Can the Pill Help my Performance as a Runner?

What Is the Contraceptive Pill?

The impact of the contraceptive pill and athletic performance is a complex and nuanced topic, so strap yourself in for our take at Femmi.

The pill generally refers to the combined oral contraceptive pill (or the OCP), which is a tablet that contains synthetic versions of our female hormones, i.e., a synthetic oestrogen and a synthetic progesterone.

How the Pill Works in the Body

So how does the pill actually work? Well, the pill turns off our body's natural hormone production. So rather than having fluctuating hormones on a monthly menstrual cycle, we have low natural hormones and steady synthetic hormones that we take in a tablet each day. If we consider athletic performance, most studies do not show the pill has a significant impact on athletic performance, but these are generally short studies with small sample groups. There is some data that shows being on the pill may decrease the benefit from strength-type training, however, some studies have shown no impact.

The Different Types of the Pill and Their Impact

The thing is, there are multiple formulations of the pill containing different doses and types of oestrogen and progesterone. We can't really put all types of the pill into the same category but unfortunately, most of the research studies examining the impact of the pill and athletic performance do. To be more specific, some pills either activate or block testosterone receptors, which may be why we see some studies showing an impact on muscle gain and adaptations, and some don’t.

What Does the Research Say?

A few years ago, researchers did a study called a meta-analysis where they look at the results from multiple studies and try to find an answer from a large body of evidence rather than a single study. This showed the pill likely has a neutral or potentially very slight negative impact on performance, but the impact was very small.

Other Forms of Contraception and Athletic Performance

Unfortunately, other forms of contraception such as the Implanon, Mirena IUD, or Depo-Provera injection have had essentially no research on their impact on athletic performance (infuriating, hey?!). I generally do not recommend athletes go on the Depo-Provera as it lowers bone density and may increase the risk of stress fractures.

Why the Menstrual Cycle Is Important for Athletes

As an endocrinologist that looks after athletes, my main concern with the pill (and other forms of contraception that turn off natural periods) is that it inhibits the body's natural menstrual cycle, which is an excellent marker of if we are fueling and recovering appropriately. Our menstrual cycle will be turned off by our body if we have low energy availability or are under significant physical or psychological stress and not recovering appropriately.

When we are on the pill, we are masking this system, and there is no accurate way to know our underlying menstrual health.

Is the Pill Right for You?

The pill is an excellent form of contraception and can also help manage the symptoms of some medical conditions such as endometriosis, polycystic ovarian syndrome, or premenstrual dysphoric disorder. Consequently, whether the pill is appropriate for you as a woman runner will be due to your unique situation and contraception and medical requirements. If you need to be on the pill or prefer the pill for contraception, it should not have a major impact on your performance, but it is important you monitor your energy availability and fuelling and risk of REDs (relative energy deficiency syndrome) in other ways like a symptom diary or review with a sports dietitian.