Prospective Study: Concussion Affects Menstrual Patterns in Adolescent and Young Women

Severe traumatic brain injury is a well-documented cause of secondary amenorrhea (lack of menstrual periods after menses has begun) in young women. This is usually suggested to be due to traumatic injury of the pathways between the hypothalamus and pituitary which modulate the cycle of ovulation and menstruation via control of the pituitary's secretion of the gonadal control hormones FSH and LH.

The study below, from JAMA Pediatrics, confirms that even a much less severe injury to the brain, such as that seen with concussion, can change the menstrual cycle, at least over the following 3 or 4 months.

Could the effect have been due to the stress of the injury alone? Probably not, since a control group was selected to also be physcally stressed. The controls were those who had orthopedic but not head trauma.



Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women

Meredith L. Snook, MD; Luke C. Henry, PhD; Joseph S. Sanfilippo, MD, MBA; et al Anthony J. Zeleznik, PhD; Anthony P. Kontos, PhD

JAMA Pediatr. Published online July 3, 2017. doi:10.1001/jamapediatrics.2017.1140

Key Points

Question Is concussion associated with the development of abnormal menstrual bleeding patterns in young women?

Findings In this cohort study of 129 adolescent and young women with a sport- or recreation-related concussion or nonhead orthopedic injury who were followed up for 120 days after their injuries, the risk of having 2 or more abnormal menstrual bleeding patterns after injury was significantly higher among patients with concussion.

Meaning Menstrual patterns should be monitored after concussion.


Importance Brain injury may interrupt menstrual patterns by altering hypothalamic-pituitary-ovarian axis function. Investigators have yet to evaluate the association of concussion with menstrual patterns in young women.

Objective To compare abnormal menstrual patterns in adolescent and young women after a sport-related concussion with those after sport-related orthopedic injuries to areas other than the head (nonhead).

Design, Setting, and Participants This prospective cohort study of adolescent and young women with a sport-related concussion (n = 68) or a nonhead sport-related orthopedic injury (n = 61) followed up participants for 120 days after injury. Patients aged 12 to 21 years who presented within 30 days after a sport-related injury to a concussion or sports medicine clinic at a single academic center were eligible. Menstrual patterns were assessed using a weekly text message link to an online survey inquiring about bleeding episodes each week. The first patient was enrolled on October 14, 2014, and follow-up was completed on January 24, 2016. Inclusion criteria required participants to be at least 2 years postmenarche, to report regular menses in the previous year, and to report no use of hormonal contraception.

Exposures Sport-related concussion or nonhead sport-related orthopedic injury.

Main Outcomes and Measures Abnormal menstrual patterns were defined by an intermenstrual interval of less than 21 days (short) or more than 35 days (long) or a bleeding duration of less than 3 days or more than 7 days.

Results A total of 1784 survey responses were completed of the 1888 text messages received by patients, yielding 487 menstrual patterns in 128 patients (mean [SD] age, 16.2 [2.0] years). Of the 68 patients who had a concussion, 16 (23.5%) experienced 2 or more abnormal menstrual patterns during the study period compared with 3 of 60 patients (5%) who had an orthopedic injury. Despite similar gynecologic age, body mass index, and type of sports participation between groups, the risk of 2 or more abnormal menstrual bleeding patterns after injury was significantly higher among patients with concussion than among those with an orthopedic injury (odds ratio, 5.85; 95% CI, 1.61-21.22).

Conclusions and Relevance Adolescent and young women may have increased risk of multiple abnormal menstrual patterns after concussion. Because abnormal menstrual patterns can have important health implications, monitoring menstrual patterns after concussion may be warranted in this population. Additional research is needed to elucidate the relationship between long-term consequences of concussion and the function of the hypothalamic-pituitary-ovarian axis.

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