Where sports performance meets reproductive rights: hormonal contraception

Abstract

Rational: To discuss the use of hormonal contraception (HC) in elite women’s competitive sports from an anti-doping perspective because 1) it changes the natural female hormonal milieu; 2) is used to manipulate the menstrual cycle with performance enhancement intent; 3) even though lowering endogenous testosterone levels, some HCs contain testosterone-like androgenic compounds with potential performance-enhancing effects. Results: A complex interaction between rapidly advancing sports-relevant biomedical scientific discoveries, societal changes concerning sex and gender, and a zero-tolerance anti-doping ideology, leads to contentious results, jeopardizing the premises defining and protecting contemporary elite sport in general and that of women in particular. Discussion and conclusions: This is in part because of the two out of three criteria for inclusion on the World Anti-Doping Agency’s List of forbidden substances and methods: i) actual or potential for performance enhancement, ii) actual or potential for health risk, and iii) counter to the Spirit of Sport concept. These criteria would suffice for the inclusion of HC on the List, especially in their androgenic form. The fact that they are not is good for women’s reproductive rights but also illustrates the arbitrariness of the administration of WADA’s Prohibited List of substances and methods in elite sports.