Health Myths of the Female Athlete | Myth 2
By Elissa Rosen, MD, CEDS
The following is the second installment of a four-part series on the Health Myths of the Female Athlete
Myth 2: Oral contraceptive pills (OCPs) can be used to maintain bone health in athletes with amenorrhea and should be used to “jump start” periods.
Truth: It seems logical that if the low estrogen found in those with amenorrhea is part of the reason why bone density decreases then if we give an athlete hormone pills with estrogen then the bones would be protected. Unfortunately, while this would be the easiest solution, the reality is that science has not found this to be true. OCPs are metabolized in the liver and in doing so likely rendered much less effective in providing bone protection. In addition, the dose of estrogen in OCPs, even the lowest doses on the market, is above the normal level of estrogen found in a regularly menstruating female, which also contributes to it being less effective in protecting the bones.
There is some exciting news to share on the latest research on the use of hormones in protecting the bones of athletes. A brand new study out of Harvard’s Boston Children’s Hospital found that in younger endurance athletes (ages 14-25) with irregular periods, the use of an estrogen patch mixed with a progesterone pill actually increased bone density over a 12 month time period. (3) The estrogen patch used in the study is believed to be more effective than a pill not only because it avoids being processed in the liver, but the dose given in the patch was roughly equivalent to a female’s normal physiologic estrogen level. This is certainly exciting evidence that medical professionals can utilize to protect the bones of an athlete with amenorrhea while the athlete is working with a team of providers to treat and resolve the amenorrhea.
As far as “jump starting” a period with OCPs, this scientifically makes no sense. In fact, birth control does nothing to make a person have a natural menstrual cycle. Most cyclic OCPs will provide varying amounts of estrogen and progesterone during the first 3 weeks of active pills. During the subsequent placebo pill week, withdrawal bleeding will occur. This is not due to your own body’s hormone production, but thanks to the effects of the withdrawal of the hormones in the active pills. The bottom line is that OCPs function to prevent ovulation (among other things) so that pregnancy does not occur, so they are not jump starting your own natural ability to ovulate and menstruate.
3. Ackerman KE, Singhal V, Baskaran C, Slattery M, Campoverde Reyes KJ, Toth A, Eddy KT, Bouxsein ML, Lee H, Klibanski A, Misra M. Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial. Br J Sports Med. 2018 Oct 9. pii: bjsports-2018-099723. doi: 10.1136/bjsports-2018-099723. [Epub ahead of print] PubMed PMID: 30301734.