How does hormonal contraception impact my menstrual cycle?

Most women will use a form of hormonal contraceptive at some stage in their lives. The primary reason hormonal contraception is taken is to prevent pregnancy. However, there are several other reasons why women choose hormonal contraception, for example, to help reduce the impact of symptoms or a menstrual dysfunction.

Here are some of the things to be aware of when using hormonal contraceptives.

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How does contraception work?

There are a few different types of hormonal contraception, each working or acting in a slightly different way. These can be split into two categories:

Estrogen and progesterone combined, including:

  • Combined oral contraceptive pill

  • Vaginal ring (Nuva ring)

Progesterone only, including:

  • Hormonal intrauterine device

  • Progesterone only pill

  • Injection or implant

The combined forms work by releasing synthetic versions of progesterone and estrogen into the bloodstream. This causes natural hormones to be suppressed and no ovulation to occur.

With progesterone only options, only progesterone is released. This reduces natural progesterone release and the main mechanism for contraception is through the thickening of cervical mucus, making sperm entry into the uterus difficult. Ovulation is still likely to occur with progesterone only options.

How is the menstrual cycle affected by combined hormonal contraception?

The suppression of natural estrogen and progesterone with combined hormonal contraception options means that the hormonal fluctuation that occurs with a “normal” cycle does not happen.

There will still be a change in hormone levels if placebo pills are taken, but this will be on a lower level. Many women who use the combined hormonal contraceptive pill will still experience a bleed during their placebo pill phase.

This is not a period; this is a withdrawal bleed. While taking active pills, the endometrial lining develops. When placebo pills are taken instead, this lining is shed (withdrawal bleed).

How is the menstrual cycle affected by progesterone only hormonal contraception?

While progesterone levels may be suppressed to an extent, many users of progesterone only forms of contraception still experience hormonal fluctuations in line with a “typical” cycle.

This is likely to be dependent on the type of hormonal contraception (some have a greater and more systemic effect than others). They are likely to then have a bleed, which is driven by the decline of natural hormones, as would happen in a “normal” cycle.

Do my fitness and nutritional needs change throughout my cycle if I am using contraception?

Adjusting your fitness and nutritional needs is still useful if you are using a progesterone only form of contraception, e.g. an IUD, a progesterone only pill, the implant or an injection.

For those using combined options, you may still experience symptoms along the way, so you can track these alongside your exercise and use the information to help with your overall health and wellness routine. However, it is important to note that you will not experience the same fluctuations of hormones, so some of the physiological information and actions I talk about this on this blog and in my coaching will not be applicable to you.