Should climbers take oral contraceptives?

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Let’s get down to business: For many girls and women, working out or performing on their period sucks.

Menstruation can affect your weight, mood and performance. When symptoms appear on game day, they are usually undesirable. Many female athletes have used hormonal birth control pills for decades to alleviate these symptoms and even avoid otherwise unfortunate timing. Contraceptives can relieve cramps, regulate and lighten periods, and even clear skin.

But the introduction of foreign hormones into the body can be troubling for a variety of reasons. For an athlete, the effects of estrogen go well beyond developing breasts and regulating a monthly cycle. Estrogen can affect overall performance by affecting recovery, injury rates, and strength.

Looking for information on whether estrogen supplementation is good or bad for athletes Climbers in the gym interviewed Keith Baar, Ph.D., Professor of Physiology and Behavior at UC Davis and renowned expert on tendon health. Baar has published 168 articles with a total of nearly 8,000 citations over the course of his career. One of his studies, published in early 2019 in limits in physiology, went straight to the role of hormonal contraception and athletic development.

in the Effect of estrogen on musculoskeletal performance and risk of injury, Baar and Nkechinyere Chidi-Ogbolu, a Ph.D. Student at UC Davis, discussed the role estrogen plays in muscle, tendon and ligament development and thus in athletic development and performance. The simple answer: It’s complicated.

estrogen and muscle

Based on animal and human studies of aging, estrogen is decidedly beneficial for building muscle mass and strength. For example at one Study 2016 published in Journal of Endocrinology, Ovariectomized rats showed a 10 percent decrease in strength and an 18 percent decrease in muscle fiber cross-sectional area (the cross-sectional area of ​​muscle fibers is proportional to the force a muscle can generate) after just 24 weeks. Similar studies (for example one published in the Journal of Applied Physiology) have also shown an increase in injured muscle fibers in ovariectomized rats. When ovariectomized rats were supplemented with estradiol, a form of estrogen, their muscle fiber cross-sectional area and recovery rate normalized. In other words, a lack of estrogen resulted in muscle loss and strength, while restoring estrogen levels (via supplementation similar to oral contraception) returned muscle area and strength to previous levels.

Postmenopausal women, who have lower estrogen levels after a missed period, have been shown to lose muscle at a much faster rate than their male counterparts. in one Study 2012 Published in The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, Postmenopausal women received estrogen replacement therapy to raise their estrogen levels to those of premenopausal women and the result was a normalized anabolic or muscle building response. In other words, giving postmenopausal women estrogen helped them build muscle at the same rate as their younger, premenopausal counterparts.

in the another study Published in clinical science, 80 postmenopausal women were assigned to one of four groups: exercise, hormone replacement therapy, exercise and hormone replacement therapy, or no treatment, all followed for one year. The group that did both exercise and hormone replacement therapy saw the greatest increase (7.1 percent) in muscle cross-sectional area and a 17.2 percent increase in vertical jump (the highest point reached by a standing jump). The hormone replacement group saw similar, albeit smaller, increases in muscle area (6.3 percent) and vertical jump (6.8 percent). Notably, exercise alone was less effective than hormone replacement therapy alone at preserving muscle mass.

Birth control pills contain synthetic forms of the naturally occurring hormones estrogen and progesterone. While estrogen can increase the anabolic (muscle building) response, it’s also clear that progesterone has a negative impact. A Study 2011 published in Scandinavian Journal of Medicine and Science in SportsScientists compared formulations of oral contraceptives and found that a contraceptive high in progesterone, in contrast, inhibited muscle protein synthesis. Athletes who choose oral contraception should choose high-estrogen, low-progesterone contraceptives.

Given that estrogen helps athletes build muscle, what are the practical implications? Think of a woman’s natural estrogen cycle as a series of highs and lows. Insert the pill and the line flattens out – fewer highs and the lows only occur during menstruation. This flattening tends to negatively impact healthy women trying to build muscle because it reduces physiologically high estrogen spikes. It follows that healthy women trying to build muscle should not take hormonal birth control pills as it will inhibit their ability to do so.

estrogen and ligaments

However, estrogen also affects tendons and ligaments, complicating the simple conclusion that hormonal birth control is bad for athletes. Estrogen has been shown to loosen the ligaments. That partly explains why women are two to eight times more likely tearing their ACLs than their male counterparts. Lax ligaments mean loose joints that can expose athletes to serious injury.

Rahr-Wagner and his colleagues found that women who had never used oral contraceptives had a 20 percent greater relative risk of ACL injury than long-term users. Because women’s estrogen levels are highest during the pre-ovulatory and ovulatory phases of their cycle, female athletes who do not use oral contraceptives are at greater risk at these times than those who do, and thus may need to exercise more caution in training routines these phases.

So oral contraceptives are bad for building muscle but good for protecting the ligaments by keeping the joints tighter.

estrogen and tendons

While studies suggest that estrogen loosens ligaments, estrogen has a similar effect on tendons that can be both good and bad. A stiff tendon will pull the muscle faster, allowing the athlete to achieve better peak performance. A stiff tendon is also more likely to pull or tear a muscle.

Due to naturally occurring estrogen spikes, women’s tendons are generally looser than men’s, and as a result, women suffer fewer muscle injuries, strains, and groin and thigh strains. Women also have a lower risk of Achilles tendon ruptures – that is, until menopause. Likewise A Study 2015 published in European Journal of Applied Physiologyshowed that oral contraceptives (ie, women with no estrogen levels) were associated with greater muscle damage and soreness, and a Study 2006Published in Foot and Ankle International, showed an increased risk of Achilles tendinitis when using oral contraceptives.

It follows that oral contraceptive users may be able to generate higher peak force than their peers, but they will also have less recovery time and be at greater risk of muscle and tendon damage.

The formula

So what is a woman supposed to do?

Baar and Chidi-Ogbolu summarized it in this strategy: According to their recommendation, a woman in a training and off-season phase is better off avoiding oral contraceptives because the body’s high levels of estrogen generally allow athletes to build muscle to recover quickly and to be less prone to tendinopathy. However, when an athlete is in game season, taking oral contraceptives can be beneficial. Lower estrogen levels can increase strength as the tendons become stiffer. The athlete may not need to recover as quickly as they would normally like as they are likely to have more time between comps or send gos. She also may not need to build muscle—just maintain it. The oral contraceptives can also help protect their ligaments from injury during competition.

But to add to the complexity, every woman is different and responds differently to oral contraceptives. This formula is a good place to start, but it’s not a formula for everyone. Climbers must experiment with their own formulas and training programs under the guidance of their healthcare professionals to find what works best for them.

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