Evaluating the Relationship Between Hormonal Cycle Regularity and Sports-Related Concussion Outcomes in Adolescent Athletes
ABSTRACT
Context:
Females sustain more sports-related concussions (SRCs) and report more severe symptoms than males. Up to 66% of female athletes within reproductive age report experiencing irregular menstruation. Evidence suggests a rapid post-concussion decrease in the sex-based hormone progesterone can increase symptom severity. No studies have examined pre-injury menstrual cycle regularity and SRC outcomes in adolescents.
Objectives:
Evaluate the association of hormonal cycle regularity and menstrual cycle phase with SRC symptom burden in adolescent athletes.
Design:
Cross-Sectional Study
Setting:
Clinical and outcomes data from the Carolina Concussion Consortium Registry (3CR).
Participants:
Adolescent athletes who sustained a SRC.
Main Outcome Measures:
Rivermead Post Concussion Symptoms Questionnaire (RPQ), Beck Youth Inventory-Version 2, Depression Subscale (BYI-D), Beck Youth Inventory-Version 2, Anxiety Subscale (BYI-A), Quality of Life in Neurological Disorders Short Form - Sleep Disturbance (NeuroQOL Sleep) and a modified version of the Cogstate Digital Cognitive Assessment (CogState).
Results:
Females reporting regular menstruation were at significantly increased odds of reporting more severe total SRC symptoms, affective, cognitive, depression-related, and anxietyrelated symptoms, and sleep problems compared to males (Ps ≤ 0.05). Females reporting irregular menstruation are at significantly increased odds of reporting higher levels of depressive symptoms compared to males (Ps ≤ 0.05). Females in the luteal phase of menstruation had significantly higher odds of experiencing more severe affective and cognitive symptoms compared to females in the follicular phase at the time of injury (Ps ≤ 0.05).
Conclusions:
Pre-injury menstruation regularity may be related to sex differences in SRC outcomes. Menstruation regularity may increase the odds of reporting more severe SRC outcomes and could be moderated by menstrual cycle phase at the time of injury. These results highlight the importance of considering hormonal levels at the time of injury when diagnosing and treating SRCs.
Contributor Notes