Jane S. Thornton

The purpose of this review was to summarize existing information and identify critical research gaps around pregnancy and the postpartum period in elite endurance athletes. Current literature is primarily exploratory and lacks high-level evidence. We anticipate that continued research will help in identifying the best support mechanisms to offset setbacks associated with pregnancy and postpartum recovery in elite female athletes.

Background: While there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport. Objectives: Study objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes. Methods: This was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively. Results: A total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport. Conclusions: This exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.