054 - Hormonal Contraceptives & Muscle Growth: Gains, Gaps, and Clarity
This systematic review and multilevel meta-analysis pooled data from 12 studies (including RCTs and observational cohorts) assessing how hormonal contraceptive (HC) use affects resistance training outcomes in healthy, premenopausal women.
What They Found:
No significant negative effect of HC use on muscle hypertrophy, maximal strength, or muscle power outcomes
Training benefits occurred regardless of contraceptive status
Slight trend (non-significant) suggesting higher gains in non-HC users, but confidence intervals overlapped and lacked statistical weight
Differences between HC type (combined vs. progestin-only) or formulation were inconclusive
Training load, frequency, and duration were far more influential than hormonal status
What This Means:
For tactical coaches and clinicians working with female athletes or operators, this study provides evidence-based reassurance: hormonal contraceptive use does not hinder strength, hypertrophy, or power gains.
That said, variability still exists across individuals. The presence of individual outliers, training experience, nutritional status, and cycle history matters far more than blanket assumptions about HC use.
This supports a training-first approach where loading principles, program design, and recovery matter more than micromanaging hormonal status, unless clear symptoms or performance plateaus occur.
Tactical Implications:
Program Confidently for Women on HC: No need to alter strength or hypertrophy prescriptions based solely on contraceptive use.
Monitor the Individual, Not the Label: Some may respond differently, but it’s case-by-case—not category-based.
Focus on the Fundamentals First: Training volume, intensity, sleep, and recovery still outweigh hormonal nuances in outcome influence.
Educate, Don’t Overhype: Many female athletes get misled into fearing their contraceptive will kill their gains. The data say otherwise.
Questions To Consider:
Are you hesitating to push load or volume because a female athlete is using hormonal contraceptives?
Do your clients believe their HC is limiting their performance, and is that belief holding them back more than biology?
Could you be tailoring programming more based on symptoms, trends, and training response rather than generalized cycle advice?
Are you collecting useful data (e.g., training logs, sleep, mood, readiness) that helps uncover real patterns?
How can your team better educate female tactical athletes about the true (limited) impact of hormonal contraceptives on performance?
Nolan D, McNulty KL, Manninen M, Egan B. The Effect of Hormonal Contraceptive Use on Skeletal Muscle Hypertrophy, Power and Strength Adaptations to Resistance Exercise Training: A Systematic Review and Multilevel Meta-analysis. Sports Med. 2024;54(1):105-125. doi:10.1007/s40279-023-01911-3