Abstract Details

Moderate or severe traumatic brain injury often disrupts menstrual cycle function. Research is limited in concussion, with mixed results, mostly focused on adults.

This study sought to describe menstrual cycle patterns in acutely concussed adolescents and to investigate if cycle phase at injury influenced post-concussion cycle pattern changes or symptom endorsement.

Data were collected prospectively from patients aged 13-18 years presenting to a specialty care concussion clinic for initial visit within 28 days of concussion and a follow-up visit 3-4 months post-injury. Primary outcomes included changes in menstrual cycle pattern since injury (change/no change), menstrual cycle phase at time of injury, calculated using date of last period prior to injury, and symptom severity, measured by the Post-Concussion Symptom Inventory (PCSI). Fisher’s exact tests were used to determine the association between menstrual phase at injury and change in cycle pattern at follow-up. Multiple linear regression was used to determine if menstrual phase at injury was associated with subsequent PCSI symptom severity, adjusting for age. 

Five hundred ninety-eight post-menarchal adolescents were enrolled (mean age 15.4±1.4 years) with 136(22.7%) returning for follow-up. Menstrual pattern change was reported in 4% of patients at initial visit and 12.5% of patients at follow-up. At 3-4 months, menstrual phase at injury was not associated with menstrual cycle changes (p=0.18) but was associated with PCSI severity (p=0.03). Patients injured in the early luteal phase reported the highest symptom severity at follow-up.

One in eight adolescents reporting to clinic at 3-4 months post-concussion had experienced a change in menses. Menstrual cycle phase at time of injury was associated with post-concussion symptom severity, but not a change in menstrual pattern. Leveraging the largest study sample of post-concussion menstrual patterns to date, this study represents important foundational data regarding potential hormonal effects of concussion in adolescents.