Research Breakdown: Effects of Oral Contraceptives on Exercise with Coach Chantelle Robitaille | Koopcast Episode 57

Trail and ultra runners, what is going on? What's happening? I hope everybody is well. Welcome to another episode of the KoopCast. As always, I'm your host, coach Jason Koop. And on this episode of the podcast, we have another research breakdown. You might remember the first two research breakdowns we did with coach Corinne Malcolm and coach Stephanie Howe. I got a ton of great feedback from you, the listeners on those episodes. So we decided to do it once again. This time I speak with CTS coach Chantel Robitaille, who you will remember from KoopCast number 13.

She and I break down a recent systematic review and meta analysis all about how or if oral contraceptives affect exercise performance. It's an area that has gotten more and more attention recently. And as you will find out during the course of this podcast, it's very difficult to provide blanket recommendations across the board. So coach Chantel and I try to navigate these nuanced waters with you in a clear and actionable way so that you can better inform your training. We do mention a few apps on this podcast. And as always, there is zero financial interest in them. And I'm still not taking one sponsor on this podcast, despite getting at least two unsolicited requests each and every month. There you go. That's my effort of full disclosure. So let's get right into it. Here's my conversation with coach Chantel Robitaille. You ready to get into it, Chantel?

Yep. Let's go. All right, let's do it. Okay. The paper that we're going to go over, the title of it is the effects of oral contraceptives on exercise performance in women, a systematic review and meta analysis. And it's a big one. I killed a lot of trees printing this off. I did not do a digital version as sometimes I do with these podcasts. And it was, oh my gosh, how many pages was it? Let's see. I have to do math right now. It says 89 to 30 pages or so, 34 pages. Yeah, it was a big one. Including the references. It's hard enough to figure out the page count and rather than the information to get into it. But let me kind of set this up first in terms of what we're actually looking at. And then we'll dive into the practical pieces of it. Because I think a lot of times when we talk about research, the type of research that's being conducted or being reported is important context. And not a lot of the listeners like read this on a daily or read this stuff on a daily basis. So what we're looking at is a meta analysis, which is essentially a study of studies. They're not doing any original research. They're not taking a group of subjects and saying, okay, you guys get the red pill and you guys get the blue pill. And we're going to see what the, you girls get the red pill and you girls get the blue pill. I should like change that for this podcast.

And determine, you know, what the differences between those two interventions are. They're looking at the existing body of literature, finding out within that existing body of literature, what is relevant to what they want to study. And then within that determining what is actually going on, what kind of conclusions can we draw upon. And I always feel that meta analyses are both like loved and loathed in the, in the scientific community, but also in the community that like access, accesses those pieces of research like you and I do as coaches. And we love them because they synopsize a large body of research with which we cannot keep track of. Like we just, it's just impossible to keep track of it all, especially as a coach where it's interdisciplinary.

We have to like cross into nutrition and, you know, hormones and training interventions and electrolytes and everything. It's impossible to keep track of it. And so these meta analyses by taking, you know, sometimes several hundred different papers and filtering them down into some logical conclusions provide like an easy and convenient way to filter through the research, but they're low because you miss out on a lot of the detail. And there's a lot of like mechanistic information and a lot of nuance within one or two, or maybe even a handful of studies that you can peel out that are applicable. And so even when we look at meta analyses, it's all, it's like I said, I've always had a love hate relationship with it because I can get right to the point. And I love that, but I hate it because inevitably there's something that I, that I missed. And also I end up usually spending way too much time going into all the individual papers and it just becomes its own like quite proverbial rabbit hole. Um, yeah, it, it really does. It really can.

Well, and I know it's like a Wikipedia page, right? You just keep clicking, keep going, keep going. Exactly. And I know you went down, you went down the rabbit hole with a few of these links that, um, that, that we're getting into the easy way that I think, uh, a lot of, uh, listeners can kind of conceptualize this is that these meta analysis, they, well, they start out trying to compare like apples to cows and that's like the huge body of research, right? That exists. And then they end up comparing apples to oranges. That's the relevant, relevant research. And then once they get down to the studies that are like actually truly relevant to the question that they want answered. And in this case, it's the effects of oral contraceptives on exercise performance in women, that's the very specific question that they're trying to, that they're trying to get answered. It's like trying to compare like a red, you know, red, delicious apple to a green, delicious apple or something like that. Right. They're trying to get really specific and try to find those studies that are absolutely relevant to each other. That's the best way I can explain it. I haven't come up with another clever analogy to explain these types of things. Um, so let's get right into it. Chantel, you're going to kind of lead this dance. What was your kind of key takeaway or takeaways from this meta analysis? I think, you know, with, as you mentioned, meta analysis, you can really go down a lot of rabbit holes. And this one, we have a systematic review where you systematically look at all

those studies and the meta analysis part is when you actually attempt to attach some statistical significance to those. So that's what, you know, makes them, um, makes a meta analysis quite interesting because they're attempting to compare all these wide ranges of variables and try to come up with something, um, enlightening out of it, or even sometimes something new out of, you know, all these studies that have already been done. Um, in this particular one, you know, it was interesting to see how many studies they started with looking at, and then they finally pulled out 42. Um, 83% of those studies were moderate to low quality and only 17% were high quality. That's seven. Right. Um, so you can tell, you know, there's, there's research out there, but, um, maybe not a lot of good research. So that's one kind of interesting thing. And out of all those 42 studies, we're talking about 590 participants.

So it's not, it's not a lot of individual data that we're looking at, um, in this study. So in this one, what they're trying to look at is whether or not, you know, looking at different studies that have been done and comparing different types of analysis, do oral contraceptives, um, help or hinder or neither exercise performance. And some of the, you know, some of the takeaways out of this, unfortunately, weren't super conclusive. I know, like sometimes you get a, you do a study, which is real fun being in research. You know, you're expecting an answer. You're expecting to, to find something conclusive to go with. But a lot of times in science, you just learn that you need to do more research. Um, and in this case, that's kind of what we come down to because in the end, they found that there wasn't really enough of, although there was some small, um, decrease in performance in some of the women in some of the studies who are on oral contraceptive pills, they felt that the, the difference was pretty trivial and that, um, you know, it was probably a pretty small, small effect anyway, and that it's probably better to take an individualized approach, which is kind of what you should do when you're considering, you know, as a coach, considering an athlete anyway, right. Is take an individualized approach.

End of podcast. It depends on the athlete. The end. Let's go, let's go have a drink. Yeah, there you go. This will be a short one. Let's, let's contextualize the, the, the, the, the, the potential decline in performance. So let's first kind of set this up for what the researchers are doing. They're taking literally hundreds, almost a thousand studies, filtering it down to how many were at the very end of the Chantal? 42. 42. Down to 42. Down to 42. And looking through those 42 and determining are women better, different, the same, or do we not know taking oral contraceptives versus not taking them? And to kind of summarize it, it's, I think it's in two points. A, it's highly individual, meaning the spread between the women who were doing in most women were doing generally doing worse on oral contraceptives, but some of it was just a smidge worse, meaning tenths of a percent. And some of them were, I would say significantly worse, 8%, 10%, 11%, kind of somewhere around there.

So that's the first thing is that that leads to the individualization of it is you absolutely need to take an individual approach. The second thing is, is you'd be hard pressed to find a study that says they were better. The group of women were better on an oral contraceptive as compared to naturally menstruating. Right. And I think there was actually one of the studies that I pulled out of there that they were, it was a study that showed that there wasn't any difference. And one of the things they mentioned in their conclusion was that birth control oral contraceptive pills were not considered an ergogenic aid, that they didn't have an advantage on performance. Yeah. And I remember when some of this research originally started to come out, and I think this is a point worth mentioning. A lot of this is relatively new. In fact, most of this is relatively new.

We've lamented for a long time, and I've lamented several times on this podcast, that there's a lack of research that's specifically done on women. This is your stereotypical design involves anywhere from 12 to 20 college-age males because they're good subjects. They're easy to recruit. They're fairly consistent. It's a very homogeneous group. And research is hard to do. And the more complicating factors that you have to add into that research and adding women into a pool of homogenous men is one of those complicating factors. It's just something that a lot of graduate students and PhD students and things like that, they just don't want to deal with. The really high-level ones in this group led by Kirstie Sale is one of those high-level ones. They're taking the extra steps to study females, to try to produce more research on the whole. And my point with all that is, is when some of the initial papers started to get produced on the effects of oral contraceptives with women, is we would always see a performance decline. And one of the things that the coaches did, and I think erroneously did maybe 15 or 20 years ago, when we first started seeing a lot of this research emerge, is we prematurely kind of pushed the panic button and said, oh, we're seeing these big performance declines, particularly at the Olympic level, particularly at the world-class level.

Let's get all of these women off of oral contraceptives because we don't want their performance decline so much. Now we're learning more and more and more. There's such a huge individual variation, and it's almost impossible to predict with any one single person unless you do trial and erroring amongst each individual. Yeah. And that's, that's a big, that's a really big thing, you know, and it's, you can't just lump, you can't just lump them all together. You really have to consider the individual person and you have to study that individual person for quite a while. You know, in some of these studies that was, you know, first of all, one thing that's, that's missing out of all of these would be a randomized, a randomized trial, which you can't really do, you know, in a randomized study is where the individuals in the studies don't know what they're getting. You know, that's ethically, you couldn't do that to a group of women, right?

Child age, childbearing aged women, that wouldn't be, that would be unethical to have them say, take this pill, you might or might not. It might or might not work. You know, a contraceptive pill. So that's, that's unethical. You couldn't do it that way. But what's difficult is you have different types of oral contraceptive pills. They have, you know, that have different ingredients that have different concentrations of, of synthetic hormones. You, and then also within each individual woman, the way that the, the half-life of those, those hormones in their systems are different too. So not only is a woman's actual menstrual cycle different one to the other, you know, and it's typically not a nice, even 24 day cycle. Some women, we now know, you know, this is fairly new research as well, that some women, their menstrual cycle might be up to 40 days long. So the, the times where we are, you know, where we might expect performance to decline and where it's likely to be better is going to be different in those individuals. And that's, you know, something that I think is great that that information is coming a little more to light, but I think there's still a lot of basic information about the menstrual cycle and about oral contraceptive pills that most women are not told by their doctors.

Oh, a hundred percent because they're going into their doctor as just a female and a person. And the doctors trying to almost do what this meta analysis is doing is taking a huge group of people and prescribing one thing that has a tremendous amount of variability that that one person might actually experience. So you're absolutely a hundred percent right on that. You know, me, Chantel, we've been, you know, meeting on these weekly coaching calls for, for how long, how long now? Three years, four years, five years. Jesus, I'm losing track of time with COVID now. It's been, it feels like a long time, but it's only been two. It feels like a long time. For me anyway. But my point with that is, is I will not let anybody get away with saying, oh, it's just individual and throwing their hands up and using that as an excuse to not answer the question.

And so let's try to drill this down to the, like the real practical, like nuts and bolts of it. You coach women, you are a woman. That's why I've got one of the big reasons why I have you on this podcast. It's not just two dudes talking about this. You coach women, you are a woman. You've gone through this yourself. How do you figure out this intra-individual variability amongst an athlete that you work with, or how did you figure it out? Oh, well, before I knew any better, it was a lot of trial and error, you know, and, uh, I had, I was experiencing as an athlete, a lot of health problems. And I had, I was fortunate at the time to live in Switzerland and have a really amazing doctor who taught me all kinds of stuff at the age of 32 that I should have learned when I was 14, you know, and I think this happens for a lot of women, particularly in my generation, you reach a certain age, you have some period cramps and they put you on birth control pill and that's that. And then they tell you that you're, you know, this is how it's going to work. You're going to take these pills and then you're going to take these pills on these days. And then you're going to get a period. What we're not told is that's not a period, what you experience on oral contraceptive, that's a withdrawal bleed. So there's blood involved, but it doesn't have the same change in the hormonal, uh, cycle as you would with your natural hormones.

Um, and, and basically what happens when a woman takes oral contraceptive pills, they are kind of like a double agent and they are down regulating the natural hormones while at the same time giving your body exogenous or outsider hormonal, um, outsider versions. So this kind of can change the, the natural hormonal milieu in the body. And that's why, you know, looking at some of these studies thinking that because we're changing the natural hormonal environment, that that's leading to potentially an impact on the performance. So trying to understand. So the main thing is, I think for most women, the number one thing I recommend, you know, is every woman and every cook should, if they have a coach or not has to, you have to have a look at, be honest with yourself. If you're not tracking it, you can't manage it. That's, that's thing one. And you have to track it for, you know, a period of time because you want to see, you know, are there any particular patterns? Do you notice any changes in weight? Do you notice any changes in appetite, you know, hungrier or not hungry at all? Um, physical, physical pain, you know, headaches, body aches, pain in the lower back or elsewhere, mood changes, energy level changes, all those types of things. Because if you can find a pattern and for, for most, you know, and this is where the individual piece comes in. Every woman is going

to have more than likely an individual pattern, whether they're on oral contraceptive pills or not, they will probably have a pattern of symptoms. And if they're getting along and they have, you know, a couple of days out of the month where they're not feeling particularly awesome, then that's great. Probably you don't have to adjust a lot. Maybe you get a little more sleep on those days. Fine. But if there's a woman who is having really drastic symptoms or really big drops in energy or, um, worst of all, a woman who's not menstruating because a non-menstruating woman is not a healthy woman. You've got to know what's, you know, you've got to know what's happening before you can start thinking about whether or not changes can or should be made. But that's such a practical recommendation.

It's just like, look at the athlete before and afterwards, figure out if there was a difference. And if there was a difference, then you can start to try to mitigate it. And that's what I've always kind of come back to whenever I've had an athlete that wants to change their birth control or go on birth control in the first place is if I've been working with them for a while, we already have a baseline. Like we know what your performance data is because I've been looking at it. We look at it every single day, every single workout that you actually do. And there's, I'm not going to say it's like a complete random guess because there is a lot of like educated guessing and okay, we could use this type of contraceptive or is that type of contraceptive. Here's how this might affect this. Here's how that might affect that. But there, you can't only look at the performance data. You also have to look at who they are as a human and what their goals are. And does it even matter? Sometimes you'll approach somebody that's like, Hey, listen, if you're okay with a, who knows, three, four, five, 6% performance decline and ongoing from no birth control to an oral contraceptive, they're okay with that. Great. Let's just go ahead and kind of plow forward and, you know, just let the, let the chips fall, you know? Yeah. And it's really a case of, you know, do the ends justify the means, you know, for every, every individual woman, their choice of birth control is very individualistic, right? And what they choose to use is very much dependent on, gosh, a million circumstances. It could be some other

kind of health problem. Like if a woman has, I don't know, something like PCOS or endometriosis or, you know, an actual health condition where conscious oral contraceptives may actually help relieve those symptoms. Or, you know, it could be a financial decision. It could be a religious decision. There could be all kinds of things, right? So, you know, making that decision, first of all, is it's important for the individual woman to be educated about the different options. Because aside from oral contraceptive pills, they could consider something like an IUD, you know, an IUD, there's an IUD that has no hormones at all, which is going to give them the benefit of having, you know, a reliable contraceptive source that doesn't impact their natural hormones. Or even something like one popular one here in the US and probably Europe too is Mirena, which is an IUD with progesterone. Because that progesterone is localized, within about six months, the woman still has a very natural cycle of hormones. So again, they can have that protection without having any disruption to their natural hormones. So there's lots of options out there. But again, I think a lot of women just aren't given enough information to make be able to make the best choice for themselves.

From a practical standpoint, if you have an athlete that says, hey, I think my oral contraceptive is interfering with my performance, and I would like to change that somehow. And you don't have the background information, let's just say it's a new athlete, or for some reason, they're kind of like new to the sport, they're just kind of getting getting into it. How would you go about like actually triaging that in terms of figuring out if another solution is better for them, and like walking them through that process? Well, I think first of all, we have to, you know, think about the fact that full well, for me, anyway, I'm not a doctor, right? I'm not a I'm not a clinician. So I'm, I'm informed about a lot of this. And certainly have my own experiences or experiences with other athletes. The first thing is to find their why, you know, what's leading them to that conclusion? Have they experienced, have they been experiencing some things that lead them to that? Or do they just feel like, like many women often do in their kind of, you know, mid 30s, or even early 40s, I've been on these birth control pills for 15 years. And, you know, maybe it's a good idea to come off of them, or maybe they're not helping me. That's a decision that they have to make with their physician to see what you know, and because going off of those pills also can have some repercussions, because the body, especially for women who've been on these pills for 1015 or more years, it's going to take quite a long while for the body to be able to readjust and be able to produce

hormones naturally after being suppressed for such a long time. So there's that's a huge consideration, too. Yeah. And that's one of the conundrums, right? Like if you really don't have the before the before performance data, and you do get stuck into this like trial and error process, a lot of times I've thought that because the process is so long, between trial A, trial B and trial C, whatever you lose in that intermediate time, just because of like loss of training or whatever, that's worth more than the performance decline that you started out with. So a lot of times it's just kind of like, listen, let's just stay the course and deal with it. Because if you don't know that you have a if you don't know that you're getting if you don't know that you're getting a market performance decline, sometimes the ends to ping off of your ends justify the means, sometimes the ends are actually worse than the initial, you know, the initial situation that you're set up with because of that timeframe.

Right? Yeah. And that's and that's what you what always has to be considered, you know, even in like looking at some of these studies where they did crossovers where the same women were either not taking birth control pills, and then taking birth control pills. You know, again, even when a woman is has not taken any oral contraceptives, and then starts taking them, there's going to be again, because the body's trying to recalibrate itself, there's going to be some time at the beginning that is going to be kind of challenging. And so for most women who've started taking oral contraceptives, sometimes they have to take several different ones to find one that actually works for their body. Because again, even though these are the same pills, they don't work the same way exactly in all women. So yeah, so when people you know, when when researchers say that women are more challenging to study, we definitely are. I'm saying that as a former researcher, right?

Yeah, right. No, I mean, it's it's like some people like look down at that, like, you guys need to figure that out. I'm like, well, listen, this is the practical aspect of this. Like it just takes more time, energy resource, you have to more carefully craft the studies and the way that the research comes in through graduate students and PhD students and tenured professors and research groups and things like that. Not all of them, in fact, none of them are going to be perfect. And a lot of times you're constrained, you have real life constraints of time, energy, money, subjects, the whole nine yards. So, so let's kind of get let's kind of get back to the meta analysis kind of part of this. Was there anything else that like, stuck out to you, when you were looking at this study of studies, where you can kind of like take that out and say, yeah, this is what's this is what athletes need to take away from this, we've already got the individual piece, right? And we've already got the piece that there's a very, very small when you average everybody out, there's a very small performance decline in the group of people that are taking oral contraceptives. Is there anything else within that nuance, it's important for people to know? The other thing probably that I that I could pick out that, you know, kind of came through in the in this analysis was looking at the so what they tried to do in a number of the studies was compare the same timing, the same, the same cycle in the the women taking oral

contraceptives with the same time in the cycle, same phase in the cycle with women who were naturally menstruating. And so that showed that the, that that the performance, the performance level was consistent across those cycles. So that kind of tells you that there's, you know, not, it's not going to be a bad thing if you're taking it, right? It's not going to affect your actual performance. And then there's also, you know, a lot of research that shows that naturally menstruating women experience some, some more detrimental symptoms and the early part of the follicular phase anyway. So the follicular phase is the time from, you know, day one, when the woman gets her period that month until she ovulates. So that's the follicular phase. So from, for any, you know, for most of the women listening out there, when you're, you know, you're, you're feeling kind of crummy before the period starts, the first couple of days of the period, you're feeling kind of crummy. And then you have a couple of days where you might feel like superwoman, or you might just feel a little bit better again, individual, but that's the, you know, that's the timing across all these studies where they showed whether the women were on oral contraceptives or not, that's when they were more likely to, to have some performance issues. But in terms of performance, the better performance happened, you know, during that same time, regardless of whether the women were taking the oral contraceptives or not. Okay. So here's the practical piece of this that I want

to bat around with you because you and I, we both have athletes that are terrible during a certain part of their menstrual cycle. They're absolutely, and we know it and we see people, we hear, you know, we hear stories of people that fit this profile of, for whatever reason, they have a really bad three to seven days and it's unavoidable. It's super consistent. And this is where this whole concept of, of one of Stacey Sims quotes, who's been a guest on this podcast as well, of women are not small men. And it's something that I ask her consistently since she's a leader in this field. And we don't exactly see eye to eye on this. And you, you and I might have some disagreement on this as well, but I always come back to how does the training change or how should the training change when we notice these hormonal related performance declines? Like what should the athlete practically do during those phases? Should they training, change the training completely? Should they just kind of give into a rest phase? Should they put the horse blinders on and just plow forward with reckless abandon? Like what do, what should athletes do when they know, when they know that they fit that pattern?

I think it also depends on the, on the severity and how many days, you know, if it's one to two days of feeling really crummy, well then maybe that can be a rest day or, you know, more of a recovery, recovery run. You know, if it's longer than maybe you want to think about like in your training cycle, if your training cycle is typically four weeks, maybe for that particular athlete, maybe your training cycle becomes six weeks instead so that you can build in a little bit more rest. Because during that time, you know, the, the, if what other symptoms are they experiencing? Are they having difficulty sleeping? You know, during that time when, if there's certain times in the cycle where, let's say someone's having difficulty sleeping, they're getting night sweats, you know, this can happen to women, not only women who are, you know, coming into menopause, menopause, but this can happen to, you know, women in the, in the part of the menstrual cycle too. So figuring out what are some of those symptoms and what are some things, what are some things you can do, not just with training, but also, you know, what are some lifestyle or nutritional changes that can be made during that time to try to, you know, maximize how they're going to feel during those times.

And again, that's a little bit of, a little bit of trial and error. And I think first you have to track, you know, and get a history of what some of those things are, and then start thinking about, are there some changes you can make before going to bed that can help you sleep better? Are there some changes with, you know, if someone has really crummy nutrition, that's not going to help, right? So maybe cleaning up their nutrition a little bit, making sure that they're getting enough of the right foods to make sure that they're, you know, fueling enough with the right, enough of the right things to help try to alleviate some of those symptoms. And I think in Stacy's work, you know, she's identified a number of other things that may be helpful in terms of changing the ratio of macronutrients. So eating a little bit more protein at certain times, or a little bit more carbohydrate at certain times, or adding in some adaptogens that might help to balance the hormones.

And if it's really that bad, get to a doctor and figure out what the heck is going on. Because there could be a hormonal imbalance that's happening, whether or not the woman is taking oral contraceptives. And if there's a hormonal imbalance happening, you've got to get to the heart of that and get that balanced out, or else there's not really going to be a lot you can do to make things better. Yeah, I've always, so the reason I wanted to kick it back and forth is because I've honestly like always struggled with this as a coach, because when I coach, when I coach women, first off, I'll usually notice that they're worse before they'll admit anything to me. In most cases, some, some athletes are super obvious, super blunt. Hey, I'm going to be really bad here. You know, I'm going through this phase of my menstrual cycle. I'm always really bad here.

I'm moody. I can't sleep, all this other kind of stuff. And, uh, but most of the times I figure it out first and then I bring it up and then we start to work through it. And I don't, I don't, I don't claim to have my thumb on the right answer. And the reason is because I see these recommendations that range from change everything, change your nutrition, change your sleep, change your recovery, change your hydration, change your training from one extreme to the other, two, don't do anything and plow forward and every, and like everything else in between. And I think a little bit of that speaks to the individual nature of it. But when I first encountered this, I always kind of come back to like the same de facto, um, way of solving the problem. And that's, I, I look to avoid the double negative. I look to avoid the time when the athlete is going to be the worst. And once we figure that in the basic way we do that is we just count the days of their menstrual cycle. And if it's day five through 10 or whatever it is, we know those are going to be the worst days. Avoid the highest training loads on those days first. So however, I'm orchestrating the training and whatever type of, you know, three weeks hard, one week easy, or whatever it happens to be, whenever that cumulative and acute training load is the highest, I'm avoiding those times. Yeah. Start there or I will start there. And then if like advanced

interventions need to be made like month after month, I'll gradually kind of like layer them in because I feel that that's the right way to preserve the correct, like training architecture that I want and the individual nature of that particular athlete. And if you don't do it that way, how do you know what's working? How do you know what the solution is? Right. If you're just throwing it all against the wall. So I think that's like with all, like you always, you're always fond of saying, you know, the best training sometimes is the simplest and most boring. And sometimes, you know, and I feel the same way about this. Like you don't want to just throw everything at it. I think you have to, you know, track things, identify the patterns, try to work the training with those patterns, just as you said. So you're not going to plan, you know, some hard, intense intervals on the days where, you know, the athlete is likely to feel really crummy or not have a lot of energy. And that it can be as simple as that. And then if it's, you know, if you do that and it's getting a little bit better and then you're looking somehow to find another, you know, another form of improvement, or you're not really seeing much improvement from that, then you've got to, you know, dig in a little deeper and see if there are a few other little things that are going to, to move the needle in the right direction.

Yeah. Like I said, I don't profess to know that that's like the right first step. I think that's a reasonable first step. And if anything, I might be a little, my athletes are probably, that are listening to this probably laughing their asses off because they could like, they probably, or at least my female athletes are laughing their asses off because they've experienced this. Normally I make the adjustments in really small increments. So it's, let's try this. Let's see how much better, worse, and different it is. And then let's try something else. And let's try. And when I'm talking like really small things, I'm talking about like moving two or three days of training from one week to the next week. Yeah. And then moving two or three more days of training from the next week to the following week. And it's only been very rare. I can probably count on one hand of the entire 20 years of coaching that I've done where I've had to take like the drastic, full blown measures. Like we're going to do ice baths and, you know, increase protein intake dramatically and, you know, flip flop the training every which way from Sunday and do strength training on these five days, but not on those five days. Like it's only been like really, really rare where I've had to like, let the, I'm going to, I'm going to use another really terrible saying that somebody's going to criticize me on, but like the, let the hormonal tail wag the training dog. It's only been really rare where I've had to do that over the, over the entirety of my coaching career. Not to say it's not out there because it obviously is, but I just think, I just think this layered approach is

the best, I guess is what I'm saying. Yeah. I think again, like you just don't want to make it too complicated. I think also, you know, for a lot of athletes, they're really nervous, right? To change things. Like if they've been doing things a certain way and they've been getting results for a certain amount of time. And sometimes probably that's why they're nervous to mention to their coach that they're experiencing something because they're afraid you're going to say, stop running. They're afraid they're going to, you're going to cut back their volume or cut back the, the, the harder intense workouts and things like that. They're afraid of change. So again, I think you always have to think about like, what's, what's, you know, the best approach is not always, you know, a lot of things, but like some small things. And if you, and then again, it's also gaining trust with the athlete, right? If you suggest the small change, just trust me on this, let's try it. And they feel better, then they are going to be more open or more receptive potentially to another type of change or intervention that you might suggest down the road, you know, that you see that might be beneficial to provide them some additional support. Yeah. It's a signal through the noise problem too, right? A lot of times when you're making a whole lot of changes in a small amount of time, there's too much noise to determine what the signal you're actually receiving. So it's always, like I said, it's always been this interesting proposition where as a coach, I can normally pick out what's going on right from the get go for, even from a social standpoint, like you can, you can usually pick it out from the get go. I mean, we have interactions with our athletes,

you know, weekly or, you know, every several days or something like that. And that normally comes before the admission of, okay, I'm always bad on these kind of on these particular days. Have you ever had an athlete Chantel where you have had to go through like several of those different iterations to find what the best setup for them is going to be? Myself as one example, but I've also had, I would say most of the athletes that I work with, we haven't had to go too far down the line. And, you know, I want to come back to, you know, what you were mentioning about, like some of the other interventions in terms of protein content and strength training, things like that, you know, having to rechange, change the whole structure.

I think probably some of the bigger changes happen in women that are maybe perimenopausal, because that's when even, you know, and a lot of those women are in a situation often where they've been on the oral contraceptive for a long time, they're thinking about getting off of it. They're having their body is going through some crazy shifts. And that's where you might have to dig a little bit deeper. But, but I would say, you know, aside from myself and one other athlete, you know, that where we had to make a lot of systematic changes, get some hormonal panels done, recognize that she had definitely a hormonal imbalance. And we had to really, we had to really scale training back until she got that a little bit more under control. But once she did, the difference was just astounding. It was like a different, totally different athlete.

Here's the way that I, that I can kind of stylize that after, you know, working with several, several women throughout all three of those stages, right? Throughout when they're having a normal menstrual cycle, perimenopausal and post postmenopausal is the training structure has generally shifted from lots of volume, some intensity, some strength training to moderate amounts of volume, proportionally more intensity, but spread out more and much more strength training. Like if you take that entire timeframe, you could summarize the change in that. And if you looked at it over the course of, let's just say four years, three or four years, that's the general description that you would apply to the changes in training that are, that are being made. But if you like drill down to any one month, it really wouldn't look all that much different from the previous month. Right. So we're talking about changes over a long period of time, not changes over a short period of time.

Yep. Yeah. And that's, and that's the thing, right? We're trying to, you know, in all cases, when we're working with athletes, we're trying to, we're trying to build, you know, stronger, resilient athletes, athletes that can, you know, not just be running for a couple of years, but running for a long time and running and for women, you know, being able to run healthily throughout the course of time, you know, regardless of what hormonal state their body is in. So paying attention to those things, you know, at various cycles and being on top of things and looking at those, those changes in their cycle throughout the month, that's going to be really important for an athlete, because if, if she's tracking these things and she's got, let's say, you know, five years of tracking and it's been really consistent. Now she's 38 and she's noticing things are not as, not as regular, or she's having a lot more brain fog as well. And other types of symptoms by tracking that, having all those records of time of, you know, she might be seeing some changes in training too. So having those records over time and being aware of how her body's functioning. And I think for a lot of women that aren't tracking these things, they don't have a sense of how their body is functioning. They don't have a sense of even how long their cycle is. I was just talking to my cousin last week, in fact, who's 38 and had no

idea that, um, that a menstrual, that her menstrual cycle was not 24 days, you know, and I worked with her to try to figure it out and figured out that she had like a super short, um, she had a super short, uh, luteal cycle compared to most other women. So it's just, you know, know your body, track things. And also, you know, for women working with a coach, communicating things and don't, you know, not being afraid to speak to your coach, even if they're a male coach, because if they're any good at what they do, they should be learning about this stuff too. Well, they should be that much in tune that they know that. What do you mentioned? We've mentioned tracking a few times. Let's throw out a few options for women that are out there and coaches that are out there listening of different ways they can either track them themselves or the coaches can kind of help their athletes track this stuff. So there are, um, there are a lot, I mean, you can, you can do it just with a calendar, you know, you can write it down on a calendar, just the old fashioned way.

Nobody has those anymore. Chantel, you're showing your age. Nobody has a physical calendar. People can, some people do, um, or they've, or even your Google calendar, you know, you can do it that way. Um, Garmin, the Garmin watches do have a feature and it will remind you if you, if you start tracking on your Garmin, um, connect app, it will remind you if you're not putting the information in, um, training peaks, a little clunkier, but they do in the training peaks metric function, you are able to put that information in. I'm really hoping, um, and if anyone from training peaks is listening, you've seen my, my notes on your site, um, asking if there's a way to somehow bring, cause it's, it's annoying if the athlete's tracking on Garmin, but the coach can't see it. And then you want them to track it in training peaks as well. Um, hopefully one day they will be linked. And then there's other, um, some other great apps out there that people can use and there's all kinds of them, but probably one that's really useful for active, uh, women is called fitter woman, F I T R woman. And fitter woman is a really awesome app. It's totally free, but it also has a lot of really great educational information about the menstrual cycle, um, about what might be happening in your body, um, at that particular time of the cycle. What are some things, you know, what are some symptoms you might experience and what are some lifestyle things that might help you feel better during those times. So it's a really awesome little app. As always, there's no financial

conflicts of interest with any of those. They're just good tools that we like, uh, yeah, good disclaimer. Yeah. We, so we use training peaks with our athletes on a day-to-day basis. I just command one of the, uh, uh, one of the blanking on the category that they, uh, the metrics, sorry, metrics. I'm having brain fog too. I'm about to turn 42. You should get your estrogen checked. Exactly. I should get a lot of checked. Let's put it that way. Um, I, I, I commandeer one of the, the notes fields are one of the metrics fields and just have people and just have a lot of my female athletes just numerically number, uh, the days of their cycle through their simple. And what's what, uh, one other thing I wanted to notice, uh, mention, um, about the fitter woman app is you, people can also put their symptoms in. So how their sleep was, uh, mood, things like that. So that's also helpful for tracking, but again, in training peaks, if you're not using fitter woman and tracking in training peaks, or I think in the Garmin connect app, you have this as well, where you can just put some other notes and sometimes, you know, tracking sleep is, is helpful for a lot of different reasons, obviously. And, uh, give some good correlation if you're tracking all, you know, all that stuff along the way.

Can I just say as an aside, I'm generally a curmudgeon with how many things that we have been able to track over the years as coaches. I mean, it used to just be miles, right? You had your training log and you showed how many miles you did and that was kind of about it. And now we have everything from heart rate variability to sleep and, you know, training stress scores and just on and on and on and on and on. I think this is one of the fields being able to track a woman's menstrual cycle that is practical, impactful, and something that should be widely adopted by almost all athletes, all athletes, critical. It's critical. Yeah. You don't have to have a lot of these other metrics. You don't have to have any metrics, but a lot of these things are far, far, far less useful, far less useful than simply tracking a menstrual cycle.

Absolutely. But it's invasive. People view it as invasive. That's why they're not, uh, as keen on tracking it or intimate, I guess. Yeah, but it's so silly. It's just like, it's, if you're a woman, you have a menstrual cycle or you should have a menstrual cycle unless you're, you know, peri or post-menopausal. So it's, it's, and that's, I think a big thing. And I, um, that I probably should mention is we need to get rid of the stigma because, you know, a menstrual cycle is, is just part of a woman's life. It's not something to be hidden or to be shamed about, or to be afraid to talk about because it's, it's no different from, you know, tracking your heart rate. It's a, it's a physiological metric, you know, to, to track.

I'm, I'm rather, I'm, I'm, I'm really happy to see a lot of women speaking out about this because, trust me, a lot of the male coaches, they've wanted this change to occur. They've wanted their female athletes to be like more open and honest about telling them about what's, you know, what's going on with their menstrual cycle. But for some reason, because coaching is such a male dominated profession and don't get me wrong. Coaching is a hugely male dominated profession. That's something that we have to work on as an industry is getting more, more women into coaching. That's another topic that for another podcast, but because it's been such a, such, so heavily influenced by men, they, I think most of them genuinely want to change it, but it's been this chasm that has existed for a while. And very fortunately, it's taken the female athletes to be like the leaders first to bridge that chasm. And finally, like the male coaches have been, I think, generally accepting and encouraging of their athletes to come, to come forward with this and start to break some of that stigma down.

Yeah, I'm really happy to see that too, you know, especially with the way, you know, particularly in our sport, you know, it's really growing the number of female athletes. So this is something that, that all coaches, male and female really need to know about and be prepared to talk about. And I think for male coaches, a good place to start is even just having an athlete, you know, ask an athlete to start tracking their cycle. That's always a good place to kind of open things up and explain why you're asking them to track it and think about it as, you know, just one other metric of, metric of information that we're trying to collect to look at you as an athlete. Because, you know, when you're, you have an athlete and you're, you're changing their training or you want to see how their training's doing, you would look at how it affects their sleep, right? If their sleep's being impacted from the change in the training, then you'd know that probably something's going on with the training load.

So this is no different if there's, you know, if you're, you're changing up the training or you're doing things differently, changing volume, et cetera. And there's a corresponding change in the menstrual cycle, then that's a, that's just another, you know, little flag. I'm not going to say a red flag, but a little flag to really look into things and figure in and figure out, you know, if there's, if there's a little missing piece there, because obviously it's, it's impacting that woman's body. Yeah. I used to, it's, so here's a good personal coaching anecdote that I'm sure a lot of the listeners will get a kick out of. I used to have to find some sort of creative way to insert into the conversation, Hey, I want you to track this. And it took me, I don't know, four, eight, 12 weeks of working with an athlete to like manipulate the conversation in such a way that, Hey, I want you to track your menstrual cycle. Now I just start out with it, like right out of the gate. These are the things I want you to track, upload your stuff from your, from your watch and track these metrics.

That's awesome. That's, and I think that's for, for any coach that's working with a new athlete. I think about like, when I start interviewing a new athlete and you want to learn about their history and learn about them, ask about their menstrual cycle. It should be one of your, one of your first conversations, you know, not in your, obviously not in your, uh, your, your intro, but you know, your first conversation that you're having with the athlete, where you're talking about their, their health, their, their home situation, their lifestyle stress, all those things. Menstrual cycles got to be on that top 10 list. A hundred percent. Definitely. A hundred percent. Like I said, I've been, it's been really refreshing to see that change over the course of, uh, over the course of my coaching career. And I couldn't say that statement in 2000, 2001, 2002 when I first, when I first started coaching, absolutely not. Not that it was, it was just awkward. It's not that we didn't want to talk about it. It's just that for whatever reason, we are idiots and we thought it was weird. Yeah. Which is weird to say now.

And, and I think, again, it comes back to, you know, I think slowly there's been a lot of great work from not only, um, women athletes, but also, uh, women's science, you know, scientists who are studying, not just studying in the background in their lab coats, but, you know, out there talking about it, you know, Stacy Sims is a, is a prime example. Um, and even, uh, one of the, one of her courses that I took, there were actually a couple of male, male coaches taking the course too, which is great. And I think a lot of other organizations doing a lot of work to try and, and take away the stigma and realize like, this is just, this is just the way it is. We have to talk about it. A hundred percent. You mentioned that you, uh, took one of these courses with, with Stacy. This, so this will be kind of a soft plug for her courses that, uh, uh, that, that she puts on related to the point that we need to get more women into coaching. What would you say the ratio of female coaches to male coaches in that, uh, in that course was slightly off topic, but I'm more just curious to know the answer to that. Well, it's, it's different than the regular female to male coach ratio out in the world, but I would in, uh, in her courses, we definitely were more women in the courses, but there were a couple of male coaches, um, which was, which was great to see. Um, and hopefully there will be more. Um, I remember seeing Stacy speak at the training peaks conference last fall, and it was really awesome to see how many male coaches were there in the audience, not just hiding in the background behind their book or something, but actually really

listening and really, um, getting engaged with asking questions and really wanting to, to learn how to be part of that conversation. Well, it's because female participation in endurance sports has been, uh, been on the rise. It's still not where it should be, but it's been on the rise and coaches have to, they definitely have to react to that. The reason I ask is we just went through this podcast will air after this process is done, but that's, it's inconsequential. We're going through a new hiring process right now for new coaches, as you know, Chantel. Yeah. I used to get like a 10 or 15 to one male to female ratio of incoming applicants, which make, it just made me want to pound my head against the wall. It was just so disproportionate. And now I'm getting about a six to an eight to one. So about double, if you want to think about it like that, double the number of female coach applicants. So it's changing slowly, but surely. Okay. All of that is aside, is an aside.

Right. Let's, let's get back to the salient points until let's kind of wrap this up. So all right, I will let you do the summarizing. We're going to put ourselves in the position of a female athlete or a coach working with female athletes. That's considering what the implicate, what the performance implications are of that athlete using an oral contraceptive. What are the big takeaways? So again, the, um, as I mentioned, the, the, if the outcome or the effects were pretty, pretty trivial. So a couple of things you can take from that is if it's trivial or a small effect, maybe you take a closer look if it's an elite athlete, because a small change in performance, you know, can, can be, can make the difference between first place and third place. Right. So who's your athlete. Yeah. Potentially more consequential at the elite level or where the margin of success or failure is very small, potentially more consequence to that. Okay.

That's a good one. Yeah. So, so for that, you know, thinking about, you know, whether to look into it a little deeper, deeper, that could be, that could be the one thing. And then the second thing is that, you know, if we think about the fact that, that, um, there is, you know, as we mentioned, um, there is a bit of a performance decline in that early, um, in that early follicular phase for the women on oral contraceptives. So if you're a woman and you're on a oral contraceptive and you're noticing that there's, you know, that you're not feeling so great in those first couple days, then you got to figure out, you know, is it a couple of days and you'd give yourself a little grace and you go a little easier, or are you feeling like more than two days out of the month, you're feeling really crummy, then look into it, you know, talk to your, talk to your doctor.

Maybe there's a better, um, pill for you, maybe a different, um, hormonal, um, hormonal, um, percentage or, or actual hormone itself. You know, is it a tribe, is it a two hormones or one hormone pill, et cetera, or should you consider some other form of birth control, like an IUD, or something else. And, you know, if, if you're not really noticing much change and you're health, healthy, otherwise, then that's your personal choice, you know, to, to stay the course and stay where you are. If you are, um, looking to go on a contraceptive, talk to your, again, talk to your doctor about it and do some research. You know, there's lots more information out there. Um, you know, you don't have to go rabbit holing and, and reading a hundred studies, um, or even, or even a meta analysis, but look into some information. You know, there's lots online.

Certainly Stacey Sims is a great resource to learn a little bit more about some of these things. Uh, but there's other ones, um, other researchers out there that are putting some things into a more digestible format, learn what your options are to, and then work with your doctor to figure out what the best option is for you. Uh, for all women, I definitely say track it, track it, track it. I can't say it enough. If you don't track it, you can't manage it. Track, not just your cycle, but track, um, how you're feeling around your cycle, energy levels, mood, sleep, weight, et cetera. Um, and see if you notice any particular patterns, if you notice a particular pattern and you can, you know, as you mentioned, uh, you know, taking it a little easier on those days when that's happening, that's completely fine. And, um, you don't have to make any broad sweeping changes necessarily unless they're warranted. How do you know the broad sweeping changes are more warranted?

Talk to your doctor, maybe get some hormonal testing, you know, because if there's the hormones should move unless you're perimenopausal, you know, your hormones should move in a predictable manner throughout the month. And every woman's cycle is going to be different. It could be 24 days, it could be 40 days. And the difference there could, you know, could make some impacts for some women in terms of how they feel. If you feel that something is not right, it may not be. So talk to your doctor, get some information and get things on, you know, get things into the proper balance. And you'll probably see some big differences. And if you're not having a period and you're not perimenopausal, not a healthy athlete, you got to get to the bottom of that and figure out what's, what's going on.

What a great summary, Chantel. Okay, so once again, the study is the effects of oral contraceptives on exercise performance in women, systematic review and meta analysis. This was in the journal Sports Medicine, and we accessed this in July of 2020. The links to that will be in the show notes. Chantel, if you want anybody to follow you on social media, where can they find you? I am pretty lazy on Facebook, but you can find me on Instagram at run telly run. Chantel has good Instagram photos of her dogs. True statement. They're always on your four wheelers and out in the snow. Yeah, she's my best athlete. Oh my gosh, it's so cool. All right, Chantel, thanks a lot. Really appreciate you coming on the show today. Thank you.

And there we have it. There you go. Thanks to coach Chantel for coming on the podcast today. Insightful as always. I hope everybody had a lot of fun with that and learned a little bit along the way. If you think that one of our CTS coaches is right for you to take your training to the next level. You've heard those coaches throughout the course of all of these episodes of the KoopCast. Go ahead. You can hit me up on social media and I can point you in the right direction. Or you can go to www.trainright.com and you can look at all of our coaching packages there. As always, I appreciate the heck out of each and every one of the listeners. And as always, we will see you out on the trails. Thanks to my video.