Effective, simple or dangerous? The facts behind the contraceptive pill

Injuries amongst female athletes are  not uncommon, if the reason for this seems to correlate with the usage of contraceptive pills you may want to think twice before using them. An interview with a German track and field athlete sparked a conversation that showed there is disagreement amongst athletes over the effects of the pill.

The contraceptive pill has become the number one contraceptive in Germany since it launched onto the market in the 1960’s, it is widely considered as an uncomplicated and effective drug for the prevention of unwanted pregnancies.

However there is disagreement about just how good the pill actually is, the list of critics is long and there are lots of negative reviews on the internet which cause uncertainty. Could the pill be dangerous? What does it mean for athletes?

The facts behind the contraceptive pill by Stefanie Asendorf and Stefanie Michallek

The contraceptive pill is still the most popular method of contraception.
Photo: pixabay.com

Safe, simple and effective – this promise promotes birth control pills and ensures that it enjoys great popularity worldwide. Since it’s creation it is considered a symbol of female self-determination and millions of users take it on a daily basis. According to the Federal centre for health education about 55% of women in Germany are taking the pill. Even among the young generations the oral contraceptive is incredibly popular.

However the reasons for taking the pill differ greatly between ages, the actual goal of the pill specifically relief of pain and ensuring safe contraception often take a back seat amongst the younger girls and they are seduced by alleged side effects such as nicer hair, cleaner skin and a larger bust size.These hopes are typically completely false although this remains unclear to many teenagers.

Teenagers regard the pill more as a life style product rather than as a drug that has many potential side effects, however carelessly taking the drug can produce serious consequences and it is high time that we got to the bottom of the pill.

The pills and how they work

The contraceptive pill which has been approved in the US since 1960 and in Germany since 1961 is considered a safe and effective contraceptive with a Pearl index of 0.1 to 0.4. (INFOKASTEN: Der Pearl-Index gibt an, wie viel Prozent derFrauen, die genau ein Jahr lang mit diesem Mittel verhütet haben, schwangerwerden. Je kleiner die Zahl ist, desto sicherer ist das Verhütungsmittel.) 

However there is not just one pill, rather there are several different formulas with different active ingredients and concentrations that are on the market. There is a distinction between combination preparations and the so-called mini-pill.

Combination preparations trim the cycle to a 28 day rhythm and suppress monthly ovulation, in addition they thicken the mucus at the entrance of the uterus so that sperm cannot penetrate and survive in the uterine lining. Combi-pills contain both estrogen and progestin and can be divided into single and multi-phase pills. The individual phases differ in the level of hormone dosage within the monthly cycle.

 The alternative, mini pills, on the other hand are pure gestagen pills with the active ingredient levonorgestrel. Although they are unable to completelyprevent ovulation they cause changes in the lining of the womb so that sperm is unable to pass and a fertilized egg cannot take hold. Only a drug which has a higher dose of progestin desogestrel prevents ovulation. The mini-pill is especially suitable for breast feeding women that cannot tolerate estrogen. (INFOKASTEN: WAS IST GESTAGEN UND WAS IST ÖSTROGEN?)

When taken regularly and correctly the contraceptive pill promises almost 100% protection against unwanted pregnancy and it is effective immediately. The convenience and ease of use is one reason why birth control pills remain at the top of the market for contraceptives. Furthermore it promises a good cycle control as the pill trims it into an always steady rhythm.

The benefits of the pill

The bleeding that occurs during the scheduled break from the pill is in most cases weaker and shorter than it would be without being on the pill, it can also alleviate potential pelvic spasms.

Many athletes also use the pill to prevent cycle-related discomfort and potential performance fluctuations. Additionaly they are able to bring forwards their bleeding or postpone it by using the pill. This is very useful in competitions as it allows the unfavourable physical effects of the menstrual phase to be experienced at the most opportune time.

In most cases taking the oral contraceptive pill improves the appearance of many women, especially in girls and young women as there is often a hormonal imbalance in the body whilst female and male sex hormones are being formed. Due to an elevated level of male sex hormones in the body blemishes often develop and by taking female hormones which are found in the pill the hormone balance can be restored.

Potential Side Effects

Even if the contraceptive pill has given the women a new sense of life and new freedoms it should nevertheless be treated with caution and should never be taken as a recreational drug. Anyone who reads the leaflets on the pill will come across a whole series of potential side effects.

You may experience nausea and vomiting but more seriously you may also be at increased risk of thrombosis,strokes, heart attacks, pulmonary artery emoblism, jaundice, increased body weight, decrease in libidio, headache, chest tightness, mood swings and liver damage.

The risk of thrombosis has been frequently discussed in recent years and investigated in several studies. The report on the pill by the Techniker Krankenkasse, for example, comes to the conclusion that contraceptives of the 3rd and 4th generation (ex newer pills)have a significantly higher risk of thrombosis compared to their predecessors.

(INFOKASTEN: Pillen-Generationen und ihre Unterschiede)

Nevertheless the report showed that between 2011 and 2013 most women switched from a „known low risk drug to a higher or unclear risk drug“. Even the 20 year old Lina Decker (name changed by editor) has been taking one of the newer drugs for the last five years.

At the time of switching she was not informed about the possible side effects and the higher risk of thrombosis, „my doctor only made me aware in the conversation that despite taking the pill, there is alow risk of pregnancy. She also said that the pill will help well with pimples,“ Lina Decker is not an isolated case, many young girls confirm that their discussions with gynecologists only lasted a few minutes and they merely referred to the benefits of the pill. The side effects were only available to read on the leaflet.

Effects of the pill on athletes

Although much is already known about the effects of the pill and some studies on individual side effects have been published we do not know everything about the contraceptive. For example what has so far been underestimated and insufficiently discussed in previous studies are the effects of the pill on female athletes.

A study by scientists from Texas A&M University and the University of Pittsburgh from 2009 suggests that the possible consequences could be far more extensive than previously estimated.

In the study 73 women, aged 18 to 31, were divided into two groups and required 10 weeks of full-body strengh training. The first group consisted of 34 women who took the contraceptive pill and 39 that did not, in addition all the women had to eat daily at least 0.5 grams of protein per kilogram of body weight to promote muscle growth.

The participants trained three times a week and blood tests were carried out before and after training to measure anabolicand catabolic hormone levels. (Infokasten: anabol bezeichnet die muskelaufbauende Vorgänge,katabol die muskelabbauenden.)

The researchers concluded that muscle growth in women taking the pill was 60% less than in women who were not taking the pill. Further to this increased levels of cortisol were found in the blood of the first group. Cortisol is a stress hormone that is formed in the adrenal cortex and has negative effects on muscle development. It releases glucose and amino acids from the muscles in order to provide more energy to the body however as a result it reduces muscle mass.

In studies carried out at the Institute of Sports Medicine in Copenhagen in 2011 (https://www.ncbi.nlm.nih.gov/pubmed/19883384) further possible effects of the pill on muscle mass were noted.

In the study 23 women performed kick exercises,eleven of them took a combined preparation of ethinyl estradiol during this time. (INFOKASTEN: ETHINYLESTRADIOL)

The next day, the myofibrillar protein synthesisrate (MPS) was measured. Myofibrils are part of the skeletal muscle and form the muscle fibers. In protein synthesis, new proteins are formed in the cells,in this specific case proteins in muscles. The scientists concluded that the contraceptive pill had a negative effect on the synthesis of tendon and muscle collagen.

 (INFOKASTEN: Kollagen ist entscheidend für die Stabilität von Sehnen – diese sind die Verbindung zwischen Muskel und Knochen und setzen somit die Kontraktion von Muskeln erst in tatsächliche Bewegung um.)

The reduce collagen levels reduce the flexibility of the musculoskeletal system against resistance training(weight training). This also increases the risk of injury during sports as well as potentially slowing down the healing process after sports related injuries.

It has also been found that taking the contraceptive pill reduces the formation of myofibrillar protein,myofibrillar protein are directly linked to muscle power and the less protein there is the less muscle power there is. (INFOKASTENDANN AN DIESER STELLE, DAMIT DOPPLUNG NICHT SO AUFFÄLLT: Myofibrillen sindFunktionseinheiten der Muskelzelle, die dieser eine aktive Verkürzung(Kontraktion) ermöglichen. Der Muskel kann sich also Ziehen und eine Bewegungausführen.)

In a conversation with a Berlin athlete who wants to remain anonymous it came out that she already suffered from similar side effects, as found in the studies, of the contraceptive pill.In 2015 she broke her ankle inexplicably, an injury that according to the athlete very rarely occurs in her discipline.

Her doctor finally concluded that the cause of the injury was the pill, the young athlete had only been taking it for a year. Additionaly she felt „I was not sprinting enough during training,was quite often tired, the training was incredibly difficult and I struggled to concentrate“. In addition there was a high level of water retention, which led inevitably to a reduction in training. In 2016 she suffered another injury, a muscle tear in her thigh, since it takes some time for the pill to be properly broken down by the body this injury could also be related to the pill.

Lack of meaningful studies

Since 2009 there have been no known further studies that deal with the potential side effects on the bones and muscles of healthy athletes, there have only been studies that examine the effects on already diseased athletes. One study looked at the positive and negative effects of the contraceptive pill on athletes that suffered with amenorrhea.

Amenorrhoe is the absence of menstruation and is one of the most common menstrual disorders. This is associated with potential consequences such as bone loss, osteoporosis and disorders of cognitive abilities. When the study came to the conclusion that there was further bone loss or even improvements in bone density after taking the pill it was not clear to what extent amenorrhea had caused this.

In an article called „Obstacles in the optimisation of bone 2011 Women’s Health Outcomes“ the Female Athlete Triadstates that many physicians refrained from treatment due to too few studies and a lack of information on how hormone preparations affected the muscles and bones of athletes.

In addition it is shown that opinions on hormone intake and possible side effects diverge widely, this is also down to the lack of information available.

Further reading

It has become clear that more needs to be done in the field of hormonal contraceptive research and education, many doctors and experts either do not want to comment on the potential side effects or do not want to be named. The fear of spreading misinformation and it’s potential consequences is too great a risk to take.

Even affected athletes want to remain unrecognised and no tbe publicly associated with the topic, shame may play a role due to it being such a sensitive topic and there may be a risk of being portrayed once again as the weaker sex.

Additionaly there may be a fear of attracting attention from sponsors should the issue be raised publicly, after all competitive athlete strain long and hard in order to get close to achieving their dreams. They push their limits because only the best of the best make the breakthrough and inmost cases it is often down to the help of their sponsors.

When sponsors realize that athletes that they may potentially support are struggling with performance limiting issues they may reconsider their investment, to risk this requires a lot of courage especially when the potential side effects of the pill are yet to be proven.

There is a lack of current long-term studies that show the exact effects on the female body, those taking the pill should know what the potential consequences are not only after a few weeks or months but also after several decades.

Particularly young people should not only be told about the benefits of the pill by their gynecologists but should also be shown the risks and alternatives, the side effects of the alternatives of the contraception pill are known in detail, especially if current research shows that the possible side effects of the pill could be risky.

Only after a detailed explanation of all possible positive and negative side effects should women opt for the pregnancy prevention of their choice.