Of the fistful of elite runners I know, most of them are using some sort of IUD. Most popular one being the Mirena.
Of the fistful of elite runners I know, most of them are using some sort of IUD. Most popular one being the Mirena.
Personally I used the NuvaRing and it had no effect whatsoever. I recently had to get off it because of thyroid issues but I really didn’t notice a difference. It was very easy and convenient, I only had to deal with it once a month instead of taking a pill every day.
I think it depends on your body and what works best for you. Some women hate the pill and others have no issue. Some women like the IUD and others bleed for months on it. I recommend trying out a few and see what you like. Also talk to your doctor and see what she/he recommends. Good luck!
Not on BC myself, but most of the sub-elite or elite women I know use IUD (copper/non-hormonal). I think your choice depends a lot on personal factors/other health issues. Personally, I would opt for an IUD as I would like to have the feedback of a regular menstrual cycle to make sure I'm not overtraining (which can be hidden if you are on the pill ), and because my base state doesn't cause me any problems with training or life in general. But, I do know some athletes who have hormonal issues that cause a lot of menstrual symptoms/pain and so the pill helps them with that. Realistically, you could try out different methods to see how they make you feel... seems like a medical topic with lots of individual variability.
You nailed it--research is limited in existence, has methodological problems, and isn't good enough to answer the question. Which is pretty frustrating. We should have a much better answer to this in 2022. And an answer may be even farther off now that it's getting harder and harder to discuss anything related to female biology without drawing the ire of the "must be inclusive to trans" crowd...
Mechanistically, it seems like hormonal BC almost has to produce performance-decreasing effects. Progesterone increases body temperature. Estrogens change fluid balance. Both progesterone and estradiol have been implicated in airway function. Etc. etc.
As far as individual experiences, here is mine--I took oral hormonal BC as a teen, to control extremely heavy periods. I started on it during xc season in high school and in the space of about two months, I went from being part of our varsity state champion team to midpack or back of the pack straggler, with no other health problems going on. I was clueless to anything medical at the time, so it took several months for me to realize what the problem was and stop the BC pills. I've never even considered taking them again. It still infuriates me that the doctor who prescribed them to me never bothered to ask if I was an athlete or explain the possible side effects.
Wow, I was not expecting so much good feedback. Glad I’m not the only one a little frustrated with the lack of information. Anyone using or who has used the copper IUD, did the additional pain and bleeding associated with it hinder your running or racing significantly? If so, would you still recommend it over the hormonal options?
One of my friends was a professional distance runner and had an IUD that ended up having a bunch of negative side effects including weight gain which basically ended up contributing to her getting a bunch of random injuries and getting slower from that and the weight gain and essentially ruined her professional career.
From an article in STAT News, December 2021:
Despite the wide use of hormonal contraceptives, there are few studies on side effects or long-term effects, which physicians told STAT is largely due to two reasons: the lack of incentives to explore a drug that is widely known to be safe, and the difficulty of such studies. A large study conducted in Denmark — where drug prescription data are publicly accessible — suggests hormonal birth control is correlated with an increased risk of depression. Another large study, this one from Sweden, followed more than 300 women who took either oral contraception or a placebo pill for three months. It found that women who took the pill scored lower on a measure of general psychological well-being, though there wasn’t any difference in symptoms of depression between the two groups.
“Oral contraceptive pills are one of the most widely used drugs over an incredibly vast cross section of humanity over a long period of time,” said Michael L. Lipton, medical director of MRI services and professor of radiology, psychiatry, and behavioral sciences at Albert Einstein College of Medicine and the Montefiore Health System, who conducted a small-scale study in 2019 on oral contraceptive pills’ associations with brain structure — specifically the hypothalamus and pituitary. “I think it’s remarkable that there’s not more known about the [pill’s] mechanism of action.”
According to the National Center for Health Statistics, 65% of women aged 15 to 49 used contraception between 2017 and 2019. Female sterilization was most common, accounting for 28% of contraception among women who used any form of contraception, followed by the pill at 21%, long-acting reversible contraceptives like implants and intrauterine devices (IUDs) at 16%, and the male condom at 13%.
The pill has been widely shown to be safe, but as is the case with any drug, it can come with side effects and risks, including an increased risk of blood clots...
Still, given how many people take hormonal contraception, the lack of more robust data on side effects is notable, and leads some patients to want to experiment with going hormone-free.
Paula Castaño, associate professor of obstetrics and gynecology at Columbia University Irving Medical Center, said there’s a range of reasons that influence whether patients decide to stop taking the pill.
“I think [that decision] is multifactorial,” she said. “For some women, it’s a feeling or desire that they want to know what they feel like when they’re not on birth control, for some it is a question about whether there are any health reasons why they should, for some there is concern about whether fertility is affected in any way by long-term contraceptive use. A large factor in deciding to stop taking the pill can be influence from friends and family based on their opinions and experiences, whether or not those are based in medical fact.”
One such patient, Amanda Miller, 29, who lives in Brooklyn, N.Y., was put on the pill at 16 for periods that lasted too long. For Miller, hormonal contraceptives seemed to be an almost compulsory step in young adulthood for American women.
“I feel like the pill is so ingrained in US culture — it felt like everyone was on it,” she says. “There wasn’t much discussion at all with my doctor when I first got on it. It was more about ‘better safe than sorry.’”
After years of taking the same brand of pill, Yasmin, with no issues, a change in price caused her to try an IUD, before ultimately returning to her original pill.
But the second time around, Miller experienced emotional side effects, including depression and moodiness. She stopped the medication, but still wanted to use a reliable method to prevent pregnancy, so she turned to her gynecologist for guidance.
“[My doctor] made a comment about how if I wasn’t on birth control, I might as well start taking prenatal vitamins,” she says. “It was passive aggressive, but also didn’t help me in thinking about what my other options are. That broke the trust with me, I didn’t feel safe to talk to her to discuss options.”
https://www.statnews.com/2021/12/06/patients-doctors-clashing-side-effects-hormonal-birth-control/
Hormonal contraceptives, particularly oral birth control pills, lead to dramatic increases in Sex Hormone Binding Globulin in women who take them, and there is now research to suggest that SHBG levels remain elevated even after women stop taking hormonal BC. SHBG is the protein that binds testosterone, so the levels of SHBG in a person's system directly affect how much testosterone is available to serve various physiological functions.
Testosterone is found as either bound or unbound in the body. Unbound testosterone is considered Free Testosterone. Testosterone that is bound to albumin, a transport protein, is also considered free since it is a relatively weak bind. Surprisingly, only about 3% of testosterone in the body is completely “free”, or unbound, and about 30-35% if bound to albumin. The remaining 70% is bound to sex hormone binding globulin, SHBG.
One large meta-analysis found that [women's] total testosterone levels can decline by roughly 30%, while free testosterone decline by nearly 60% with the use of hormonal contraceptives. That is a huge reduction! It is thought that it's caused by three mechanisms: 1) the suppression of testosterone production by the ovaries, 2) suppression of testosterone production by the adrenal glands, and 3) increased SHBG levels.
SHBG rises dramatically with the use of some hormonal birth controls—by as much as 250%. SHBG exist to bind to sex hormones, making it easier for them to safely travel through the bloodstream. [SHBG] is produced in the liver in response to testosterone and estrogen, and since hormonal contraceptives typically include a form of estrogen, it makes sense that SHBG levels increase when hormones are added to the body.
https://blog.insidetracker.com/surprising-way-birth-control-affects-health-hormones
The current literature review and meta-analysis demonstrates that COCs [combined oral contraceptives containing estrogen and progestin] decrease circulating levels of total T and free T and increase SBHG concentrations. Due to the SHBG increase, free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T, but both affect SHBG. The clinical implications of suppressed androgen levels during COC use remain to be elucidated.
By pointing to the impact of hormonal BC on women's SHBG and thus free testosterone, I don't mean to be suggesting that testosterone is as key to female wellbeing and sports performance as it is to males. Coz that's not what I believe, and it's not what the evidence shows.
The sustained amounts of natural testosterone that boys and men produce over long periods of time play a plethora of essential roles in the development and maintenance of male anatomy, physiology, general health and wellbeing, sexual function and sports performance. But the same isn't true of girls and women because we are physically different to males in thousands of ways, including having entirely different androgen receptors in kind, number and location - and probably in specific and overall function too.
Starting in utero, females do naturally produce testosterone - but in very small amounts, especially compared to males. Moreover, the small amount of natural testosterone we make is not crucial for us to develop normally as females during gestation in utero - or during the mini puberty of infancy that occurs in the first year after birth or the longer puberty of adolescence - the way that the large, sustained amounts of natural T which males make from their testes day after day during these periods of life are so crucial for their male development, functioning and wellbeing.
Nor does testosterone play the same number or types of roles in human females after adolescence as it does in human males. (In fact, recent research suggests that in girls and women, the development and maintenance of muscle mass and strength are predominantly dependent on estrogen, just as estrogen is the sex hormone that is key to us developing and maintaining healthy bone density and strength). Therefore, think it's a grave mistake to assume - as many have done historically - that the more testosterone women naturally produce and have freely available for our bodies to use in various ways, the better we will perform, or will be equipped to perform, in sports. Where and when it exists, the relationship between girls' and women's natural T levels and sports aptitude and performance is more complex and far less straightforward than that.
The normal range for natural T in women 18 and up is 0.02-1.68 nmol/L. In men 18 and up it's 7.7-29. nmol/L. In 2014, physicians working with/for World Athletics tested 838 athletes competing in elite international women's track and field, and found that 75% had T under 0.91 nmol/L. Some had T of 0.01 nmol/L. (Only 8 athletes tested had T of 3 nmol/L or above, and the researchers said they suspected those athletes were either doping or had undisclosed XY DSDs.)
This and other research refutes the notion that high natural T in women directly and automatically leads to better sports performance, which many people automatically assume is the case. The athletes competing in elite international women's track and field who've been shown to perform better in sports due to having consistent levels of "high natural testosterone" for females over time are not "women with hyperandrogenism" or "female athletes with naturally high testosterone" the way they are routinely described. They are all XY athletes with male genetics, male gonads (testes) and male physiology, including male androgen receptors, that enable them to make use of the male levels of natural testosterone their testes pump out as other males do. Such as Semenya, Niyonsaba, Wambui, Seyni, Chand, Mboma and Masilingi.
Still, the small amounts of testosterone that adult females naturally produce do appear to be important to various aspects of our health, including our moods, mental wellbeing, energy levels, libido and sexual functioning. Testosterone also presumably plays very important roles during the time of women's lives when we perform truly amazing feats of endurance, strength and bravery, and when our capacity to withstand excruciating pain and evince a "can do" and "don't give up" attitude is very important: pregnancy, labor and childbirth. If a spike in testosterone didn't serve so many purposes during the third trimester, labor and childbirth, then I see no reason why evolution would have arranged for why women's T to go up so markedly yet temporarily then.
(The normal reference range for T in pregnant women is 1.7-4.2 nmol/L, with the levels climbing as the pregnancy progresses; these levels are considerably higher than the normal range of 0.02-1.68 for women who aren't pregnant. Some women at the end of pregnancy have been found to have temporary T levels in the male range. One of the many reasons for the "baby blues" right after birth and the longer-lasting, all-too-common problem of post-natal clinical depression in mothers is probably the rapid, very steep decline in testosterone women experience after giving birth. The enormous temporary surge in natural testosterone that occurs in women as we near childbirth also probably helps explain why in the days/week before labor commences, many women experience great spikes in energy, get-up-and-go and atypical strength that cause us to suddenly start doing major home improvement, landscaping, auto repair and reorganization projects - and/or going on heavy housecleaning binges in which we single-handedly move all the heavy furniture and major household appliances such as the refrigerator, washer and dryer so we can get rid of all the dust and gunk behind them. LOL. )
So just as it's known that without any free testosterone whatsoever over time, women are likely to experience negative effects such as clinical depression and lack of sex drive, I don't think it's a stretch to think that the relatively small amounts of testosterone that female athletes naturally produce and have freely available to them over time in late adolescence and adulthood often play an important role in helping them to have and maintain numerous features that are crucial in sports, such as positive outlook, good mood, high energy levels, drive to excel, perseverance and competitive spirit. As a result, by increasing SHBG and thus reducing the amount of free T available, hormonal birth control most likely has a negative impact on some women's sports performance.
TL;DR version: female athletes - all girls and women, in fact - would do well to think twice and look into the possible negative effects before going on hormonal birth control. Interfering with the natural functioning of the female endocrine system often comes with downsides that don't get enough attention.
Not an elite but long time above average runner. I ran through most of my college years on the pill, starting at 19. The hard part with this topic is that every woman is so different. So my story can be so different than others. I was super lucky and even pre BC had moderate periods with rarely any difficulties beyond light cramping. I eventually switched to the Mirena IUD and had it for 5 years. Lost period completely which I loved but my already troublesome skin went crazy. So I recently decided to go back to the pill for that alone. But now I'm noticing more migraines, worse cramping, and tenderness. In terms of impacting my running I never experienced anything that I attributed to BC but the jury is still out on my research switch.
There definitely needs to be more research in general about birth control, especially now that there are so many different options. Since I'm married and in a child free relationship my husband will be getting a vasetomy soon but I still see benefits in birth control for various reasons (I like no periods which may be controversial but on the other hand I like my skin better with more hormones in the pill). It is such a frustrating topic for so many reasons.
another perspective wrote:
Of the fistful of elite runners I know, most of them are using some sort of IUD. Most popular one being the Mirena.
I have the Mirena and might be considered sub-elite on a good day. Never noticed any side effects (but I've had it for 10+ years) and not getting a period is super nice for races. But I've had friends who hated it and went with the copper one instead because there are no hormones. I think Quigley did an IG post about it a bit ago (the one non-sponsored one).
I love that you are bringing more attention to this subject! I’m in the medical field and found the paucity of research surprising/try to participate in every study I see where I qualify to share my experience. When I was looking to need birth control I took into account the most efficacious types (besides abstinence and sterilization, IUDs are among the best), other resident physicians’ recommendations (nearly all the OB/GYN gals were using progesterone only IUDs), as well as side effect profile (lighter versus heavier periods) and went with the progesterone only IUD. I’ll admit even though the studies didn’t seem to support it I was concerned about weight gain. Initially I had some spotting/irregular bleeding early on, but I’ve been very happy and haven’t seemed to gain weight. While training certainly factored in I ran PRs in the 5k/10k/half marathon since getting my IUD. I’ve had it for 2-3 years now. With the hormones being local I don’t really notice any side effects besides lighter periods. Just my two cents/n of 1 but I would definitely recommend the progesterone only IUD as long as you are okay with potentially losing your period (as many as 25% of women do, and I get that it can be really helpful in gauging proper fueling)! Otherwise the copper iud is a great, effective option as long as you can tolerate the heavy bleeding that should improve over time.
Hi,
Speaking from anecdotal experience only (and not from supported research), a low-dose hormonal IUD has worked well for me. I currently have the Liletta IUD. I previously experienced consistent periods, heavy bleeding, and strong cramps. I was basically making a decision between going on some sort of BC or not being able to run on my period because of the symptoms. I had looked into a copper IUD, but with the side effects of that being documented as sometimes increased cramping, I really didn't want to do that. I've found that for the first few months I had a little spotting, but 1.5 years later, I no longer get a period. I haven't noticed any difference in terms of running and performance and have PR'd in almost all events since getting on the IUD. It's actually been a huge relief because I'm not stressed about getting my period on a race weekend, for a hard workout, etc. Also, just noting that I chose the IUD because the hormones are localized as opposed to taking a pill and experiencing more system-wide side effects. This is obviously just my personal experience with BC, but so far the IUD has been a good move.
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