Menstruation Doesn’t increase Injury Frequency in Elite Women’s Football, But Prolongs Recovery
Table of Contents
A recent paper published in teh journal Frontiers in Sports and Active Living examines injury rates in elite women’s footballers during the days of bleeding (the early follicular phase), when ovarian hormone levels are expected to be low.
Hormonal shifts raise questions about injury risk
Menstrual bleeding results in the loss of one milligram of iron per day, over a period of 4 to 8 days each cycle.This can lead to iron deficiency, which reduces the training load, weakens endurance, and slows recovery. Muscle health, post-training recovery, inflammation, and neuromuscular performance are other areas that may be susceptible to fluctuations in hormones during the menstrual cycle.
Much prior research has focused on tracking injury risk across the menstrual cycle. Conflicting findings from earlier studies make it challenging to determine whether any specific menstrual cycle phase increases the risk of injury. The difficulty lies in the need for invasive testing to identify each phase by hormonal measurements accurately.
such knowledge woudl shape safe and optimal training and recovery strategies to protect the health of women athletes and prevent injuries where possible.
four seasons of injury and cycle tracking
The study included 33 players from a single professional Spanish team. They where tracked over four seasons, from 2019-20 to 2022-23, during which they won two UEFA women’s League titles. None of them were on combined oral contraception, and all were menstruating during the study period.
While 17 players were included in the first season, the second and third seasons had 20 and 18 players, respectively, and the last had 22. There were eleven players tracked through all four seasons.
Their cycles were charted using a digital calendar, with a mean length of 31 days. The average number of bleeding days was four, accounting for 13 % of the entire cycle. Only bleeding days were counted as early follicular phase days for this study; the rest were documented as non-bleeding days.
This classification was used since no hormonal measurements were available, and menstruation is the only phase in which ovarian hormone concentrations can be inferred with relative confidence.
Injuries were documented and classified with the Orchard Sports Injury Classification System (OSICS-10) codes.
Injury severity was reported by the number of time-loss injuries, injuries that led to absence
Summary of Key Findings from the Study on Menstrual Cycles and Injury in Elite Women Athletes:
Here’s a breakdown of the key takeaways from the provided text:
* Injury Frequency is Unchanged: The study found no statistically notable increase in the incidence of injuries during menstrual bleeding days. Injury rates were comparable to other phases of the cycle.
* Injury Impact is Higher: Though, injuries sustained during the bleeding phase resulted in a substantially higher burden of lost training/playing days. Specifically, soft tissue injuries during bleeding days caused roughly three times as many lost days compared to other phases.
* Ligament Injuries Drive Lost Days: While ligament injuries occured less frequently than muscle injuries, they resulted in a much higher median number of lost days (29 vs. 8.4). Crucially, two out of four cruciate ligament injuries happened during the bleeding phase.
* Moderate Injuries Cause Most Lost Time: Although severe injuries were less frequent,moderate injuries contributed to the greatest total number of days lost.
* Possible Explanation: Estrogen Levels & Recovery: The authors suggest lower estrogen levels during the early follicular phase (including bleeding days) may contribute to this increased impact. Low estrogen is linked to increased muscle damage, DOMS, and slower recovery. However, they caution this isn’t the whole story.
* Other Contributing Factors: Symptom severity, fatigue, training load, nutrition, and recovery practices likely also play a role, autonomous of hormonal fluctuations.
* Importance of Tracking: The study strongly suggests that individualized menstrual cycle tracking is important for injury prevention and athlete health management.
* Need for Further Research: The authors emphasize the need for larger studies using objective hormonal measurements (not just calendar tracking) and broader physiological data to refine training and recovery strategies for female athletes.
In essence, the study doesn’t suggest women are more likely to get injured during their period, but that when they do get injured during that time, the injuries tend to be more severe and require longer recovery periods.