Prevalence and Self-Perceived Experiences With the Use of Hormonal Contraceptives Among Competitive Female Cross-Country Skiers and Biathletes in Norway: The FENDURA Project

Abstract

Purpose: To investigate the prevalence of hormonal contraceptive (HC) use by female cross-country (XC) skiers and biathletes competing at a national and/or international level, their reasons for HC use, and to compare negative symptoms related to the HC-/menstrual cycle in HC users and non-HC users. Additionally, to characterize the self-perceived influence of HC use on training and performance.

Methods: A total of 113 Norwegian competitive XC skiers and biathletes completed an online questionnaire including both closed and open-ended questions. The questions were designed to assess the type of HC, reasons for use, self-reported negative symptoms related to HC-/menstrual cycle, as well as athletes' experiences regarding how HC use affects training and performance.

Results: In total, 68% of all the athletes used HC, with 64 and 36% of them using a progestin-only and combined type HC, respectively. Non-contraceptive reasons for HC use were reported by 51% of the progestin-only HC users vs. 75% of the combined HC users (P = 0.039), with reduction of negative menstrual-related symptoms as the most common reason. Of the athletes reporting regular withdrawal bleedings in connection to HC use, 80% of the progestin-only and 86% of combined HC users experienced negative menstrual-related symptoms, which was comparable to the non-HC group (86%). The majority (81%) of HC users experienced solely positive, or no effect, of HC use on training and performance, with no differences between progestin-only and combined HC users (P = 0.942).

Conclusions: In total, 68% of the XC skiers and biathletes used HC, with the highest proportion (64%) using a progestin-only HC. Many athletes used HC to manipulate their menstrual cycle due to perceived negative menstrual-related symptoms that interfered with their training sessions and/or competitions.

Keywords: combined hormonal contraceptives; endurance; female athletes; hormonal contraceptives; progestin-only hormonal contraceptives.

Figure 1

The prevalence of type, delivery methods, and preparations of hormonal contraceptives (HCs) used. Concentration of synthetic hormones in the different delivery methods: Mini-pills, 75 μg Desogestrel; Implants, ~40 μg Etonogestrel in 24 h over 3 y; Intrauterine devices (IUSs), 6–15 μg Levonorgestrel in 24 h over 3–6 y; Oral contraceptives (OCs), * 20–30 μg Ethinyl estradiol (EE) and 100–150 μg Levonorgestrel, **35 μg EE and 2,000 μg Cyproterone acetate, ***30 μg EE and 150 μg Desogestrel, ****35 μg EE and 500–1,000 μg Noretisterone; Transdermal patch, 33.9 μg EE and 203 μg Norelgestromin in 24 h.