How to tell if you’re in low energy availability if you’re on hormonal contraception

Is it possible to know if you’re in low energy availability while you’re using hormonal contraceptives? Since hormonal contraceptives can mask any menstrual cycle irregularities, it’s a fair question! Contraceptives like the pill can induce a ‘withdrawal bleed’ each month, which looks and feels just like a period, only it’s not the real thing. 

You can experience these withdrawal bleeds even if you’re in a state of low energy availability, meaning it’s more challenging to identify if you’re meeting your body’s needs, or experiencing menstrual irregularities or suffering from hypothalamic amenorrhea. 

There’s also no way to accurately test your natural hormone levels while you’re using hormonal contraceptives, adding to the complexity of the situation. With research showing that low energy availability can have negative impacts on so many facets of your health, including performance, energy levels, fatigue, bone health, and hormone production, it’s important to be aware of signs to look out for if you’re concerned about your own energy availability.

Accredited practising dietitian and sports dietitian, Taylor Wales-Ryan, has a few tips for identifying if you’re experiencing low energy availability while using hormonal contraceptives.

How do contraceptives impact your menstrual cycle and reproductive hormones?

Taylor says there’s strong evidence showing hormonal contraceptives suppress natural fluctuations in the production of women’s sex hormones, and keep progesterone and oestrogen levels consistently low.

“The pill introduces synthetic hormones into the body which suppress ovulation and natural hormone production. The bleed you get monthly is simply a withdrawal bleed, not a period,” she explains.

She says issues arise when people who use similar contraception methods don’t recognise this bleeding isn’t a true period.

“We need to educate hormonal contraceptive users about their withdrawal bleed and dispel the myth that this is a period, and a marker of reproductive health,” Taylor says.

When it comes to recognising abnormalities in your cycle while you’re using hormonal contraception, Taylor agrees that identifying hypothalamic amenorrhea (HA) or other health concerns becomes much more challenging.

“Generally, what causes HA is a suppression of the hypothalamic-pituitary-ovarian axis… This is very easy to identify before going down the pathway of additional tests if a woman has a natural cycle, as her period will be irregular or absent. Obviously this isn’t the case with the pill or hormonal contraception,” she says.

Taylor adds that measuring or tracking your energy intake and expenditure is also often inaccurate and misleading, making this a suboptimal way of determining whether you’re in a state of low energy availability.

“It’s important to work with a team of health professionals who can assist you in this area to ensure this isn’t going undetected!” she suggests.

“The problem is that most females are in a subclinical low energy state as it is. It’s very easy to fall into the trap of not eating enough daily, coupled with high training and life stress,” Taylor adds.

So what signs should you keep an eye out for? 

Long-term low energy availability can lead to the development of nutrient deficiencies, chronic fatigue, and a compromised immune system, Taylor says. She suggests looking out for the following acute and chronic symptoms of low energy availability if you’re on hormonal contraception and don’t have a normal menstrual cycle to guide you.

“Common acute signs of low energy availability include impaired performance, compromised immune system, reduced energy, weight loss, gastrointestinal problems, absent periods, recurrent illness or injury, decreased sports performance, mood changes, delayed/disordered growth or development in children and teenagers, and iron deficiency,” Taylor says.

More chronic symptoms include a reduced metabolic rate, difficulty gaining lean muscle mass, inability to achieve your body composition goals, infertility, and loss of bone mass density.

If you do decide to undergo further testing to identify whether you’re in a low energy state, there are other markers to look at.

Taylor suggests testing for, “Low vitamin D, low iron or risk of anaemia, cortisol levels, and a thyroid panel as well. Look for elevated total cholesterol and low-density lipoprotein cholesterol.”

She adds that Dexa scans can be useful to measure changes to your bone mass density, and stress levels – both of which are significantly impacted by HA and low energy availability. Taylor says abnormal metabolic hormone levels, such as insulin, cortisol, growth hormone, ghrelin, leptin and ketones, can also be strong indicators of low energy availability.

How can you ensure you’re getting adequate energy while using hormonal contraception?

Taylor says whatever hormonal contraception you choose to use is entirely your own decision, and should be based on your individual circumstances.

“It’s not at all uncommon for female athletes to be on the oral contraceptive pill, as a contraceptive or simply because it just makes life (ie. training & competing) more convenient. The pill can make cycles more predictable and easier to manage,” she notes.

“However, it’s important to understand your life stressors, your training stressors in particular, and monitor your food intake regularly to ensure you’re adequately fueling for your chosen sport or activity,” she urges.

Taylor says that while many individuals on hormonal contraceptives don’t experience HA, it’s important we all recognise the importance of adequately nourishing and fuelling our bodies so we can identify any red flags or warning signals as they arise. 

If you are experiencing some of the signs of low energy availability, there are some proactive actions you can take to give your body the nourishment it needs, such as increasing your energy intake, reducing exercise, or both. 

“Having interventions that address suboptimal practices related to energy spread over the day and around exercise sessions, dietary composition and food-related stress [is also essential],” Taylor says.

She says the most important factors to address are ensuring your energy intake is sufficient to support your training, daily activities and normal body function without compromising your health and performance.

Taylor also recommends keeping an eye on your intake of certain nutrients to support your body.

“[Make sure you’re getting] adequate calcium and Vitamin D to support bone health, and increase your calories and protein intake to support exercise and recovery. Ensure your carbohydrate intake is adequate to replenish glycogen stores used during training sessions. The more intense the training, the more carbs need to be consumed!” she says.

She also notes how important a positive relationship with food is. “It’s really important to work with a team of health professionals who specialise in this area to ensure you’re not at risk of long-term health consequences,” she adds.

So, while hormonal contraception can make it far more difficult to identify if you’re suffering from hypothalamic amenorrhea or low energy availability, there are some warning signs and signals you can keep an eye on. These can help you be sure you’re giving your body adequate fuel and energy to perform optimally and feel its best.

If you’re struggling to properly nourish your body, or feel “stuck” in rigid patterns, habits and rules around food and exercise, join us today in Recovery Club – you’ll get all the tools, strategies and support you need to take control of your recovery journey, and learn how to give your body what it needs!

If you want to hear more from Taylor Wales-Ryan, or work with her, you can find her at her website here, or over on Instagram at @the_sportsdietitian