes who have normal menstrual cycles. There are also many non-athletic, average weight young women who are amenhorreic. Body-fat and training-level don’t necessarily tell the whole story.
One of the side effects of oral contraceptives that I find very troubling is the increased incidence of depression and mood disorders. The altered brain activity is largely contributed to interference of serotonin uptake and absorption of B-vitamins. This can be extremely detrimental for athletes and anyone suffering from disordered eating. In addition to helping the body handle and process stress, B-vitamins also play an important role in carbohydrate metabolism.
Another consideration is that the hormones in birth control pills, estrogen and progesterone, help feed the overgrowth of yeasts in the female body. Systemic yeast imbalance can result in a variety of very serious conditions including many digestive problems, food sensitivities, allergies, yeast infections, UTIs, skin conditions like acne and eczema, infertility problems, weight gain, and various other ailments.
The latest study about birth control pills reducing a women’s chance of gaining lean muscle mass is really disturbing for athletes. Running, especially, is all about strength to weight ratio.
Again, there isn’t an easy answer to the question of whether birth control pills are good for female distance runners (or athletes in general). There are a number of reasons why I think they aren’t a good idea for everyone. I don’t agree with the blanket prescription policy that is currently in place in most health institutions. Obviously birth control pills can be appropriate for some individuals, but that doesn’t mean that they should be prescribed out so quickly as the solution to every female problem.
I am not a medical doctor, but in my experience, health and athletic performance are best fostered when we look at the whole person. I also feel that a discussion of oral contraceptives in female distance runners or other athletes is incomplete without a further discussion of eating disorders, but I’ll reserve that for another post.
If you are wondering whether you should be taking the birth control pill, I urge you to weigh the positives and negatives and research the subject for yourself. Most doctors see a variety of patients, don’t specialize in treating athletes, and don’t necessarily keep up on the latest research. You have to be your own advocate. If you are you only taking the pill for birth control and are a serious athlete, it might really be worth taking the time to evaluate the trade-offs.
*A side note about Ortho Tricyclen…. My theory is that this company gives a lot free samples and kickbacks to Doctor’s offices because they always prescribe patients on this pill first. According to doctors, they start women on a tri-phasal pill (meaning three different levels of hormones) because it mimics the normal phases of the female’s cycle. The flaw in this logic, as far as I’m concerned, is that when you’re talking about girls who are amenorehic, they don’t have a cycle… so this artificial phasing is very difficult on their systems.