Contraception Choice for Female Endurance Athletes: What's Sport Got to Do With It? A Cross-Sectional Survey.
Journal
Sports medicine (Auckland, N.Z.)
ISSN: 1179-2035
Titre abrégé: Sports Med
Pays: New Zealand
ID NLM: 8412297
Informations de publication
Date de publication:
01 Sep 2024
01 Sep 2024
Historique:
accepted:
09
07
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
1
9
2024
Statut:
aheadofprint
Résumé
While there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport. Study objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes. This was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively. A total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport. This exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.
Sections du résumé
BACKGROUND
BACKGROUND
While there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport.
OBJECTIVES
OBJECTIVE
Study objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes.
METHODS
METHODS
This was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively.
RESULTS
RESULTS
A total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport.
CONCLUSIONS
CONCLUSIONS
This exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.
Identifiants
pubmed: 39217588
doi: 10.1007/s40279-024-02078-1
pii: 10.1007/s40279-024-02078-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Schulich School of Medicine and Dentistry, Western University
ID : 4500
Organisme : Schulich School of Medicine and Dentistry, Western University
ID : 4500
Informations de copyright
© 2024. The Author(s).
Références
Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. JAMA. 2021;326(24):2507–18. https://doi.org/10.1001/JAMA.2021.21392 .
doi: 10.1001/JAMA.2021.21392
pubmed: 34962522
Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363–E363. https://doi.org/10.1503/CMAJ.220637 .
doi: 10.1503/CMAJ.220637
pubmed: 36918177
pmcid: 10120420
Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668–80. https://doi.org/10.1016/S2213-8587(22)00163-2 .
doi: 10.1016/S2213-8587(22)00163-2
pubmed: 35934017
Britton LE, Alspaugh A, Greene MZ, McLemore MR, Laura FE. An evidence-based update on contraception: a detailed review of hormonal and nonhormonal methods. HHS Public Access Am J Nurs. 2020;120(2):22–33. https://doi.org/10.1097/01.NAJ.0000654304.29632.a7 .
doi: 10.1097/01.NAJ.0000654304.29632.a7
Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: a review. JAMA. 2021;326(20):2055–67. https://doi.org/10.1001/jama.2021.17633 .
doi: 10.1001/jama.2021.17633
pubmed: 34812859
Downey MM, Arteaga S, Villaseñor E, Gomez AM. More than a destination: contraceptive decision making as a journey. Womens Health Issues. 2017;27(5):539–45. https://doi.org/10.1016/J.WHI.2017.03.004 .
doi: 10.1016/J.WHI.2017.03.004
pubmed: 28412049
Oxfeldt M, Dalgaard LB, Jørgensen AA, Hansen M. Hormonal contraceptive use, menstrual dysfunctions, and self-reported side effects in elite athletes in Denmark. Int J Sports Physiol Perform. 2020;15(10):1377–84. https://doi.org/10.1123/IJSPP.2019-0636 .
doi: 10.1123/IJSPP.2019-0636
pubmed: 32957078
Heyward O, Elliott-Sale KJ, Roe G, et al. Oral contraceptive use in premiership and championship women’s rugby union: perceived symptomology, management strategies, and performance and wellness effects. Sci Med Footb. 2022;8(2):95–102. https://doi.org/10.1080/24733938.2022.2156588 .
doi: 10.1080/24733938.2022.2156588
pubmed: 36474141
Sung ES, Han A, Hinrichs T, Vorgerd M, Platen P. Effects of oral contraceptive use on muscle strength, muscle thickness, and fiber size and composition in young women undergoing 12 weeks of strength training: a cohort study. BMC Womens Health. 2022;22:1. https://doi.org/10.1186/S12905-022-01740-Y .
doi: 10.1186/S12905-022-01740-Y
Reif A, Wessner B, Haider P, Tschan H, Triska C. Strength performance across the oral contraceptive cycle of team sport athletes: a cross-sectional study. Front Physiol. 2021;1:2. https://doi.org/10.3389/FPHYS.2021.658994 .
doi: 10.3389/FPHYS.2021.658994
Henderson ZJ, Scribbans TD. Intrauterine contraception and athletic performance. Health Fitness J Canada. 2020;13(2):37–45. https://doi.org/10.14288/HFJC.V13I2.308 .
doi: 10.14288/HFJC.V13I2.308
Langan-Evans C, Hearris MA, McQuilliam S, et al. Hormonal contraceptive use, menstrual cycle characteristics and training/nutrition related profiles of elite, sub-elite and amateur athletes and exercisers: One size is unlikely to fit all. Int J Sports Sci Coach. 2023. https://doi.org/10.1177/17479541231163088 .
doi: 10.1177/17479541231163088
Martin D, Sale C, Cooper SB, Elliott-Sale KJ. Period prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes. Int J Sports Physiol Perform. 2018;13(7):926–32. https://doi.org/10.1123/IJSPP.2017-0330 .
doi: 10.1123/IJSPP.2017-0330
pubmed: 29283683
Ekenros L, von Rosen P, Solli GS, et al. Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports. Front Physiol. 2022. https://doi.org/10.3389/FPHYS.2022.954760 .
doi: 10.3389/FPHYS.2022.954760
pubmed: 36111164
pmcid: 9468598
Elliott-Sale KJ, McNulty KL, Ansdell P, et al. The effects of oral contraceptives on exercise performance in women: a systematic review and meta-analysis. Sports Med. 2020;50(10):1785–812. https://doi.org/10.1007/S40279-020-01317-5 .
doi: 10.1007/S40279-020-01317-5
pubmed: 32666247
pmcid: 7497464
Engseth TP, Andersson EP, Solli GS, et al. Prevalence and self-perceived experiences with the use of hormonal contraceptives among competitive female cross-country skiers and biathletes in Norway: the FENDURA project. Front Sports Act Living. 2022. https://doi.org/10.3389/FSPOR.2022.873222 .
doi: 10.3389/FSPOR.2022.873222
pubmed: 35498528
pmcid: 9047044
Baumgartner S, Bitterlich N, Geboltsberger S, Neuenschwander M, Matter S, Stute P. Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study. Front Physiol. 2023;14:1232656. https://doi.org/10.3389/fphys.2023.1232656 .
doi: 10.3389/fphys.2023.1232656
pubmed: 37565143
pmcid: 10410265
Spencer MR, Gastin PB. Energy system contribution during 200- to 1500-m running in highly trained athletes. Med Sci Sports Exerc. 2001;33:1. https://doi.org/10.1097/00005768-200101000-00024 .
doi: 10.1097/00005768-200101000-00024
Dusek GA, Yurova YV, Ruppel CP. Using social media and targeted snowball sampling to survey a hard-to-reach population: a case study. Int J Doctor Stud. 2015;10:5. https://doi.org/10.28945/2296 .
doi: 10.28945/2296
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:9. https://doi.org/10.1177/1049732305276687 .
doi: 10.1177/1049732305276687
Golobof A, Kiley J. The current status of oral contraceptives: progress and recent innovations. Semin Reprod Med. 2016;34:3. https://doi.org/10.1055/s-0036-1572546 .
doi: 10.1055/s-0036-1572546
Dhont M. History of oral contraception. Eur J Contracept Reprod Health Care. 2010;15:2. https://doi.org/10.3109/13625187.2010.513071 .
doi: 10.3109/13625187.2010.513071
Nelson A, Massoudi MPHN. New developments in intrauterine device use: focus on the US. Open Access J Contracept. 2016;7:1. https://doi.org/10.2147/oajc.s85755 .
doi: 10.2147/oajc.s85755
Bruinvels G, Burden R, Brown N, Richards T, Pedlar C. The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 London Marathon. Br J Sports Med. 2016;50:9. https://doi.org/10.1136/bjsports-2015-095505 .
doi: 10.1136/bjsports-2015-095505
Bruinvels G, Burden R, Brown N, Richards T, Pedlar C. The prevalence and impact of heavy menstrual bleeding (Menorrhagia) in elite and non-elite athletes. PLoS ONE. 2016;11:2. https://doi.org/10.1371/journal.pone.0149881 .
doi: 10.1371/journal.pone.0149881
Bianchi P, Guo SW, Habiba M, Benagiano G. Utility of the levonorgestrel-releasing intrauterine system in the treatment of abnormal uterine bleeding and dysmenorrhea: a narrative review. J Clin Med. 2022;11:19. https://doi.org/10.3390/jcm11195836 .
doi: 10.3390/jcm11195836
McNicholas C, Madden T, Secura G, Peipert JF. The contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol. 2014;57(4):635. https://doi.org/10.1097/GRF.0000000000000070 .
doi: 10.1097/GRF.0000000000000070
pubmed: 25286295
pmcid: 4216614
Stanford JB, Mikolajczyk RT. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 2002;187:6. https://doi.org/10.1067/mob.2002.128091 .
doi: 10.1067/mob.2002.128091
Lowe RF, Prata N. Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review. Contraception. 2013;87(4):486–96. https://doi.org/10.1016/j.contraception.2012.09.025 .
doi: 10.1016/j.contraception.2012.09.025
pubmed: 23122687
Fanse S, Bao Q, Burgess DJ. Long-acting intrauterine systems: recent advances, current challenges, and future opportunities. Adv Drug Deliv Rev. 2022;191: 114581. https://doi.org/10.1016/j.addr.2022.114581 .
doi: 10.1016/j.addr.2022.114581
pubmed: 36270490
pmcid: 10302114
Cabre HE, Moore SR, Smith-Ryan AE, Hackney AC. Relative energy deficiency in sport (RED-S): scientific, clinical, and practical implications for the female athlete. Dtsch Z Sportmed. 2022;73(7):225–34. https://doi.org/10.5960/dzsm.2022.546 .
doi: 10.5960/dzsm.2022.546
pubmed: 36479178
pmcid: 9724109
Bennell K, White S, Crossley K. The oral contraceptive pill: a revolution for sportswomen? Br J Sports Med. 1999;33:4. https://doi.org/10.1136/bjsm.33.4.231 .
doi: 10.1136/bjsm.33.4.231
Schaumberg MA, Emmerton LM, Jenkins DG, Burton NW, Janse de Jonge XAK, Skinner TL. Use of oral contraceptives to manipulate menstruation in young, physically active women. Int J Sports Physiol Perform. 2018;13(1):82–7. https://doi.org/10.1123/ijspp.2016-0689 .
doi: 10.1123/ijspp.2016-0689
pubmed: 28459358
Berenson AB, Rahman M. Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. Am J Obstet Gynecol. 2009;200:3. https://doi.org/10.1016/j.ajog.2008.12.052 .
doi: 10.1016/j.ajog.2008.12.052
Gallo MF, Grimes DA, Schulz KF, Helmerhorst FM. Combination estrogen-progestin contraceptives and body weight: systematic review of randomized controlled trials. Obstet Gynecol. 2004;103:2. https://doi.org/10.1097/01.AOG.0000107298.29343.6a .
doi: 10.1097/01.AOG.0000107298.29343.6a
Lindh I, Ellström AA, Milsom I. The long-term influence of combined oral contraceptives on body weight. Hum Reprod. 2011;26:7. https://doi.org/10.1093/humrep/der094 .
doi: 10.1093/humrep/der094
Shahnazi M, Khalili AF, Kochaksaraei FR, et al. A comparison of second and third generations combined oral contraceptive pills’ effect on mood. Iran Red Crescent Med J. 2014;16:8. https://doi.org/10.5812/ircmj.13628 .
doi: 10.5812/ircmj.13628
Costescu D, Chawla R, Hughes R, Teal S, Merz M. Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review. BMC Womens Health. 2022;22:1. https://doi.org/10.1186/s12905-022-01657-6 .
doi: 10.1186/s12905-022-01657-6
Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79:5. https://doi.org/10.1016/j.contraception.2008.11.012 .
doi: 10.1016/j.contraception.2008.11.012
Hassan DF, Petta CA, Aldrighi JM, Bahamondes L, Perrotti M. Weight variation in a cohort of women using copper IUD for contraception. Contraception. 2003;68:1. https://doi.org/10.1016/S0010-7824(03)00079-9 .
doi: 10.1016/S0010-7824(03)00079-9
Albright M, Rani S, Gavagan T. HelpDesk answers: do hormonal contraceptives lead to weight gain? J Fam Pract. 2015;64:6.
Kaunitz AM, Miller PD, Rice VM, Ross D, McClung MR. Bone mineral density in women aged 25–35 years receiving depot medroxyprogesterone acetate: recovery following discontinuation. Contraception. 2006;74:2. https://doi.org/10.1016/j.contraception.2006.03.010 .
doi: 10.1016/j.contraception.2006.03.010
Sherry E, Rowe K. developing sport for women and girls. 1st ed. Routledge; 2020 https://doi.org/10.4324/9780367854201
Graham LC, Blackett AD. ‘Coach, or female coach? And does it matter?’: An autoethnography of playing the gendered game over a twenty-year elite swim coaching career. Qual Res Sport Exerc Health. 2022;14:5. https://doi.org/10.1080/2159676X.2021.1969998 .
doi: 10.1080/2159676X.2021.1969998
McMillan SS, Kendall E, Sav A, et al. Patient-centered approaches to health care: a systematic review of randomized controlled trials. Med Care Res Rev. 2013;70(6):567–96. https://doi.org/10.1177/1077558713496318 .
doi: 10.1177/1077558713496318
pubmed: 23894060
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–97. https://doi.org/10.1136/bjsports-2023-106994 .
doi: 10.1136/bjsports-2023-106994
pubmed: 37752011
Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52:11. https://doi.org/10.1136/bjsports-2018-099193 .
doi: 10.1136/bjsports-2018-099193
Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: Beyond the female athlete triad-relative energy deficiency in sport (RED-S). Br J Sports Med. 2014;48:7. https://doi.org/10.1136/bjsports-2014-093502 .
doi: 10.1136/bjsports-2014-093502
Ackerman KE, Singhal V, Baskaran C, et al. Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial. Br J Sports Med. 2019;53:4. https://doi.org/10.1136/bjsports-2018-099723 .
doi: 10.1136/bjsports-2018-099723