Female Athletes Six Times More Likely To Get Injured in the Days Leading Up to Their Period

With interest in women's sports at an all-time high, researchers from UCL and the University of Bath are investigating the menstrual cycle's potential impact on injury risk among elite footballers in the Women's Super League (WSL). Published in Medicine & Science in Sports & Exercise, the study monitored injury risk in female footballers at different points of their menstrual cycle. Their results have prompted a call for a revaluation of athlete support strategies.

The menstrual cycle’s systemic effects

Along with the menstrual cycle comes an assortment of physiological and psychological changes, both of which can impact the well-being and performance of women. Female sex hormone levels can change by over 100% in 24 hours at certain points of the cycle. These hormonal fluctuations often affect musculoskeletal tissue such as muscle, tendon, and bone.

Roughly two-thirds of elite athletes claim menstrual cycle symptoms negatively impact their performance. Women are also up to eight times more likely to suffer from anterior cruciate ligament (ACL) injuries than their male counterparts. Several studies have also found the incidence of ACL injuries in female athletes increased during the late follicular phase when estrogen concentrations are at their peak.

With the ACL crisis seen in women’s football right now, researchers are calling for further investigation into how the menstrual cycle could be impacting female athletes.

Injury risk was elevated during the luteal phase

The researchers followed 26 players who were based at a WSL club in the tier-one football division for women's football in England. The players were monitored across three seasons, tracking their menstrual cycle data and time-loss injuries. Over 13,390 days, the researchers tracked 593 cycles and 74 different injuries. They calculated the injury incidence rates (IRR) and ratios (IIRR) for overall injuries, injury severity, type, contact vs non-contact and game/training.

The players were six times more likely to experience a muscle injury during the pre-menstrual phase and five times more likely to experience an injury during the early-mid luteal phase, compared to when they were in the menstrual phase.

Muscle injuries were the most common type of injury the players suffered from. No ACL injuries were recorded over the three seasons.

Further research is needed to end the sex data gap

“While these results must be viewed with caution, this data highlights a need to investigate this area further,” said corresponding author Dr. Georgie Bruinvels, research scientist from UCL surgery & interventional science and the institute of sport, exercise & health.

“Given the growth of women’s sport it’s an exciting time to be working in female physiology, but there are a number of known challenges when conducting research with female athletes, in part explaining why there is such a significant sex data gap.”

“At the elite level, injuries to your squad can mean the difference between winning and losing, the difference between being crowned champions and runners-up. But perhaps more importantly, it means pain and suffering for players that could perhaps be avoided with better player-centered support,” added author Dr. Jo Blodgett, a senior research fellow in the institute of sport, exercise and health and the department of targeted intervention at UCL.

Reference: Barlow A, Blodgett JM, Williams S, Pedlar CR, Bruinvels G. Injury incidence, severity and type across the menstrual cycle in female footballers: a prospective three season cohort study. Med Sci Sports Exerc. 2024. doi: 10.1249/MSS.0000000000003391

This article is a rework of a press release issued by University College London. Material has been edited for length and content.