Inflammation and Oral Contraceptive Use in Female Athletes Before the Rio Olympic Games

Abstract

This study investigated the association between synthetic ovarian hormone use [i.e., the oral contraceptive (OC) pill] and basal C-reactive protein (CRP), peripheral blood immune cell subsets, and circulating pro-and anti-inflammatory cytokine concentrations in elite female athletes. Elite female athletes (n = 53) selected in Rio Summer Olympic squads participated in this study; 25 were taking an OC (AthletesOC) and 28 were naturally hormonally cycling (AthletesNC). Venous blood samples were collected at rest for the determination of sex hormones, cortisol, CRP, peripheral blood mononuclear memory and naïve CD4+ T-cells, CD8+ T-cells and natural killer cells, as well as proand anti-inflammatory cytokine concentrations. C-reactive protein concentrations were elevated (p < 0.001) in AthletesOC (median = 2.02, IQR = 3.15) compared to AthletesNC (median = 0.57, IQR = 1.07). No differences were reported for cortisol, cytokines, or PBMC immune cell subsets, although there was a trend (p = 0.062) for higher IL-6 concentrations in AthletesNC. Female Olympians had substantially higher CRP concentrations, a marker of inflammation and tissue damage, before the Rio Olympic Games if they used an OC. Future research should examine the potential consequences for athlete performance/recovery so that, if necessary, practitioners can implement prevention programs.

Patterns of endogenous and exogenous ovarian hormone modulation on recovery metrics across the menstrual cycle

“…The data from the current study indicates a reduced recovery in women using combined BC with every unit of increased strain, as compared with naturally cycling or progestin-only pill women across regardless of cycle phase. In addition to the exogenous effects described above, recovery may have been attenuated due to greater Open access inflammatory responses associated with BC use [32][33][34] and to the difference in stress responsiveness of women on BC. Larsen et al 34 reported a higher incidence of IL-6 and C reactive protein (CRP) in Olympic-calibre female athletes using BC as compared with the same calibre naturally cycling female athlete.…”

“…In addition to the exogenous effects described above, recovery may have been attenuated due to greater Open access inflammatory responses associated with BC use [32][33][34] and to the difference in stress responsiveness of women on BC. Larsen et al 34 reported a higher incidence of IL-6 and C reactive protein (CRP) in Olympic-calibre female athletes using BC as compared with the same calibre naturally cycling female athlete. Moreover, Cauci et al 33 observed a marked elevation of low-grade elevation (as measured by CRP) in female athletes using BC, which may exacerbate inflammatory responses to physical stress, increasing the time course for recovery.…”

The Specificities of Elite Female Athletes: A Multidisciplinary Approach

“…COC use has been associated with increased resting blood, saliva cortisol, or urinary cortisol [ 350 , 356 , 379 ], with similar change [ 350 ] or a blunted response [ 351 , 354 , 356 ] to exercise, with or without a training effect. However, other studies observed no change in cortisol levels in moderately trained subjects or elite female athletes [ 335 , 380 , 381 ], either at rest or after exercise, indicating a similar immune-endocrine function in both temperate and hot environments [ 381 ]. Weeke et al [ 364 ] reported an increase in TSH with COC vs. NMC, with similar fasting plasma glucose, C-peptide, insulin, and adiponectin levels [ 58 , 382 ].…”

“…Moreover, it seems that the fed or fasting conditions for exercise performance have a greater impact on substrate oxidation than COCs [ 400 ]. In some studies, COC use was reported to increase total and LDL cholesterol [ 30 , 36 , 67 , 379 ], with elevated chronic low-grade inflammation and oxidative stress that could be detrimental to physical activity and elevate cardiovascular risk [ 401 ], such as basal CRP [ 379 , 380 ] alone [ 380 ] or combined with TNFα [ 379 ]. During exercise, an increase in CK [ 402 , 403 ] and a decrease in IL-6 with COCs vs. F was reported in moderate-level athletes [ 350 ], although this was blunted in elite female athletes [ 380 ].…”

Sex differences and considerations for female specific nutritional strategies: a narrative review

“…It should be noted that the use of a monophasic and triphasic OC, respectively, could potentially explain the differences seen. Oral contraceptive pills may have a negative influence on inflammatory markers as evidenced in elite Olympic level female athletes who were using oral contraceptives as they displayed higher levels of C-reactive protein, a marker of inflammation, than eumenorrheic peers, potentially suggesting increased muscle damage or inadequate recovery [ 67 ]. A study assessing less elite but still highly active females found similar results as those taking OC had higher levels of high-sensitivity C-reactive protein than non-OC users [ 68 ].…”