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Concussion increases risk for abnormal menstruation in young women

After sustaining a concussion, adolescent and young women can have an increased risk for multiple abnormal menstrual patterns, indicating that it may be necessary to monitor these patterns in this population after head injury, according to findings published in JAMA Pediatrics.

“To date, researchers have yet to examine the role of concussion on menstrual patterns in adolescent and young women,” Meredith L. Snook, MD, from the department of obstetrics, gynecology and reproductive sciences at Magee-Women’s Hospital and University of Pittsburgh Medical Center, and colleagues wrote. “Although the [AAP] and American College of Obstetrics and Gynecologists advocate for clinicians to regard the menstrual cycle as a vital sign in adolescents because of the importance of estrogen in bone health and other tissues, the assessment of menstrual status is neither a standard for care nor routine practice after a concussion.”

Researchers compared irregular menstrual patterns in adolescent and young women after sport-related concussion with those after sport-related orthopedic injuries sustained to other parts of the body (nonhead). In this prospective cohort study, they examined 68 young women aged 12 to 21 years with a sport-related concussion and 60 young women with a nonhead sport-related orthopedic injury who presented within 30 days after the injury to the University of Pittsburgh Medical Center Sports Concussion Clinic or Center for Sports Medicine. The follow-up period was 120 days after injury. To determine abnormal menstrual patterns, the investigators used an online survey sent weekly over text message that asked about bleeding episodes each week.

Of the participants who had a concussion, 23.5% experienced two or more irregular menstrual patterns during the study period while only 5% of participants in the orthopedic injury group experienced two or more abnormal menstrual patterns. The risk of 2 or more abnormal menstrual bleeding patterns after injury was significantly greater among patients with concussion compared with those who sustained an orthopedic injury despite similar gynecologic age, BMI and type of sports participation between the groups (OR = 5.58; 95% CI, 1.16-21.22). Participants with concussion had significantly greater risk for intermenstrual intervals of less than 21 days compared with those who had orthopedic injuries (5.6; 95% CI, 1.19-26.38)

“We recommend monitoring menstrual patterns after concussion … [so] patents with abnormal menstrual patterns could be identified and subsequently referred for appropriate evaluation and possible treatment,” Snook and colleagues wrote. “Larger studies with hormonal assessments and long-term follow-up are needed to better understand the effect of concussion on the [hypothalamic–pituitary–gonadal] axis and potential implications for menstrual patterns, estrogen production, and any persistent consequences.” – by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.