How and whether hormonal birth control contributes to weight gain has been a debate since the introduction of the pill. While studies suggest that the weight gain caused by the pill is most likely due to water retention or is minimal, there are other studies pointing toward a negative effect of the pill on body composition. In short, it may contribute to decreased muscle mass, strength gains, and thereby, reduced metabolism.
As it turns out, the connection between the pill and our health is more complicated than we imagined. It's important to understand how the pill sabotages you in the gym—and why we need to be looking at more than just weight loss, starting with its effect on one specific hormone, testosterone.
The relationship between testosterone and your metabolism.
True, testosterone is often thought of as the "male sex hormone," but it's an important hormone in women’s health too. Testosterone plays a role in our mood, heart health, bone strength, libido, and muscle mass. And while it can cause acne, oily skin, and hair loss when out of balance, it is still an essential part of your health.
Acne and PCOS are some of the primary reasons women are prescribed the pill for noncontraceptive reasons. That is because the pill is effective at lowering total and free testosterone, by decreasing the ovaries' production of this hormone, by as much as 50 percent. While women are on the pill, they experience higher levels of sex-hormone-binding globulin (SHBG), which binds free testosterone. So in addition to reducing testosterone production, it also binds to free testosterone available in the body.
As I explain in my book, Beyond the Pill, testosterone is rising in your cycle leading up to ovulation, during the follicular phase. Research shows this is a time when our metabolism also speeds up, which means there is an opportunity to make gains in muscle mass and strength training. Your follicular phase is a great time to lift weights and build muscle. Testosterone has been shown in studies to increase our muscle mass through protein synthesis.
In a natural menstrual cycle, you will also experience a rise in your metabolic activity and will burn more calories during certain times in your cycle due to hormonal fluctuations around ovulation. Unfortunately, while on the pill, you aren't ovulating and therefore won't enjoy the bump to your metabolism.
In addition to lowering testosterone production, some birth control pills also block androgen receptors. Unfortunately, that means that androgens like testosterone and DHEA can't aid in muscle growth or stimulate positive changes to muscle tissue. And while blocking these receptors works wonderfully for decreasing acne, it could sabotage your long-term metabolism health.
Why athletes should think twice about the pill.
Over the years, you might have heard recommendations that athletes begin or remain on the pill to overcome the decrease in exercise tolerance during the luteal phase. And while some studies have shown a decrease in time to exhaustion during the luteal phase, other studies have noted that in temperate climates, there is no decrease in female athletic performance during the luteal phase. In fact, a 2003 study published in the Medicine & Science in Sports & Exercise concluded that "regularly menstruating female athletes, competing in strength-specific sports and intense anaerobic/aerobic sports, do not need to adjust for menstrual cycle phase to maximise performance."
All this biology can get complicated, so the point I want you to walk away with is this: You don't need to suppress your cycle with the pill to excel as an athlete. In the "Metabolic Mayhem" chapter of Beyond the Pill, I provide in-depth information on how hormonal birth control affects our metabolism, weight gain, and insulin resistance and may even put us at risk for diabetes.
How to boost your metabolism—whether you're on or off the pill.
In the meantime, I want to provide you with the Brighten Metabolic protocol that we use in my clinic to help you improve your metabolic health—whether you choose to stay on or come off of birth control. The four main steps of the protocol are as follows:
1. Banish sugar and refined carbs.
If you're on a medication like the pill that causes insulin resistance, blood sugar dysregulation, and potentially decreased metabolism, then eliminating offending foods is a must. This includes processed foods, desserts, white bread, and pastries. Does this mean you'll never get to have a slice of pie? Not at all. But it does mean you'll need to rein in those foods that spike blood sugar at least for a period of time in order to recover your metabolism.
2. Eat real food—and plenty of veggies.
My philosophy on food is to fill your plate with so much nutrient-dense goodness that you just run out of room for anything that doesn't serve your hormones and metabolic health. A bonus to eating protein, fat, and vegetables at every meal is that in addition to balancing blood sugar, it will also support your liver and gut in their ability to detoxify hormones.
3. Move your body daily.
Don't throw in the towel just because birth control may be hating on your muscle gains and gym efforts. Keep moving! Exercise has numerous benefits, including lowering inflammation, improving insulin sensitization, and helping you enjoy better moods.
4. Time your meals.
If you feel like your adrenals are shot and you're having episodes of hypoglycemia, then it may be necessary for you to eat regular meals. Otherwise, I encourage patients in my practice to engage in intermittent fasting with a simple practice of shutting down the kitchen at a certain hour in the evening and then not eating again until 12 or more hours the next day. Intermittent fasting has been shown to be effective for weight loss but, more importantly, helps maintain your lean body mass (aka muscle).
We're learning more and more that maintaining a healthy weight and body composition is about way more than just calories and time spent in the gym. So whether you're an athlete or just a frequently gym-goer, it's important to know how your homeyness and the birth control pill can potentially affect your energy levels and ability to achieve your goals.
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