Athlete’s Guide to Birth Control

A quick Google search for birth control is enough to make your head spin. There are So. Many. Options. Which one should you choose? Is one better than another for athletes? Will it negatively impact your athletic performance? We dive into all of this here. If you’re an athlete curious about birth control, you’re in the right place.  Your athlete’s guide to birth control!

Whether to use birth control and what type of birth control to use is obviously a personal decision, to be made by a menstruating athlete under the guidance of their medical doctor.  We encourage all athletes to find a medical provider with experience and expertise working with athletes. Have an honest conversation with that medical provider about the impact of birth control on your athletic performance. 

Types of Birth Control

Birth control can be divided into two categories: hormonal and non-hormonal. Hormonal birth control alters natural hormone levels in a female’s body to prevent pregnancy. Non-hormonal birth control does not impact hormone levels. It physically prevents sperm from reaching the egg.

Non-hormonal Birth Control Options for Athletes

• Diaphragm-  A saucer-shaped silicone cup that you put into your vagina to block semen from entering your womb. This requires getting fitted for a diaphragm by your doctor. 
• Cervical cap- A little hat-shaped piece of silicone that you put over your cervix to keep sperm out. It’s similar to a diaphragm and should be fitted by a doctor. One downside: you should use it with a spermicide.
• Spermicide- a chemical that you place in the vagina to kill or paralyze sperm. You can buy spermicide over the counter in different forms including gels and foams.
• Sponge- A small sponge that contains spermicide. It works similar to a diaphragm or cervical cap. A plus is that you can buy it without a prescription.
• Vaginal gel- You use an applicator to insert the gel in your vagina before sex. It keeps the pH of the vagina low so sperm can’t move in the reproductive canal and reach the egg.
• Copper IUD- A T-shaped plastic piece that’s placed in your uterus by a doctor. It’s wrapped in copper, which is toxic to sperm and keeps them from swimming through the vagina to reach the egg. 
• Male condom- A thin sheath, often latex, that a man wears over his penis during sex to prevent semen from entering a woman’s body.
• Female condom- a lubricated latex tube that a woman puts in her vagina with flexible rings on both ends (one end is closed to keep semen out).

Do non-hormonal birth control methods affect performance?

In short, no. Non-hormonal birth control doesn’t alter female hormone levels, so doesn’t risk impacting athletic performance, mood, energy or other variables.

Hormonal Birth Control Options for Athletes

Up to 40% of women of reproductive age use hormonal contraception. The two types of hormonal birth control: estrogen + progesterone or progesterone only.

Estrogen + Progesterone Birth Control

This type of birth control prevents ovulation (release of an egg) and suppresses hormonal fluctuations through synthetic hormones so a “normal” cycle doesn’t happen. These include birth control pills and vaginal rings. Both methods induce a withdrawal bleed that may mimic a period but isn’t a real period.

• Birth control pill- a pill you take every day at the same time that provides a dose of estrogen and progesterone
• Vaginal ring- a silicone ring placed in the vagina three weeks out of the month that delivers hormones via the vaginal wall

Hormonal Birth Control Impact on Sex Hormone Binding Globulin

Hormonal birth control, such as birth control pills, patches, or hormonal IUDs, can increase the levels of Sex Hormone Binding Globulin (SHBG) in the body. SHBG is a protein that binds to sex hormones like estrogen and testosterone. When someone takes hormonal contraceptives, especially those containing estrogen, the liver produces more SHBG. This increase in SHBG levels leads to a decrease in free, unbound hormones circulating in the bloodstream. Consequently, the estrogen and testosterone levels available to exert their effects on the body’s tissues may decrease, affecting various processes in the body.

A common finding among ABT users on hormonal birth control is elevated SHBG with low free testosterone. Low free testosterone can impact performance by impacting recovery and adaptation to training.

Progesterone Only Methods  

Progesterone-only methods affect the menstrual cycle differently depending on the method/route. Some users still ovulate and experience hormonal fluctuations in line with a hormonal cycle, such as a hormonal IUD. These methods can also thicken the cervical mucus so sperm can’t reach the egg. 

• Injection- an injection of progesterone that typically lasts several months
• Progesterone-only pill (mini pill)- a pill you take daily that provides a dose of progesterone.
• Implant- a small plastic rod placed under the skin in the upper arm (don’t worry, you can’t see it) that prevents pregnancy for up to 4 years

Does hormonal birth control affect athletic performance?

This is a bit more complicated. The short answer is it depends, and it may.

A recent meta-analysis and systematic review concluded that birth control pills might result in slightly inferior exercise performance compared to naturally menstruating women.  But (and it’s a big but) the effects in this analysis tended to be trivial. 

Anecdotally, we hear from many athletes who feel that hormonal birth control decreases their performance, and many coaches recommend that their athletes avoid hormonal birth control.  This article, published in November 2022, would tend to agree.  Dr. Stacy Sims discusses the conundrum here.  Therefore, an individualized approach is best.

Questions to ask your doctor

Discuss with your medical doctor what type of birth control is best for you. Here are some questions you might want to ask your doctor when choosing a method of birth control.

1. Are there athletic performance-related side effects?
2. Does this method impact bone health?
3. How does birth control affect fluid balance and hydration?
4. Will this method interact with any medications or supplements I’m taking?
5. How quickly can fertility return after stopping the birth control?

And remember: if you are an athlete and aren’t menstruating, this is a warning sign. Check out our article on RED-S and consult your doctor to rule out an underlying medical condition.

Conclusion Athlete’s guide to birth control

Types of birth control can be grouped into non-hormonal and hormonal. Non-hormonal prevent sperm from reaching an egg and do not affect a woman’s hormone levels. Hormonal birth control alters a woman’s hormone levels. It’s a highly personal decision, so talk with your doctor about the best method for you.

And no matter what type of birth control you choose, we’ve got a panel for you! Check out our Gold Panel if you are on hormonal birth control or ABT.she if you aren’t.

Enjoyed Athlete’s Guide to Birth Control? Check out more articles in our Knowledge Hub!