A Prospective Examination Of Abnormal Menstrual Patterns In Adolescent Female Athletes Following Concussion

Abstract

Retrospective studies suggest that brain injury may interrupt menstrual patterns in adult women via its effects on hypothalamic-pituitary function. Investigators have yet to evaluate the effects of concussion on menstrual patterns in adolescent athletes. Accordingly, menstrual status is not routinely assessed or managed following a concussion. PURPOSE: To prospectively compare menstrual bleeding patterns of adolescent athletes with a sport-related concussion (SRC) to those with an orthopaedic sport- related injury during the first 120 days following injury. METHODS: Female athletes ages 13-21 years with either a SRC (n=58) or orthopaedic sport-related injury (n=34) who presented to a concussion or sports medicine clinic within 30 days of injury were enrolled. Inclusion criteria included: greater than two years from menarche, regular menses, no use of hormonal contraception. Menstrual patterns were assessed for 120 days post-injury using a weekly text message link to an online survey inquiring about bleeding episodes each week. Response rate was 94% across all weeks. Abnormal menstrual patterns were defined by intermenstrual interval < 21 (short) or > 35 (long) days, or bleeding duration <3 days. RESULTS: A significantly higher proportion of menstrual patterns were abnormal following SRC (47/237, 19.8%) than orthopaedic sport-related injury (20/163, 12.3%) (OR 1.77, 95% CI 1.00-3.12, χ2= 3.96, p=0.047). Although a prolonged intermenstrual interval was the most common abnormality observed (49/67, 73.1%), menstrual patterns were 5 times more likely to be short following SRC (OR 5.05, 95% CI 1.13-22.5, χ2= 5.51, p=0.019). Female athletes with SRC were over 10 times more likely to have two or more abnormal bleeding patterns following injury (OR 10.5, 95% CI 1.13-59.69, χ2= 7.06, p=0.008). Among athletes with SRC, initial signs/symptoms of injury severity, neurocognitive testing, and vestibular/ocular screening were not predictive of abnormal menstrual patterns. CONCLUSIONS: Adolescent female athletes were at increased risk for abnormal menstrual patterns following SRC. Because abnormal menstrual patterns are likely associated with disruptions in ovarian estrogen production, monitoring menstrual patterns following SRC is warranted in order to avoid potential consequences of estrogen deficit.