REF-574 · Martin, Sale, Cooper & Elliott-Sale, 2018 · International Journal of Sports Physiology and Performance, · Paper · PubMed
~Half of elite female athletes use hormonal contraception; progestin-only methods (esp. the implant) draw the most perceived side effects, with large individual variability
Protocol
Cross-sectional questionnaire study: 430 elite female athletes (from the abstract)
The questionnaire covered period prevalence of hormonal contraceptive (HC) use, reasons for starting and stopping HCs, and side effects experienced by HC users and non-users
Analysis: descriptive statistics, between-group comparisons and associations between categorical variables
Key Findings
Of 430 elite female athletes: 49.5% current HC users, 69.8% ever-users. Combined pills most common (68.1% of users); progestin-only ~30% (implant 13.1%, injection 3.7%, IUS 2.8%).
Perceived negative side effects were method-dependent: 39.1% of progestin-only vs 17.8% of combined-HC users (P=.001), highest in implant users (53.6%; P=.004).
Non-HC users: mean cycle 29 d; 77.4% reported cycle-related negative symptoms, mostly days 1–2.
Practical Application
Treat "hormonal contraception" as many different drugs, not one — the *type* (combined pill vs progestin implant/injection/IUS) matters far more for tolerability than "on birth control."
If an athlete reports mood/bleeding/well-being changes after a progestin-only method (esp. the implant), take it seriously and encourage a physician discussion — don't dismiss it.
Keep an open, ongoing dialogue; let her track symptoms; don't prescribe or steer contraceptive choice yourself.
Limitations
Self-reported *perceived* side effects (recall/attribution bias); elite cohort; cross-sectional — no causal/performance outcomes.
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How this entry was checked and changed
Content correction 2026-09-27
2026-09-28: added Protocol from the abstract (Europe PMC/PubMed PMID 29283683).