Intrauterine Contraception and Athletic Performance: Where is the data?

Background: Oral contraceptives (OCs) represent the most popular form of female contraception among the general and athletic populations. In female athletes, OCs are often used therapeutically to treat dysmenorrhea, which is perceived by many to affect training and performance. Recently, copper intrauterine devices (IUDs) and hormonal intrauterine systems (IUSs) have increased in popularity, and are now recommended by the Canadian Paediatric Society as a first-choice contraceptive. IUDs, however, present no therapeutic benefits with respect to dysmenorrhea, and may increase physical side effects associated with the menstrual cycle. Alternatively, IUSs have therapeutic application for dysmenorrhea, and therefore may present an option for athletes looking to reduce menstrual cycle symptoms. Purpose: To review the effects of IUDs and IUSs on exercise and athletic performance. Methods: Databases were searched using MeSH terms and key words in Boolean combinations. Studies were included if they 1) used a validated assessment of exercise performance (i.e., V02 max test, 1-repetition maximum, time to exhaustion), 2) included human participants who were moderately to very physically active (as assessed by a validated tool), and 3) used any copper IUD or hormonal IUS. Results: 245 titles were returned from the literature review; however, no studies met the inclusion criteria. Conclusion:  The review returned limited relevant literature, and therefore, focuses on the theoretical bases of why IUDs and IUSs should be examined in the context of exercise and athletic performance. The need for future, experimental data exploring the effects of IUDs and IUSs on exercise and athletic performance is highlighted.