The menstrual cycle, a fundamental physiological process in women, influences various aspects of physical performance, including neuromuscular control, metabolism, and immune response. For professional female athletes, hormonal fluctuations throughout the menstrual cycle may significantly affect the risk and severity of injuries. Recent research by teams in Spain and the UK has explored whether menstruation affects injury incidence or severity among professional female football players. Their findings, published in Frontiers in Sports and Active Living, reveal critical insights into the interplay between menstruation and sports injuries.
“We show that menstruation itself does not increase how often injuries happen,” said Dr. Eva Ferrer, the study’s first author and a specialist in sports medicine at Sant Joan de Déu Hospital and the Barça Innovation Hub in Barcelona. “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: Tracking Menstrual Cycles and Injuries
Over four seasons, from 2019/20 to 2022/23, researchers monitored self-reported menstrual cycle data from 33 elite football players competing in Spain’s top women’s league, Liga F. Eleven players participated in all four seasons. The players recorded both bleeding and non-bleeding days, the only reliably identifiable phases of the menstrual cycle without blood hormone testing. In total, 852 menstrual cycles and 80 lower limb injuries were documented, with 11 injuries occurring during menstrual bleeding phases.
The study’s findings indicated a significantly higher injury burden during bleeding phases, suggesting that injuries sustained during menstruation were more severe and required longer recovery times. For instance, the burden of soft tissue injuries—affecting muscles, tendons, and ligaments—was over three times higher during bleeding days compared to non-bleeding days, with
684 vs 206 days lost per 1,000 training hours, respectively.
Understanding the Hormonal Influence
Injuries result from multiple factors, and hormonal influences alone do not solely cause them. “Hormonal levels may not cause the injury, but they may influence how severe the injury becomes and how long recovery takes,” Ferrer explained. Low estrogen levels can impede muscle repair, while increased fatigue, pain, and sleep disturbances may alter neuromuscular control. Additionally, iron loss during menstruation can reduce endurance and slow recovery, and heightened inflammation during this time can exacerbate tissue damage.
To mitigate injuries during menstruation and lessen their impact on players’ health, 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 pointed out.
Implications Beyond Professional Football
The research team emphasized that their findings have broader implications beyond professional football. Women who engage in regular 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 your cycle and symptoms can help guide training intensity and recovery strategies.”
While the athletes in the study adhered to consistent injury prevention protocols, had access to professional medical support, and trained under standardized methods, the results may not be directly applicable to all female football players, given that all participants belonged to the same club. The unequal distribution of bleeding and non-bleeding days, four against 27 in a month, could limit the statistical power to detect differences in incidence. Furthermore, no hormone measurements were conducted, and external factors such as stress, sleep, nutrition, and symptom severity were not assessed. Nonetheless, the observed trends, coupled with the significant difference in injury burden, underscore the need for further research, the authors asserted.
Advancing Female-Specific Sports Science
The study also underscores the importance of individual menstrual tracking, at least using a calendar-based method, for injury prevention. It represents a crucial step towards 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,” concluded Ferrer.
As the understanding of the menstrual cycle’s impact on sports injuries deepens, the sports community can better support female athletes in optimizing their performance and health. The research invites further exploration into personalized training and recovery strategies, paving the way for more inclusive and effective approaches in sports science.
