Sports Medicine Research: In the Lab & In the Field: Concussions May Be Cramping Young Women’s Menstrual Patterns (Sports Med Res)


Monday, July 31, 2017

Concussions May Be Cramping Young Women’s Menstrual Patterns

Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women

Snook ML, Henry LC, Sanfilippo JS, Zeleznik AJ, Kontos AP. JAMA Pediatrics. 2017; ahead of print.

Take Home Message: Young women may have an increased risk of multiple abnormal menstrual patterns after a concussion.

Girls experience higher rates of sport-related concussion and tend to have worse concussion outcomes compared with male counterparts in similar sports. Concussions may also disrupt the neuroendocrine-pituitary-ovarian axis, which manages the menstrual cycle, and lead to menstrual dysregulation such as irregular bleeding habits. Early identification of menstrual irregularities is vital due to the irreparable damage it can have on an athlete’s body (decreased bone density). However, researchers and clinicians have yet to appreciate the role of concussion on menstrual patterns. Therefore, the authors tested whether menstrual patterns differed between 68 women who suffered a concussion (~16 years of age) and 61 women with an orthopedic injury (~17 years of age) for 120 days’ post injury. The athletes were included if they reported to an outpatient sports medicine clinic between 2014 to 2015, were 2 years postmenarche and reported regular menses for 2 years, no pregnancy, and did not use hormonal contraception in the prior 6 months. Following confirmation of injury, the patients completed a questionnaire, which included questions about their menstruation and sexual history. Then, the authors sent weekly text messages for up to 120 days after the injury to answer 4 main questions: 1. Did they experienced any bleeding episodes, and if so when did it begin, 2. Did they experience a new injury, 3. Did they start or continue any hormonal contraception, and 4. Could they be pregnant. The authors evaluated answers to define abnormal menstrual patterns (short intermenstrual intervals of less than 21 days; long intermenstrual intervals of 35 or more days, or bleeding less than 3 days or more than 7 days). The authors found that 24% of athletes who had a concussion experienced 2 or more abnormal menstrual patterns during the study compared with only 5% of athletes who had an orthopedic injury. Despite similar gynecologic age, body mass index, and type of sports participation between groups, the risk of 2 or more abnormal menstrual bleeding patterns after injury was almost 6 times higher among athletes with concussion than among those with an orthopedic injury.

This was the first study to prospectively characterize abnormal menstrual patterns after concussion in young women. The authors found that a young woman with a concussion is at greater risk of multiple abnormal menstrual patterns compared with an athlete with an orthopedic injury. These results suggest that a concussion could lead to a disruption of the neuroendocrine-pituitary-ovarian axis, which could lead to problems later in life. It should be noted that none of the athletes developed amenorrhea. It should also be noted that these menstrual cycles were subjectively reported and there was no confirmation with hormone levels. The authors also did not assess if there are long-term changes such as bone density problems after this disruption. However, the authors noted that the American Academy of Pediatrics and American College of Obstetricians and Gynecologists recommend clinicians consider the menstrual cycle as a vital sign in adolescents because estrogen is important in bone health and other tissues. Therefore, due to the ease and low risk of subjectively assessing menstruation it may be beneficial for clinicians to follow up with the athletes regarding their menstrual cycles. Additionally, parents and athletes should be educated about these menstrual changes that could arise following a concussion, so they may report any changes to their athletic trainer. If clinicians detect these menstrual abnormalities and refer the patient for evaluation and treatment it could have a major benefit to the patient’s long-term health.

Question for Discussion: Do you monitor menstrual cycles following an injury? Has an athlete ever reported a change in menstruation due to an injury?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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