Hormonal contraception for female athletes presents special needs and concerns

Abstract

Purpose

Oral contraceptives (OCs) are commonly used by female athletes raising concerns regarding the possible adverse effects of OCs on physical performance, musculoskeletal injuries, and bone density. We aimed to review all current studies on the physiological effects of OCs in physically active women.

Materials and methods

A review of literature in electronic search in PubMed and Google Scholar databases from December 2002 to December 2022 using relevant keywords. The reference lists of the articles found eligible were also reviewed.

Results

Out of 344 articles in the initial database, 54 clinical studies were eligible for inclusion in our literature review. OCs are used by about two-thirds of female athletes. Current research suggests that OCs’ effects on endurance performance and muscle strength are mostly reassuring. OCs do not seem to have a major negative impact on bone health or sports injuries. In fact, new data suggests that they may even significantly reduce the risk of anterior cruciate ligament (ACL) injury.

Conclusions

OCs can be safely used by young female athletes, who may also benefit from better menstrual cycle control. OCs offer newly realised protection from ACL injuries. The use of OCs must be carefully individualised according to their preferences, expectations, and experience.

SHORT CONDENSATION

Hormonal contraception can be safely prescribed to active women. The International Olympic Committee advocates a new and wider definition for the ‘athlete triad’, where low energy availability presents a special challenge for these athletes. New data suggests that the use of oral contraceptives may protect against ACL injury.

摘要

目的: 口服避孕药（OCs）是女性运动员常用的药物, 引起了有关OCs可能对身体表现、肌肉骨骼损伤和骨密度产生不良影响的担忧。我们旨在综述有关OCs在身体活跃女性中的生理效应的所有当前研究。

材料和方法：通过在PubMed和谷歌学术数据库中进行电子搜索, 检索时间从2002年12月到2022年12月, 使用相关关键词。还回顾了符合条件的文章的参考文献目录。

结果：在初始数据库的344篇文章中, 有54篇临床研究符合我们的文献综述的纳入标准。大约三分之二的女性运动员使用OCs。目前的研究表明, OCs对耐力表现和肌肉力量的影响大多令人放心。OCs似乎对骨健康或运动损伤没有重大负面影响。事实上, 新的数据表明它们甚至可能显著减少前交叉韧带（ACL）损伤的风险。

结论：年轻女性运动员可以安全使用OCs, 她们可能还会从更好的月经周期控制中受益。OCs提供了新实现的对ACL损伤的保护。使用OCs必须根据她们的偏好、期望和经验进行仔细个体化。

简短摘要：

激素避孕可以安全地开给运动员女性。国际奥委会提倡对“运动员三联症”的定义进行新的和更广泛的界定, 其中低能量供应对这些运动员提出了特殊挑战。新数据表明口服避孕药的使用可能对前交叉韧带损伤具有保护作用。

Keywords:

• ACL injury
• athlete triad
• athletic performance
• female athletes
• low energy availability (LEA)
• oral contraceptives (OCs)
• relative energy deficiency in sport (RED-S)

Acknowledgments

This manuscript is dedicated to Jonathan Seidman, a 26-year-old soul, son, and brother of our co-authors, Daniel S. Seidman and Liron Seidman. Jonathan was brutally murdered on October 7th, during a tragic terrorist attack while participating in a Peace Music Festival in Israel. This tragedy has left the authors and our nation profoundly devastated. This manuscript was finalized in the wake of these events, while we grieve and mourn.

Ethical approval

Institutional review board approval was not necessary for this systematic review, as all data were extracted from previously published studies.

Disclosure statement

No potential conflict of interest was reported by the author(s).