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Menstrual disorders are frequent in female athletes, especially those participating at the elite level. Factors which may contribute to impaired ovarian function in athletes include high training volumes, eating disorders and/or low body weight, which in turn may interrupt GnRH signaling. Hormonal contraception may disguise underlying menstrual disorders, and athlete use of such approaches is common, despite limited data on whether hormonal control has positive, neutral or negative effects on athletic performance. To determine the prevalence of hormonal contraceptive use, as well as the prevalence of menstrual disorders, in New Zealand elite female athletes, we completed a national internet-based survey of 219 participants being supported by High Performance Sport New Zealand. The survey aimed to characterize the demographics, health and athletic performance history, the training load and contraceptive use. We found that athletes were training intensely, with 38% reporting training volumes of >70 hours/month. At the youngest age represented (15-19 years), 72% had been in competitive sports for more than 5 years, suggesting a young gynecological age is represented by the cohort. More than half (58%, 127/219) of the surveyed athletes reported diagnosed illness or injuries. Stress fractures (39% 50/127), concussion (31%, 39/127) and asthma (26%, 33/127) were the most common diagnoses, followed by oligo/amenorrhea (20%, 26/127), reduced energy deficit syndrome (9%, 17/194), endometriosis (8%, 16/194), and polycystic ovary syndrome (5%, 9/194). Oligomenorrhea was significantly associated with stress fracture (p=0.018) and disordered eating (p=0.009). More than 50% of athletes tracked their menstrual cycle, and self-reporting showed even higher rates of oligo/amenorrhea 37% (29/79) in athletes not using hormonal contraception. Self-reporting also indicated a high prevalence of other menstrual disorders including delayed menarche (21%,43/207), menorrhagia (30%, 60/203), and dysmenorrhea (32%, 66/203). In athletes reporting menorrhagia, there was a significant association with iron deficiency (p=0.026). Of the 219 athletes, 37% were currently using hormonal contraception, of which the oral combined pill was the most popular (64%). The most commonly cited reason for hormonal contraception was birth control, however athletes used hormonal control to manipulate either the frequency (38%) or the symptoms (29%) of menstruation, particularly around competition. The data clearly suggests that there is likely to be significant undiagnosed gynecological pathology in elite female athletes. Hormonal contraception can mask gynecological health issues and themselves can lead to side effects that affect performance. It remains that health issues, especially those related to gynecological health, need to be considered by athletes, their coaches and medical support staff.