The Pill and Performance in Sport
By Frank Horwill
In 1985, in South Africa, Van Gend and Noakes canvassed the female entrants who took part in the 1983 Two Oceans Marathon, about their menstrual histories. An astonishing 92% who participated in that event responded to their survey. This revealed that of the 108 runners who replied, 38 were on the pill, pregnant or were non-menstruating. Sportswomen use the pill for one or more reasons:
- To avoid pregnancy.
- To control menstruation if it is known that performance is affected during the menstrual cycle, or if a major competition is likely to occur while menstruating. This requires the athlete to establish the menstrual cycle length and to monitor training and competition performance during the different phases of the menstrual cycle by the careful use of a training diary.
However, sexually active runners are less likely to use oral contraceptives than are non-runners. Two separate studies in 1982 and 1983, highlighted the fact that runners make far greater use of diaphragms for birth control. The first study, noted 37-44% used diaphragms against the national average of 3%. In the second study, only 6-13% of runners used oral contraceptives, while the national average was 44%.
There is one very good reason why most female runners do not use the pill: it is associated with weight gain. This may not be too detrimental to sprinters (100m to 400m), but it is an anathema to distance runners. Most world-class distance runners are from 10 to 20% lighter for their height than non active females. While a healthy female who is 5 ft 6 inches/1.67cm tall and weights 130lbs/59kg, will be content with this, a top class runner will be thinking of 47kg to 53kg. However, this reduced weight leads to other complications, the total cessation of the period. One Commonwealth Games gold medallist many years ago went two years with such a situation, and was not unduly worried. As this condition is strongly associated with osteoporosis (declining calcium in the bones), she was put on a high-calcium food diet, together with nuts and fruit, pineapple juice and vitamin D. Her consumption of coffee (caffeine), sodium and alcohol was banned. The obscure mineral boron, found in fruit and nuts, has the power to reduce calcium loss in bones by up to 40%. Pineapple juice is a rich source of manganese. This mineral has been found to be one-third less than normal in women suffering from osteoporosis. Coffee, salt and alcohol undermine the calcium status of bones further in a non menstruating female.
There are two approaches to be considered with regard to the non birth-control use of the pill. There is not much point training for four years for an Olympic event if it is known that the Olympic Trials occur at a tedious time of the month, and the sportswoman will not be at her best. Optimum sporting performance occurs either during the immediate pre-ovulatory stage (days 9-12) or during the early luteal days (days 17-20) of the cycle. Thus the aim will be to have the major events coincide with the middle of the cycle. To achieve this the sportswoman may take either oestrogen or progesterone in high dose for varying periods of time. When this is stopped a withdrawal period is induced, and has the effect of shortening one or more previous cycles, so that when the medication is no longer being taken, the competition will fall in mid-cycle. If the cycle needs to shorten by a few days, either of the drugs mentioned need to be taken for two to three days near the end of the luteal phase. If the cycle has to be shortened by up to 12 days, the drugs should be given from day 5 to day 14 of the cycle. A withdrawal period will then occur on day 16. If the above is not pursued, and an unwelcome period is likely on the day of competition, this can be delayed by the high intake of progesterone via a suppository.
Where a sportswoman is expected to compete at a high level almost weekly, and it is known that performance is affected by menstruation, this may be completely suppressed for a few months. Different combinations of oestrogen, progesterone and progestogen may be used with the dose lowered at monthly intervals compatible with complete cessation.
Regular users of the pill for birth-control and sporting purposes, should be aware of the long-term known results:
- Some oral contraceptives decrease blood HDL-cholesterol levels. As HIGH HDL-cholesterol levels are associated with a reduced incidence of coronary heart disease, anything that reduces blood HDL-cholesterol levels is bad. The good news is that regular exercise raises HDL levels. But, a prolonged spell of inactivity caused by injury calls for a change of exercise where the injury is not involved.
- Some women on the Pill are known to have impaired blood sugar control, which can be improved by taking vitamin B6. A high sugar diet does not help this condition, nor excessive tea, coffee and alcohol consumption.
- There is some evidence to suggest that the Pill interferes with vitamin B1 metabolism. Deficiency symptoms include: Memory loss, numbness and tingling in the hands and feet, slow reaction times, personality changes and poor sleep patterns. A good test is to press the calf with your thumb. The white indentation made in the muscle should disappear in ten seconds.
- Numerous reports confirm that women on the Pill for more than three years become deficient in vitamin B2. Deficiency symptoms are: sore lips and tongue, cracking and peeling of the lips, red, greasy and scaly skin at the sides of the nose.
- The Pill adversely influences vitamin B12, but without producing anaemia. Deficiency symptoms include: Depression, clumsiness, especially walking at night in the dark.
- The Pill may interfere with blood cell formation by altering folic acid and B12 metabolism. The main deficiency symptom will be exhaustion from simple tasks, such as climbing stairs. Training performance will decline.
- Vitamin C requirements are increased when on the Pill.
- The minerals copper, zinc, iron and magnesium, are known to fluctuate while on the Pill. Nuts are a good food source for the first two and fourth, and cocoa and organ meats for the third (iron).
All the above strongly suggests that sportswomen on the Pill should take a combined multi-vitamin and multi-mineral capsule.
Those sportswomen who battle on competing during various stages of their menstrual cycle and regard "the curse" as part of the difficulties to overcome to become a champion, are greatly to be admired. The former national middle-distance coach of the Soviet Union, Suslov, stated that women were encouraged to train and compete during all the hormonal changes experienced.
In 1994, new research suggested that the female sportswoman could take active nutritional measures to alleviate the following:
Pre Menstrual Syndrome (PMS)
Eat more carbohydrates. Particularly bread, potatoes, pasta, oats and rice, taken in small amounts every three hours and one hour before sleep. Avoid coffee.
Drink a pint of milk a day just before and during the period. Also, take on board more green vegetables with meals. This will double the average calcium intake of 600mg daily. Increase tea consumption, it contains manganese, also consume more pineapple juice. Manganese is now known to reduce heavy menstrual losses.