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Lifting on hormonal birth control

By Chris Ayers 5 min read

If you take the pill and you lift, you have probably wondered whether one is quietly working against the other. The question comes up a lot, and it has a better answer than most cycle questions, because two meta-analyses have looked straight at it.

What the 2020 review found

A 2020 systematic review and meta-analysis in Sports Medicine by Elliott-Sale and colleagues pulled together 42 studies with 590 participants, comparing women on oral contraceptive pills with women who were naturally menstruating.

Their summary: “OCP use might result in slightly inferior exercise performance on average when compared to naturally menstruating women, although any group-level effect is most likely to be trivial.” They also found that “exercise performance was consistent across the OCP cycle”, meaning the active pill days and the break days looked about the same. Most of the included studies, 83%, were graded moderate, low or very low quality. The authors concluded that “the current evidence does not warrant general guidance on OCP use compared with non-use.”

So: a possible slight dip on average, most likely trivial, from mostly lower-quality studies, and in the authors’ view no basis for general guidance on using the pill or not.

What the 2024 review found about gains

Performance on a given day is one question. Whether you build muscle and strength over months is another, and for lifters it is the one that matters. A 2024 systematic review and multilevel meta-analysis in Sports Medicine by Nolan and colleagues looked at exactly that. Eight studies, 325 participants, all comparing women who trained with weights while on the pill against women who trained without it.

The pill had no significant effect on hypertrophy, power or strength. The authors wrote that there is “no evidence-based rationale to advocate for or against the use of OCPs” when it comes to training gains.

There are two limits. The authors note that every included study looked at the oral pill, with no other form of hormonal contraception, so the review cannot tell you anything about the implant, the hormonal IUD, the injection, the ring or the patch. And eight studies is not many. The authors suggested an individual approach that considers how a person responds to the pill, why she uses it and her menstrual cycle history.

Other methods

The evidence for methods other than the pill is thin. The one year-long study I know of that logged them is the FENDURA project (Journal of Sports Sciences, 2025), which followed 58 endurance athletes, some using hormonal contraception, through a year of logging. Implant users reported less severe symptoms than hormonal IUS users and non-users. Users of a hormonal IUS reported better sleep quality and readiness to train than non-users.

Those are self-reports from a small group of endurance athletes, not strength measurements, and the authors’ advice was to adjust recovery “on an individual basis”. I would not build a plan on them. They are worth knowing because they are nearly all there is.

So does birth control affect strength training?

On the best available evidence, not by much. A possible trivial dip on average in day-to-day performance, and no detectable difference in the muscle, power or strength you build from training. That is about as reassuring as exercise science gets, with the caveat that it is almost entirely about the pill.

None of this is a reason to start, stop, switch or choose a contraceptive. Those are questions for you and your doctor, and the research above was not designed to answer them. It was designed to answer whether lifters on the pill are at a disadvantage, and the answer was: not in any meaningful way.

What changes in the app

I built Ferrabelle around natural cycles first, and my accuracy page says plainly that hormonal birth control “changes what prediction means” and that ovulation-based prediction “does not apply the same way”. I did not want the app to pretend otherwise.

So there is a hormonal birth control mode. When you pick it, you tell the app which method you use: combined pill, progestin-only pill, hormonal IUD, implant, injection, ring, patch or other. Predictions and phases turn off, and the Cycle screen says so: “Predictions are off.” Instead of periods you log bleeds, plus how you feel. The Fe Score keeps running from your sleep, stress and recovery, with the cycle phase input dropped and the other weights rebalanced. The doctor report leaves cycle lengths out, since they would not mean the same thing.

The research card in the app for this mode lists the findings above, and also lists what they cannot tell you: that nearly everything studied is the pill, and that results varied between studies, so they cannot say how your own method affects your training. I would rather the app say “we do not know” than fill the gap with a guess.

One more line the app repeats, and so will I: this mode only changes what the app shows. Ferrabelle does not help prevent pregnancy, and it is not a contraceptive.

This is general information, not medical advice. Talk to your doctor about your own health.

Ferrabelle is in a closed test on Google Play right now. If you want to try it, you can join at ferrabelle.com/testers.

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