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 cycle could significantly influence the risk and severity of injuries. A new study by researchers in Spain and the UK has shed light on this issue, examining the relationship between menstruation and injury severity in professional female football players. The findings, published in Frontiers in Sports and Active Living, reveal that while menstruation does not increase the frequency of injuries, it does lead to more severe injuries.
Dr. Eva Ferrer, the study’s first author and a sports medicine specialist at Sant Joan de Déu Hospital, emphasized the implications of the findings. “We show that menstruation itself does not increase how often injuries happen,” she stated. “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: A Closer Look at the Study
Over four seasons, from 2019/20 to 2022/23, the research team monitored self-reported menstrual cycle data from 33 elite football players in Spain’s top league, Liga F. Eleven players participated in all four seasons, logging bleeding and non-bleeding days—phases of the menstrual cycle identifiable without blood hormone testing. The study recorded 852 menstrual cycles and 80 lower limb injuries, with 11 occurring during menstrual bleeding phases.
The results indicated a significantly higher injury burden during bleeding phases, suggesting a greater impact of injuries during menstruation. Specifically, the burden of soft tissue injuries—affecting muscles, tendons, and ligaments—was more than 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 are not the sole cause. Dr. Ferrer explained, “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 hinder muscle repair, while increased fatigue, pain, and sleep disturbances can affect neuromuscular control. Additionally, iron loss can reduce endurance and slow recovery, and heightened inflammation during menstruation can exacerbate tissue damage.
To mitigate injuries during menstruation, small adjustments may 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.
Implications Beyond Professional Football
The study’s findings extend beyond professional football, offering insights for women who exercise regularly. “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.”
Despite the athletes following consistent injury prevention protocols and having access to professional medical support, the results may not apply universally to all female football players, as 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, the study did not measure hormone levels or external factors like stress, sleep, nutrition, and symptom severity.
“The observed trends, combined with the significant difference in injury burden, underscore the importance of further research,” the authors noted.
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,” concluded Ferrer.
As the sports world increasingly recognizes the unique physiological needs of female athletes, this research highlights the necessity for tailored approaches in training and injury prevention. The findings could pave the way for more personalized sports medicine and training regimens, ultimately enhancing performance and well-being for female athletes worldwide.
