Women use contraception for many reasons. Many options are available, which provides the best selection for each woman. Be informed about the different types and reasons to use contraception and have regular check-ups with your primary care physician (PCP) or gynecologist (ObGyn) to safeguard your health, periods (menses), relationships, and tennis performance.

KNOW YOUR FLOW

The frequency of a woman’s menstrual cycle can vary. The following changes in the menstrual cycle require a medical examination (especially when using hormonal contraceptives): periods occurring
more often that 21 days, time between periods longer than 45 days, period length exceeds 7 days, change in the regularity of your cycle, no periods for 3 consecutive months, and older than 14 years old and no menstrual history. Low levels of estrogen, which can result in irregular menstrual periods, may cause lower bone density, which increases the risk of osteoporosis and bone stress fractures
and can negatively affect the ability to get pregnant.

Closely monitor any menstrual cramps or pain you experience. While these may be normal side effects of your menstrual cycle, prolonged pain or bleeding may be a sign of a more serious condition.

Dysmenorrhea is painful periods. It is the most commonly reported menstrual disorder. Over 5% of women report menstrual pain a couple days per month. Primary dysmenorrhea is pain that comes from having a period; secondary dysmenorrhea is caused by a reproductive system disorder, it usually gets worse over time and starts later in life. Dysmenorrhea can be effectively treated with over the counter (OTC) pain medicines or with hormonal birth control (BC) methods.

Chronic pelvic pain is pain in the pelvic area that lasts over 6 months. The pain can be cyclical, constant, or associated with certain activities such as eating, sex, or urination. Chronic pelvic pain has a variety of causes, including medical conditions of the reproductive organs, the urinary tract, bladder, bowel, or a combination of these. OTC pain medications, physical therapy, and nutritional therapy can assist to reduce chronic pelvic pain. Unexplained prolonged or severe pain should be evaluated by a medical provider to determine cause and specific treatment.

Endometriosis is a condition in which the tissue which lines the uterus grows outside the uterus, which increases the risk of infertility. It affects about 10% of women and is most common in women in their 30s and 40s. The most common symptom of endometriosis is pelvic pain that occurs before and during the menstrual period. Pain may also occur during sex, urination, or bowel movements. Some women with endometriosis have no symptoms, so regular visits to the gynecologist or PCP are important to detect it. Over the counter pain medicine and hormonal forms of birth control can
alleviate some symptoms of endometriosis. Occasionally, surgical treatment is required.

Heavy menstrual bleeding occurs in about 30% of women. It is not normal and may indicate a more serious condition. Heavy bleeding is caused by many factors. It can cause anemia due to iron loss in the blood. Bleeding is ‘heavy’ when:

  • It exceeds 7 days
  • Saturates more than one tampon/pad every hour for several consecutive hours
  • Need to change pad/tampon overnight
  • Need to wear more than one pad at a time to absorb flow
  • Menstrual flow with blood clots that are equal to or
    bigger than 1.5 cm (3/4 inch) diameter

See your PCP or gynecologist for an evaluation and probable ultrasound exam to determine the cause and treatment.

Pelvic inflammatory disease (PID) is a common infection of the female reproductive organs caused by exposure to bacteria during sexual activity. Two Sexually Transmitted Infections (STIs), gonorrhea and chlamydia, are the main causes of PID. Women under the age of 25 are more likely to develop PID. If left untreated it can lead to long term serious effects, such as infertility, ectopic pregnancies and chronic pain. Symptoms can be vague, so it may be challenging to diagnose. Symptoms include lower abdominal pain, pain during sex and vaginal discharge.

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder affecting women of reproductive age. Its cause is unknown. Symptoms include: irregular menstrual cycles, prolonged periods, increase androgens (male hormones) and enlarged ovaries. An increase in acne, facial hair changes to metabolism, weight gain and infertility result from PCOS.

TYPES OF CONTRACEPTION

When choosing contraception, it is important to consider several factors: efficacy, ease of use, protection against STIs, prescription versus OTC and most importantly, relevant medical history. Consult an ObGyn or PCP before starting any prescription birth control regimen and monitor possible side effects.

BARRIER METHODS

Barrier methods prevent the man’s sperm from reaching the woman’s egg. These methods are easy to use and available OTC, but they are less effective at preventing pregnancy, with 18% to 28% of women using barrier methods becoming pregnant. Proper use is vital to enhance effectiveness. These methods can be used alone or with other forms of contraception. The ONLY barrier methods to prevent against STIs are condoms.

Type Information Potential Side Effects/Items to Consider
Spermicide Chemical that inactivates sperm
  • Can result in allergic reaction, burning, or vaginal irritation
Condoms Physical barrier that prevents the sperm from entering the uterus and reaching an egg There are male and female condoms. Using both a condom and another form of contraception is the best way to protect against pregnancy and STIs.
  • Possible allergic reaction to latex or polyurethane
Sponge Round device made of foam that contains spermicide
  • Less effective if you have previously given birth
  • Can result in vaginal burning, irritation, or allergic reaction
  • Do not use during your period or if have a history of toxic shock syndrome
Diaphragm Small, dome shaped device made of silicone or latex that is inserted into the vagina and covers the cervix. It can be individually sized or obtained as a one-size which fits most women Must be initially fitted by healthcare professionalCan increase the risk of urinary tract infection (UTIs)Can result in vaginal burning, irritation, or allergic reaction
Cervical Cap Small plastic dome that fits tightly over the cervix
  • Must be initially fitted by healthcare professional
  • May cause vaginal irritation or odor

https://www.acog.org/Patients/FAQs/Barrier-Methods-of-Birth-Control-Spermicide-Condom-Sponge-Diaphragm-and-Cervical-Cap?

COMBINED HORMONAL BIRTH CONTROL (BC)

Combined hormonal birth control is a prescription only medicine which contains synthetic forms of two hormones: estrogen and progesterone. These hormones prevent pregnancy by stopping ovulation. If used consistently and correctly fewer than 1% of women will become pregnant in the first year of using BC. Possible side effects include headache, nausea, breast tenderness, and breakthrough bleeding. Most forms of combined hormonal birth control are Tennis Anti-Doping Program compliant both in and out of competition, but athletes should always be vigilant and check with TADP.

Type

Information

Pros

Cons/Potential Side Effects

IUD

Small t-shaped plastic device inserted into the uterus. Two types: hormonal (progestin, used for 3-5 years) or copper (used up to 10 years)

  • Inserted by your doctor in simple in-office medical procedure at any time during menstrual cycle, but easiest during period.
  • Recovery time is minimal
  • Can be inserted immediately after abortion, miscarriage, or pregnancy
  • Helps decrease menstrual pain and bleeding. Menstrual bleeding may stop completely in some women.
  • Copper IUD is the most effective form of emergency contraception
  • With copper IUD painful periods and bleeding may increase during the first months of use
  • Complete STI screens PRIOT to IUD insertion
  • Pelvic inflammatory disease (PID) after implantation is very rarely but may result. Women with undiagnosed STIs at the time of insertion are more likely to develop PID
  • An IUD itself does not increase the risk for PID

Birth Control Implant

Flexible plastic rod inserted under the skin in the upper arm. It releases progestin into the body and can be kept for 3 years.

  • Can be inserted immediately after abortion, miscarriage, or pregnancy
  • Reduces pain during menstrual cycle
  • Short-term pain at insertion site, so may want to avoid during competitive tennis season
  • Possible side effects include: digestive difficulties, headaches, breast pain, weight gain, and acne
  • More frequent and longer periods; however, in many women periods are less frequent or stop

https://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-Intrauterine-Device-and-Implant?

Annual women’s’ health examinations by a gynecologist or PCP are important for all women over 18 years of age, even when NOT sexually active. These visits provide important information regarding periods, vaccinations against STIs, contraception, pregnancy guidance, and other information about women’s sexual health. Please speak with your PCP or gynecologist for more information.

TO PROTECT, PREVENT, AND HEAL
THE POWER OF EXERCISE IS REAL!

The contents of the Health site are for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice. ?The materials herein?are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. Reliance on any information provided herein is solely at your own risk.

A special thanks to our authors, Dr. Walter Taylor, WTA Medical Advisor, and Lisa Pataky, WTA PHCP

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