How your menstrual cycle could affect your injury risk

The menstrual cycle is a complex interplay of hormonal fluctuations that has far-reaching effects on a woman’s body.

Beyond its well-known influence on reproductive health, emerging research suggests a potential connection between the menstrual cycle and the risk of injuries in women.

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Hormonal changes

“During a women’s menstrual cycle, there are hormonal fluctuations, primarily involving estrogen and progesterone,” explains Rene Schickerling, who heads up Pharma Dynamics’ women’s healthcare division.

These hormones can impact ligament and tendon laxity, muscle strength and coordination.

Some studies suggest that women are most susceptible to injury during the ovulatory phase, while others associate the luteal phase (after ovulation), when progesterone levels are higher with an increased injury risk due to potential effects on neuromuscular control and ligament laxity.

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Women suffer more ACL tears

Schickerling points out that professional female athletes are more prone than men to suffer common sports-related injuries that in many instances impact and shorten their playing career.

“Female athletes are two to eight times more likely than men to tear an ACL, which is usually the result of a twisting of the leg while applying downward pressure. So too, ankle sprains, and stress fractures are more common in female athletes.

“Since 2021, at least 87 players from eight of the world’s top women’s soccer leagues have torn their anterior cruciate ligaments (ACLs). Soccer stars like the USA’s Catarina Macario, Dutch forward, Vivianne Miedema and England’s Beth Mead and Leah Williamson have all fallen victim to ACL injuries, which take 10 months or longer to heal. Well-known tennis player, Serena Williams has faced various injuries throughout her career, including knee and ankle issues.”

There is currently no consensus as to why ACL injuries are so prevalent in women, however experts suggest it could be due to differences in anatomy, biomechanics, neuromuscular control, training and conditioning, including hormones.

Some studies have suggested that ACL laxity changes throughout the menstrual cycle and eliminating the changes in oestrogen using oral contraceptives reduces the risk of ACL rupture.

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Contraceptives a possible cure

Schickerling explains hormonal contraceptives, such as birth control pills, regulate hormone levels in a woman’s body, including oestrogen and progesterone.

“These hormones can influence ligament and tendon laxity, which might affect injury risk. Oestrogen, in particular, is believed to play a role in maintaining ligament and tendon integrity and has shown a potential protective effect.”

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Individual differences

However, the relationship between hormonal changes and injury risk is complex and various factors can influence it, including individual variability, type of sport, training intensity, and more.

“It’s also equally important to note that every woman’s experience with her menstrual cycle is unique. The impact of hormonal contraceptives can vary among individuals due to differences in hormonal response, genetics and other factors. Therefore, it is not a one-size-fits-all solution,” continues Schickerling.

“If a female athlete is considering using hormonal contraceptives for potential ACL injury prevention, it is crucial that they consult with a medical professional, such as a gynaecologist or sports medicine specialist first. They will be able to provide personalised advice based on the athlete’s medical history, current health and athletic goals.

The field of sports medicine is continually evolving, and research on the relationship between hormonal contraceptives and ACL injuries is ongoing. New insights and recommendations may emerge as more studies are conducted.

While hormonal contraceptives might have a role to play, athletes should focus on a comprehensive injury prevention strategy. This includes proper strength and conditioning training, neuromuscular control exercises and technique refinement to reduce ACL and other injury risk.

“It’s important to keep in mind that injury risk is influenced by various factors. Hormones are just one piece of the puzzle,” she concludes.