Menstrual Cycle Function Following Concussion In Adolescent Patients

Abstract

Purpose: This study sought to describe menstrual cycle patterns in acutely concussed adolescents and to investigate if cycle phase at injury influenced post-concussion cycle pattern changes or symptom endorsement. Methods: Data were collected prospectively from patients aged 13-18 years presenting to a specialty care concussion clinic for initial visit within 28 days of concussion and a follow-up visit 3-4 months post-injury. Primary outcomes included changes in menstrual cycle pattern since injury (change/no change), menstrual cycle phase at time of injury, calculated using date of last period prior to injury, and symptom severity, measured by the Post-Concussion Symptom Inventory (PCSI). Fisher’s exact tests were used to determine the association between menstrual phase at injury and change in cycle pattern at follow-up. Multiple linear regression was used to determine if menstrual phase at injury was associated with subsequent PCSI symptom severity, adjusting for age. Results: Five hundred ninety-eight post-menarchal adolescents were enrolled (mean age 15.4 ± 1.4 years) with 136(22.7%) returning for follow-up. At time of injury, 108(18.9%) were in the menstruation phase, 269(47.0%) were in the follicular phase, 105(18.4%) were in the early luteal phase, and 90(15.7%) were in the late luteal phase. Menstrual pattern change was reported in 4% of patients at initial visit and 12.5% of patients at follow-up. At 3-4 months, menstrual phase at injury was not associated with menstrual cycle changes (p = 0.18) but was associated with PCSI severity (p = 0.03). Patients injured in the early luteal phase reported the highest symptom severity at follow-up. Conclusions: One in eight adolescents reporting to clinic at 3-4 months post-concussion had experienced a change in menses. Menstrual cycle phase at time of injury was associated with post-concussion symptom severity, but not a change in menstrual pattern. Leveraging the largest study sample of post-concussion menstrual patterns to date, this study represents important foundational data regarding potential hormonal effects of concussion in adolescents. Supported by NIH R01NS097549 and T32NS043126