The menstrual cycle, a fundamental physiological process in women, affects performance, neuromuscular control, metabolism, and immune response. For professional female athletes, hormonal fluctuations throughout the menstrual cycle could influence the risk and severity of injuries. Recent research from Spain and the UK delves into whether menstruation determines injury incidence or severity among professional female football players, with findings published in Frontiers in Sports and Active Living.
Dr. Eva Ferrer, a sports medicine expert at Sant Joan de Déu Hospital and a female health specialist at the Barça Innovation Hub in Barcelona, explained, “We show that menstruation itself does not increase how often injuries happen.” However, she noted,
“Although athletes were not injured more often during their period, the injuries that happened during menstruation caused three times more days lost than injuries occurring at other times of the cycle.”
On the Bench: Study Insights
Over four seasons, from 2019/20 to 2022/23, researchers monitored self-reported menstrual cycle data from 33 elite football players in Spain’s top league, Liga F. Out of these, 11 players participated throughout all four seasons. The athletes documented bleeding and non-bleeding days, the only phases reliably identifiable without blood hormone testing. The study recorded 852 menstrual cycles and 80 lower limb injuries, with 11 injuries occurring during menstrual bleeding phases.
The findings revealed a significantly higher injury burden during bleeding phases, indicating a greater impact of injuries during menstruation. Soft tissue injuries, affecting muscles, tendons, and ligaments, were notably more severe.
Injuries sustained during bleeding days resulted in 684 days lost per 1,000 training hours, compared to 206 days during non-bleeding days.
Hormonal Influences and Injury Severity
Injuries arise from multiple factors, and hormonal influences are not the sole cause. Dr. Ferrer noted, “Hormonal levels may not cause the injury, but they may influence how severe the injury becomes and how long recovery takes.” Low estrogen levels can impair muscle repair, while increased fatigue, pain, and sleep disturbances can alter neuromuscular control. Additionally, iron loss can reduce endurance, and heightened inflammation during menstruation can exacerbate tissue damage.
To mitigate injuries during menstruation, small adjustments can be beneficial. “Small modifications such as longer warm-ups, adjusted high-speed workload, or added recovery support may help reduce the severity of injuries if they occur,” Ferrer suggested.
Beyond the Football Field
The study’s implications extend beyond professional football. Women who exercise can adapt their training schedules according to their menstrual cycle phases. “You do not necessarily need to avoid training during your period, but you may need to adapt it,” Ferrer advised. Tracking menstrual cycles and symptoms can guide training intensity and recovery strategies.
While the athletes in the study followed consistent injury prevention protocols and had access to professional medical support, the results may not be universally applicable. Participants were from the same club, and the unequal distribution of bleeding and non-bleeding days could limit the statistical power to detect incidence differences. Additionally, the study did not measure hormone levels or external factors like stress, sleep, and nutrition. Nonetheless, the significant difference in injury burden highlights the need for further research.
Advancing Female-Specific Sports Science
The study underscores the importance of individual menstrual tracking, at least with a calendar-based method, for injury prevention. It marks a significant step toward integrating menstrual cycle awareness into athlete health monitoring. “It supports a growing movement toward female-specific sports science instead of applying male-based research models to women,” Ferrer concluded.
As the conversation around women’s health in sports continues to evolve, such research is crucial for developing tailored approaches that consider the unique physiological processes of female athletes. The findings not only advance scientific understanding but also empower women to make informed decisions about their training and health.
