Estrogen, Birth Control, and Women

Mondays are devoted to female topics. 

Women are complicated. If the hormone function of a male is complex, then the function of a female is worse than quantum physics. This isn’t a dig on women; it’s just that biochemistry and endocrinology are incredibly dense and not fully understood, and the nature of the female gender makes it even more opaque. Despite all the things we know about life and the human body, there is a still a lot of unknown.

Biochemistry of the Human Cell: Schematic diagram shows its biochemical/metabolic pathways. Yikes.

 

Prescribing drugs and medications has become the norm in modern “health”. A drug may have an effect on one thing, but undoubtedly fiddles with other biochemistry to produce ill side effects. Drugs can work on neurotransmitters, hormones, or hundreds of other functions like enzymatic processes. When going on or off drugs, it can take several months for the body to normalize into a new ‘concept’ of homeostasis. Remember that the “stress/adaptation” process is constantly occurring, and an adaptive stress is basically “the sub-lethal dose, or lack thereof, of something that is different than the currently adapted homeostasis”.

I trained a kid who had hyperthyroid syndrome. He was prescribed propylthiouracil (PTU) to stop the thyroid from making it’s hormone. It’s pretty toxic to the liver, so his dosage was always being modified by his doctor. When it significantly blunted his thyroid, his strength and body weight gains were impressive. When his dosage went down, his strength and weight suffered. However, it took about six weeks or so for the changes to occur after his dosage was changed; the effect wasn’t immediate. This is an extreme example of the body undergoing a significant change, yet taking time to actually have a response.

This same concept can be applied to female trainees and their prescriptions. The most common drug will be some kind of hormonal birth control AKA “the pill”. There are different types of drugs, but they essentially inhibit ovulation and fertilization. These pills usually consist of estrogen and progestin, which are female hormones. In practice, hormonal birth control seems to have a negative effect on training. 

I’m not going to pretend to know a lot about the exact performance change from a fluctuation of female hormones . In sooth, nobody really does. Yet it’s generally accepted with practitioners that too much estrogen is a bad thing for training females. And when you think about it in simple terms, it makes sense: The female body has adapted to have a certain hormonal fluctuation throughout a month. When that is significantly altered, things will, at the very least, not be as efficient. Gals who take birth control seem to carry more body fat, especially in the hips and legs, aren’t as lean, and seem to make strength gains slower (sleeping problems may be common enough to include here).

Instead of trying to make a definitive statement about birth control and estrogen, I want to do two things. First, here are some resources I found on the internet about this topic.

a) Robb Wolf podcast with Brad Davidson. I listened to this a couple of months ago and Brad works with females, especially figure competitors and helps them clear excessive estrogen out of their system to help them lean out for their shows. Since he trains them in the gym, it has an effect on their gains. I’m simplifying, so listen to the podcast to hear what he has to say about it. There seems to be more than one source talking about a) reducing exposure to estrogens and b) clearing them from the system.

b) Mark’s Daily Apple: Estrogen. Mark’s website is easily my favorite nutrition site. He is a good writer, mixes logic with available research, and is an intelligent hombre. I’m not a perfect writer, but I really appreciate the “good writing” part. I also think Mark is interesting and if I ever chatted with him I’d make fun of his reading choices because JESUS CHRIST THEY ARE BORING. Then we’d do some push-ups on the beach and talk about living until we’re 150 years old (Mark undoubtedly will; I’ll probably get shot before then). Here’s the opening paragraph of this estrogen post:

The human endocrine system exists in a state of delicate balance. None of its constituents function in a vacuum, and trying to explain every hormonal interrelationship would take volumes, but one statement is fairly safe to make: one hormone affects another. Secreting one often inhibits the next, which in turn sets off an entirely different chain reaction of hormonal secretions, inhibitions, and syntheses. I almost feel like trying to micromanage your entire endocrine system is tedious and counterproductive (and probably impossible to do effectively). I much prefer to simply eat rightexercise smartget good sleepnormalize stress, and take advantage of simple lifestyle hacks. Still, it doesn’t hurt to understand some of the major hormonal players, especially one as widely maligned by the strength and fitness community as estrogen.

 

I really don’t need to say anything else; this is exactly what I was going to write for my conclusion.

c) Charles Poloquin on reducing estrogen. Poloquin talks a lot about this topic and he is referenced in the above Robb Wolf podcast episode. The interesting thing in this article is the mention of phytoestrogens. I’ve seen stuff go back and forth on these — saying they are harmful or helpful — but you can see Poloquin’s take on them.

d) Speaking of phytoestrogens, this “Paleo for Women” post may shed some more light on them.  I’ve never read this site, but this post had some good basic information that should help you gals. Then there’s this other article from the same site on estrogen and weight loss. Then there’s this detailed and lengthy post about birth control.

I think it’s kind of hard to get a gauge on phytoestrogens and estrogen supplementation since some sources talk about the benefits (on estrogen) and drawbacks (on phytoestrogens). And then there’s the issue of birth control itself. In actuality, I agree with Mark above: a low inflammatory diet, low stress, good sleep, and exercising regularly are the keys to creating a healthy and optimal homeostasis regardless of gender.

The second thing I want to do is ask all of the female readers if you or anyone you know takes hormonal birth control and how do you think it affects your training.

Note that some women take birth control because their menstruation periods are incredibly awful and painful. Also note that these same women may be unhealthy, do not exercise, sleep poorly, are constantly stressed, and won’t eat a low inflammatory diet that is high in nutrients and protein. I’d be curious to see if this is what you guys see.

Invite your friends to comment on this interesting issue. Please comment on a) strength training gains, b) conditioning gains, c) body composition, and d) any other life factors like sleep or stress. Also note how long it took for you to see a change in your body or body functioning when going on or off the drugs. Maybe we can come to a conclusion that will influence how females structure their training or lifestyle.

 

67 thoughts on “Estrogen, Birth Control, and Women

  1. I will comment, but first I want to criticize the pure emphasis on estrogen level while neglecting any discussion regardine female testosterone levels, which for some women (like me) are slightly elevated (7.2 according to my last blood test).

    So I am a woman who 1) eats a pretty Paleo diet and 2) lifts heavy weights on a regular basis. I used to take a low estrogen pill (to regulate my menstrual cycle, since I have amenorrhea). While I was abroad for 5 months I stopped the pill and have since been off it (almost a full year now). I can’t say I’ve seen any difference in my training or weight or hormones, except the lack of a period. Soooo I’m going back on the pill, but this time one with a higher estrogen count.

    Naturally, worrying about how this might adversely affect my weightlifting, I asked my gynecologist about what they know about weight gains and such with a higher estrogen count. She said the studies that have been done on it seem to conclude that there is no effect at all, really.

    I’ll find out for myself in a few months whether my lifting (and my body) is suffering due to my body’s need to be chemically regulated.

      • I actually tested for elevated testosterone 2 years ago when I was on a (low-estrogen) pill. Since then I have switched from CF to pure weightlifting, and went almost a year without the pill and have seen my testosterone level (Free testosterone, that is) drop…but still stay higher than the norm. Of course, I could just have PCOS.

        Ladies are complicated creatures, indeed.

          • And good point about testosterone. Were/are your elevated numbers due to anything in particular? Unknown I guess? Possibly effected by the low-estrogen you were on?

            I guess I’m asking what the dog thinks.

              • If I knew the answer to any of those things, this would be a lot easier. I just got the final results: 3 out of 3 docs say I definitely have PCOS (hopefully it stops there). So my hormones are all out of whack already (and have been since I first menstruated), so I’m a bad case study for how the pill will/might affect my training.

                As for answering your questions… I”ll try:
                elevated free testosterone is due to who knows what. Overall testosterone levels are normal, just not the free. Always have been high (on or off the pill).

                How/why I have amenorrhea… well this is probably the same reason how/why I have elevated free testosterone (which causes me to not ovulate)… it just means that I go a long time (at least 3 months or more) between menstrual cycles, or in this last case, coming on a year now without anything (ruh roh).

                I think that answers your questions?

  2. Finally! Something informative on this subject. I did a bunch of googling on this subject years ago and never found anything useful.

    I was on a relatively high-dose estrogen pill when I started lifting. I switched to a non-hormonal method because the side effects were awful. (Strangely, a low-dose pill was worse.) When I went off the pill, I lost fat and gained muscle. Everything else improved, too — mood, energy level, etc. So, I think that going off the pill improved my training immensely.

    Some caveats: (i) In this study, n = 1; (ii) I am clearly someone who is very sensitive to slight hormonal changes anyway, so I may be an outlier; (iii) my training could have simply improved because I felt better all around.

    But there’s another wrinkle. For the last few months that I was on the pill, I was on a progestogen-only pill (the “mini-pill”), which contains no estrogen. It was only until I went off the pill altogether that I noticed any improvement in my training. This suggests that *if* the hormones made a direct difference, it was either primarily progestogen or there was about a six-month delay before the change in estrogen levels made any difference.

    Ladeez is complicated.

  3. I have taken birth control since I was in highschool. Not because I needed to regulate my period, but because I like sex. Lots. And I didn’t want to have tons of babies. That would affect my training. I have had two. But these were purposeful times I stopped taking birth control.

    I can tell you, I have always been strong, with an athletic build. Thicker in the middle yes, but that I think is more of a genetic trait then blaming it on estrogen. I am built like my ancestors. I have tiny little calves and no ass and can squat a shit ton, so there goes that idea that lifting weights will make your ass and legs more shapely according to liftbigeatbig.

    I do have Hypothyroidism and when that is outta wack, everything sucks. Sleeping, training, being grumpy and looking lumpy.

    I have been off of birth control now for over a year (had surgery so I won’t have babies) and I haven’t noticed a change. I eat very well and have a high stress job.

      • No online log at the moment. Been dropping weight/improving conditiioning while trying to keep my strength. It has been a bitch.

        Have lost close to 30 lbs, and strength has also taken a huge hit. Working full time/starting grad school/having a 2 year old with number two on the way in early November hasn’t made it any easier…

        I pressed 190 lbs x 3 twice yesterday morning at a bodyweight of 208 lbs.

  4. As you mentioned, most hormonal birth control pills are a combination of estrogen and progesterone. I actually think that progesterone is a bigger problem. I practiced FAM (fertility awareness method) for a while and also had my charts confirmed by blood tests (blood testing estrogen, progesterone, FSH, LH, etc at various points in my cycle) and ovulation test strips. So I believe they are accurate. Most of my PRs occurred around ovulation, where you get a huge surge of estrogen, LH, and FSH. I am generally weaker and slower when progesterone is high. I have more energy in the estrogen-dominant portion of my cycle (follicular phase).

    • Amusing, but seemingly an over generalization. There is an evolution of what embodies a “heart throb” though. Seems like it’d be a lot of factors, mostly societal that influence this.

  5. I’m 29, 5’3″, 133#; married with no kids (a very conscious decision). I’m a firefighter/ paramedic, and a crossfitter with a heavy emphasis on lifting heavy on a regular basis. I’d consider myself lean; I don’t consider myself ripped… Though, I think that I’m stronger than I look. I hate posts about short shorts because I squat my ass off and will never have the beautiful ass and quads to fill them out, though I can hold my own on the loads I am lifting for my weight class. When I’m at work, I don’t get great sleep. When I’m off, I place a large emphasis on quality sleep; I’m usually able to get about 8 and a half hours of hard sleep 5 nights per week. I eat mostly clean (I love dessert); I don’t follow any strict diet (i.e. Paleo or Zone). I’m pretty fascinated by the endocrine system; I think it’s way more complex that we even know… far too advanced to think that we can understand and control it through pharmaceuticals or even nutrition.

    Anyway… I’ve taken several different birth control pills, had the Nuva-ring, the Depo shot, and have finally settled on the IUD. I’ve come to this conclusion for several reasons, most have been touched upon already in the comments. When on the pills, I felt that I had less control of my body composition regardless of activity/activity level, and I had emotional roller-coasters that felt ridiculous. The IUD has the lowest amount of hormonal influence, and it lasts for five years- I don’t have to do anything on a daily basis.

    Regarding training: I have had the IUD for about four years, and have been training seriously for that entire time. I’ve placed higher emphasis on weightlifting for the past two years or so, and have made the gains to be expected with that. It’s hard to say exactly what correlations not being on the pills have had, but as another commenter mentioned, just feeling better in general has to have a positive influence on training. Ultimately, I think surgical intervention would be the best route, as there would be no outside hormonal intervention, but I’m still too young to say “never” on the kiddo factor.

        • Apologies for the personal nature of the question. My partner and I have been turned off this approach (IUD) as we have read that it can affect sex if the guy is well endowed. Has anyone using the IUD had this issue?
          Would love to get the GF off any hormonal anything.

          • The only issue I had was getting the thing put it- it hurt like hell. But, the pain lasted one day. After that, it’s been great. I never have a period; I think that’s a combined effect of the IUD plus activity level and diet… whatever the cause, I’m ok with it. I do feel a bit of the emotional swing about once a month, when I would normally be ovulating, but it’s nothing like the effects of the pill. Haven’t experienced any of the size issues you reference; I don’t think that should be an issue as the IUD is placed behind the cervix.

          • You don’t need to worry about that. As HappyLittleLifter said, the business end of the IUD is placed behind the cervix. There is a small string that passes through the cervix, which your GF and her doctor will use to make sure that the IUD is still in place (and to eventually remove it). Your partner should be able to feel that if she looks around enough. You might be able to feel that immediately after insertion, but within a few days, the string will soften up and wind around the cervix. You’d never be able to feel it after that. If you can, she can have the string trimmed even shorter. And you’re not going to knock it loose, either. Trust me. :)

            I should also say that having it put in was easily the most painful experience of my life. But the severe pain only lasts a few seconds. You might suggest to your girl that she have someone go with her — you, or a girlfriend, whatever she feels comfortable with. It can help to have a meaty 70s Big hand to clamp down on while the doctor is bringing the pain.

            • I think I can feel it sometimes. No joke …

              Though it could be my imagination but it’s like a little fishing line poking your tip (at least that’s the mental picture I get when I feel it while thrusting).

              Just sayin’

              p.s. I still don’t trust any form of BC

              p.p.s. even if it felt like searing hot pokers it’s still better than changing diapers.

          • My bf said he could feel the strings at first, but he hasn’t complained about them in months now. Either they have moved aside, or he’s gotten used to it. As Caleb said below, it’s still better than diapers :)

  6. I’ve got a similar hx to MrsConnery, been on pill since high school, eat pretty paleo, lift weights routinely, rock climb more routinely, some cardio. I used to take a low estrogen pill to regulate my menstrual cycle, since I have amenorrhea, horrific cramps, and violent nausea. My doc’s over the years have tried me on a variety of meds and my weight has fluxed pretty dramatically with each trial. The lower the estrogen, the reduced excess weight, H20 or otherwise. Sleep has been an issue for as long as I can remember, avg stress. Truthfully, I find it interesting that doc’s say that there isn’t a correlation, because there’s plenty of research to show otherwise. I too took a couple years off and was put back on. Bottom line though is that each person’s body has different chemistry and will respond to different drugs differently. One BC will effect me entirely different that another women. And yes, our eating and sleep patterns all play a role in it too as well as playing a role in our metabolism. It’d be nice to think that there might be some definitive answer that will come out one direction or another, but I think we are all too unique in our body chemistry for that to be much of a reality.

    • Yes, and I didn’t mean to imply that anyone would react to the same set of circumstances the same. As I always say on this site, “It always depends on the individual, their current state of adaptation, and blah blah”, but it’s even more complicated with women and using something like birth control.

      Very complicated and fuzzy, indeed.

      May I ask why/how you have amenorrhea?

  7. After reading this, and seeing there is interest in the subject, I wanted to share my personal experience in case it is helpful to others.

    I was on hormonal BC for several years. It was fine at first, but gradually my moodiness got worse and worse. It got so bad that my relationships and work were suffering because I literally couldn’t control my emotional response at times. I would get hysterical over the smallest things. The last straw was when my Dr. suggested I could take an antidepressant to “level out”. The last thing I want is to get on a cocktail of meds. Thankfully, I figured out that it was the hormones in the BC (or perhaps my body’s response to them) that was making things difficult for me. I experimented with taking DIM, which is made from broccoli and other relative vegetables and supposedly helps metabolize estrogen. It actually made me feel a lot better, but I didn’t want to be stuck buying it all the time. I learned about the copper IUD thanks to an informative article on Mark’s Daily Apple and many comments from happy copper IUD users. Then I ditched the Nuvaring for the IUD, and within a couple of months I felt like my normal, easy-going self again. The downside is more discomfort during periods, but that is far, far better than what I had going on before.

    As far as training goes: at about the same time I switched BC, I also went from 2 workouts a week to 3-4 a week, so it would be hard to separate out any obvious physiological effect of the hormonal BC. I did see a lot of gains though, and I would bet that if I were still on that emo roller-coaster, lots of things would still be more challenging than they are now.

    • Thanks for sharing. It seems like a few of you ladies are citing the “feeling better” as a primary reason for performance improvement (in your case, it’s hard to single out a variable).

      Keep in mind that “feeling better” is a direct result of stuff going on in the body, though.

      • Oh, I absolutely credit the stuff going on in my body with “feeling better”, that is the whole point of what I shared. The emotional roller-coaster was the result of artificial hormone supplementation wreaking havoc with my endocrine system, I have no doubt about that. Maybe this is different for men, but emotions are a physical phenomenon, at least for most women I have talked to. Its not just a matter of psychological well-being, or “thinking positive”. :) It goes way beyond being happy or sad.

  8. I have mild PCOS and was on the pill to regulate symptoms. I’ve been off HBC for over two years now, but have only been lifting for less than a year so I can’t comment on effects on training. I am interested in how the (supposed) higher testosterone levels in women with PCOS effect strength gains, if at all.

    • I’m interested in that too, but I don’t think we’ll find an answer in any kind of research. It’ll need to come from you guys logging your evaluation of yourself.

    • What do you mean by “mild” PCOS… all I know is I’ve finally been confirmed diagnosed with it (after much speculation) even though I’m in the rare group of women who don’t emit any physical signs of it (overweight, acne, hairy… high blood pressure… all that). And how are you managing/”treating” it without the HBC (if at all)?

      I was wondering also if my elevated free testosterone helps my strength training, but in the end I think that has more to do with the fact that I actually go and lift and eat clean with lots of protein and recover smart.

  9. So I also don’t have a before and after comaprison since I’ve been on some form of hormonal BC since I was 18. I can say that I seem to be making good gains even on (inspite of?) the BC based on my squat more than doubling in about a year.

    At this point, I think I’m mostly curious if the Pill has any effect on recovery. It could all be in my head or a product of the fact that I’m older than a lot of the girls I train with, but I just don’t seem to recover as quickly. I don’t bruise/scuff any easier than anyone else but they tend to take longer to heal. Since I don’t have any underlying medical conditions and I’m generally healthy(everything checks out at the dr and I’m mostly paleo), that’s the only other thing I can think of.

    I know what all the studies say about BC not affecting your weight but I seem to be surrounded by too much antedotal evidence to completly believe that. I have no idea how the studies were structured but everyone I know has put on at least a little weight when they began taking it and th few that have stopped have then lost most, if not all of the weight they gained. My sister actually gained nearly 60lbs at one point and then lost it all without any real changes to her lifestyle as soon as she stopped taking the Pill. I’ve also seen a steady creeping up of pudge over the years no matter how clean my diet is or how hard I work out. Even the nutritionist at our gym is little stumped as to why I run more on the pudgy side.

    Since I’m permanently closing up shop on the baby machine in the next month or so and won’t need BC it’ll be interesting to see what, if anything changes.

    • Thanks for sharing. The body fat thing can be very odd, because it could be based on so many factors. And it isn’t a simple, “there is additional hormones from birth control and this is the effect of it”. It will have an effect on the entire endocrine system for good or ill. It could even be cortisol issues related to stress or lack of zinc/magnesium intake. It could be that the cortisol is ruffled a bit from the birth control. It could be that you have an insensitivity to insulin because of long-term diet and still need to address it, or it could be that the birth control effects the role of insulin.

      These are just little simplified examples that demonstrate that it’s near impossible to know. Regulating nutrition, exercise, stress, and sleep will probably be the only weapons you guys have at regulating stuff with or without the presence of birth control.

  10. I have absolutely nothing to add to this topic other than I think it should be called Pregnancy Control. Birth is too far down the line to get all the credit.

  11. I switched from hormonal birth control to a copper IUD four years ago. During the 17 years I was taking hormones, lifting, and eating well, I couldn’t manage anywhere near the kind of progress I’ve been seeing in the last year.

    FWIW, my endocrinologist’s advice on hormonal birth control was ‘Why on earth would you further complicate an already complicated system?!’ I see them next week, as it happens, and will get their more detailed take on it.

  12. I’m 39 and just started taking the pill for the first time about three months ago: seems as though that asshole Father Time is speeding up the menopause clock on me, dickhead. Anyway, WRT training and whatnot, I haven’t noticed anything different recovery-wise or other with the exception of that I actually feel tired (like I’m not getting enough sleep), but can still workout at the same level and get PRs at events (Highland Games).

    I’m going to stop taking it since it worked for one month out of the three – I guess my “normal” is way beyond what it can counteract. Thanks to all the other ladies (and guys who posted).

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  14. I’m 25 years old and have been on hormonal birth control for almost 10 years now. I take it because I don’t want to have babies yet and I’m one of the lucky gals who gets her period for 10+ days at a time. I have always been a healthy weight and I’m currently around 19-20% body fat. I lift heavy and eat a relatively clean diet. I went off birth control for 6 months at one point when I was lifting heavy and saw tremendous gains. I was able to drop weight for a powerlifting comp much more easily and was way leaner than I am now. I still see gains but they are slower and I have a hard time getting as lean as I’d like. I will be going off hormonal birth control in the next couple years for a while so I am curious to see what happens to my training after that.

  15. I only started lifting last year, but I have had the copper IUD for a few years now. I only wanted to post to throw in my anecdote – holy shit was I fat on hormonal birth control. I dropped all the weight (20-30 lbs) without any change in lifestyle after getting off it in my late 20s.

    I’ve been meaning in my training logs to note what days I have my period to see if I can actually see a trend in whether or not it’s affecting my performance. I know I’m tired and feel wiped, but I usually can still lift weights, even though I’m miserable doing it.

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