MENSTRUAL CYCLE, CONTRACEPTION, AND PERFORMANCE

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Women have made tremendous advances in the sporting arena. Progressive legislation for equality in organized sports and changing societal and cultural views have led to women participating in sports in unprecedented numbers. Women are not only competing in sports previously played by men only, such as ice hockey and rugby, but they also are encroaching on performance standards set by men. As of 1999, the difference between the men's and women's 100-meter world record times, 9.84 and 10.49 seconds, respectively, is a mere 6.6%. Women respond to physical training as do men: they have decreased blood pressure and heart rate, a reduced percentage of body fat, and increased maximal aerobic capacity. Physiologic differences between male and female athletes are minimized by correcting for lean body mass. The gender differences that do exist start to manifest after puberty, when the male and female sex steroids exert their influence on anatomic structures and metabolic processes.

Women must deal with fluctuating levels of hormones throughout their lives from puberty to menopause. During their reproductive years, they generally are exposed to a predictable pattern of endogenous hormones during regular ovulatory menstrual cycles, or they may be exposed to exogenous hormones by taking oral contraceptive (OC) pills that regulate their cycles for them. To what extent normal menstrual function and OC control of menstrual function affect athletic performance is less clear. This article discusses this complex and intriguing question, and also briefly reviews normal menstrual physiology and the actions of the sex steroids estrogen, and progesterone.

Section snippets

Review of Normal Menstrual Physiology

There is a well-defined, predictable pattern of hormonal changes that occur throughout the menstrual cycle. An average menstrual cycle lasts 28 days but may range from 20 to 45 days. The changes in the female sex steroids that modulate the endocrine events during the menstrual cycle can be divided into two phases. The follicular phase starts with menses and ends with ovulation. During the early follicular phase, both estrogen and progesterone levels are low. Prior to ovulation, there is a

MENSTRUAL CYCLE AND ATHLETIC PERFORMANCE

The cyclical endogenous hormonal variations throughout the menstrual cycle affect numerous metabolic, thermoregulatory, cardiovascular, and respiratory parameters that can alter athletic performance. Although physical fitness often is measured in terms of aerobic fitness, anaerobic fitness, muscle strength, flexibility, and body fat percentage, athletic performance itself is more complex. Neuromuscular, sensorimotor, psychomotor, and cognitive functions also are believed to influence

ORAL CONTRACEPTIVES

Women often require contraception during the reproductive years; however, there is no recent prevalence data on OC use in female athletes. OCs can now be administered safely to women from the age of 16 or 3 years past menarche21 up until the perimenopausal years in nonsmoking women. Evidence-based guidelines suggest that there are only two prerequisites for safe screening for potential OC users: a careful personal and family medical history with particular attention to cardiovascular risk

SUMMARY

Although understanding of the unique physiology of the female athlete has increased, there are still many questions to be answered. Endogenous and exogenous female sex steroids have been shown to influence various cardiovascular, respiratory, and metabolic parameters, but these changes probably have minimal impact on the ability of most recreational athletes to participate in and enjoy their sport. Statistically significant data may or may not have clinical or performance relevance. By the same

References (116)

  • M. Hartard et al.

    Effects on bone mineral density of low-dosed oral contraceptives compared to and combined with physical activity

    Contraception

    (1997)
  • A.M. Kaunitz

    Long-acting injectable contraception with depot medroxyprogesterone acetate

    Am J Obstet Gynecol

    (1994)
  • C.M. Lebrun

    The effect of the phase of the menstrual cycle and the birth control pill on athletic performance

    Clin Sports Med

    (1994)
  • D.R. Merians et al.

    Relationship of exercise, oral contraceptive use, and body fat to concentrations of plasma lipids and lipoprotein cholesterol in young women

    Am J Med

    (1985)
  • P.B. Miller et al.

    The usefulness of a urinary LH kit for ovulation prediction during menstrual cycles of normal women

    Obstet Gynecol

    (1996)
  • A. Montes et al.

    The effects of oral contraceptives on respiration

    Fertil Steril

    (1983)
  • M. Notelovitz et al.

    The effect of low-dose contraceptives on cardiorespiratory function, coagulation, and lipids in exercising young women: A preliminary report

    Am J Obstet Gynecol

    (1987)
  • F. Polatti et al.

    Bone mass and long-term monophasic oral contraceptive treatment in young women

    Contraception

    (1995)
  • B.W. Posthuma et al.

    Detecting changes in functional ability in women with premenstrual syndrome

    Am J Obstet Gynecol

    (1987)
  • G.M.C. Rosano et al.

    Cyclical variation in paroxysmal supraventricular tachycardia in women

    Lancet

    (1996)
  • P.M. Sarrel

    Ovarian hormones and the circulation

    Maturitas

    (1990)
  • B.B. Sherwin

    Hormones, mood, and cognitive functioning in postmenopausal women

    Obstet Gynecol

    (1996)
  • A. Sita et al.

    Estradiol, progesterone, and cardiovascular response to stress

    Psychoneuroendocrinology

    (1996)
  • S.J. Solomon et al.

    Menstrual cycle and basal metabolic rate in women

    Am J Clin Nutr

    (1982)
  • P. Bale et al.

    Effect of menstruation and contraceptive pill on the performance of physical education students

    Br J Sports Med

    (1983)
  • J.E. Bauman

    Basal body temperature: Unreliable method of ovulation detection

    Fertil Steril

    (1981)
  • D.A. Bemben et al.

    Effects of oral contraceptives on hormonal and metabolic responses during exercise

    Med Sci Sports Exerc

    (1992)
  • D.A. Bemben et al.

    Ventilatory and blood lactate responses to maximal treadmill exercise during the menstrual cycle

    J Sports Med Phys Fitness

    (1995)
  • K.M. Birch et al.

    The effect of eumenorrheic menstrual cycle phase on physiological responses to a repeated lifting task

    Can J Appl Physiol

    (1997)
  • J.T. Bisdee et al.

    Changes in energy expenditure during the menstrual cycle

    Br J Nutr

    (1989)
  • A. Bonen et al.

    Substrate and hormonal responses to exercise in women using oral contraceptives

    J Appl Physiol

    (1991)
  • A. Bonen et al.

    Effects of exercise on serum concentrations of FSH, LH, progesterone, and estradiol

    Eur J Appl Physiol

    (1979)
  • R.W. Bryner et al.

    Effect of low dose oral contraceptives on exercise performance

    Br J Sports Med

    (1996)
  • J.C. Bunt

    Metabolic actions of estradiol: Significance for acute and chronic exercise responses

    Med Sci Sports Exerc

    (1990)
  • A.J. Carpenter et al.

    Endogenous hormones subtly alter women's response to heat stress

    J Appl Physiol

    (1988)
  • M.H. Chandler et al.

    Premenstrual asthma: The effect of estrogen on symptoms, pulmonary function, and β 2-receptors

    Pharmacotherapy

    (1997)
  • P. Collins

    Estrogen and cardiovascular dynamics

    Am J Sports Med

    (1996)
  • P. Collins et al.

    Oestrogen as a calcium channel blocker

    Eur Heart J

    (1996)
  • P. Collins et al.

    Cardiovascular protection by oestrogen: A calcium antagonist effect?

    Cardiovasc Res

    (1995)
  • Committee on Sports Medicine, American Academy of Pediatrics

    Amenorrhea in adolescent athletes

    Pediatrics

    (1989)
  • T. Cundy et al.

    Recovery of bone density in women who stop using medroxyprogesterone acetate

    BMJ

    (1993)
  • T. Cundy et al.

    Bone density in women receiving depot medroxyprogesterone acetate for contraception

    BMJ

    (1991)
  • A. Daggett et al.

    Physiological and biochemical responses to exercise following oral contraceptive use [abstract]

    Med Sci Sports Exerc

    (1983)
  • B.N. Davies et al.

    Variations in performance of simple muscle tests at different phases of the menstrual cycle

    J Sports Med Phys Fitness

    (1991)
  • De SouzaM.J. et al.

    Effects of menstrual cycle phase and amenorrhea on exercise responses in runners

    Med Sci Sports Exerc

    (1990)
  • M.P. Diamond et al.

    Alterations in carbohydrate metabolism as they apply to reproductive endocrinology

    Fertil Steril

    (1988)
  • R. Dibrezzo et al.

    Relationships among strength, endurance, weight, and body fat during three phases of the menstrual cycle

    J Sports Med Phys Fitness

    (1991)
  • M.L. Dombovy et al.

    Exercise performance and ventilatory response in the menstrual cycle

    Med Sci Sports Exerc

    (1987)
  • K. Dutton et al.

    CO2 sensitivity changes during the menstrual cycle

    J Appl Physiol

    (1989)
  • R.G. Eston et al.

    Effects of the menstrual cycle on selected responses to short constant-load exercise

    J Sports Sci

    (1984)
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    Addres reprint requests to: Constance M. Lebrun, MD, FACSM, Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario N6A 3K7, Canada

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