“Menstruation and injury occurrence; a four-season observational study in elite female football players”
Author: Eva Ferrer (20205)
Journal: Frontiers in Sports and Active Living
AI generated summary
The study investigated whether menstruation (early follicular phase) is associated with differences in injury incidence and severity in elite female football players over four competitive seasons.
👥 Participants & Methods
- 33 elite players from one top club (Liga F, Spain).
- Four seasons of tracking: 2019/20 → 2022/23.
- 852 menstrual cycles recorded.
- Menstruation tracked via a calendar-based digital tool.
- 80 time-loss musculoskeletal injuries documented (OSICS-10 classification).
- Exposure data calculated using WIMU PRO GPS.
The study compared bleeding vs. non-bleeding days—the only phases that can be confidently identified without hormonal assays.
📊 Key Findings
1. Injury incidence was similar during menstruation and non-menstruation
- Overall incidence: 6.42 injuries / 1,000 h.
- Bleeding phase: 5.36 / 1,000 h
- Non-bleeding phase: 6.48 / 1,000 h
- Difference not statistically significant (p = 0.55).
👉 Conclusion: Menstruation does not increase the likelihood of getting injured.
**2. BUT injuries during menstruation were much more severe
This is the most important finding.
- Injury burden during menstruation:
684 days lost / 1,000 h - Injury burden during non-bleeding:
206 days lost / 1,000 h
➡️ Injuries during menstruation resulted in over 3× more days lost.
➡️ This difference was statistically significant (p = 0.0027).
Why?
- Two of the four ACL injuries happened during menstruation (page 5), heavily increasing time-loss burden.
- Low oestrogen levels during bleeding may impair tissue recovery and neuromuscular control.
- Symptom severity, fatigue, and iron loss may further influence injury consequences.
3. Injury type distribution
From the table on page 4:
- Muscle injuries: 57.5% (most common)
- Ligament injuries: 30% (highest burden, median 29 days lost)
- Tendon injuries: 12.5%
Ligament injuries produced the highest total burden despite being less frequent.
4. Match vs. training
- 22.5% injuries in matches
- 77.5% in training
No meaningful difference in risk or severity between match and training load.
📌 Interpretation
The study challenges the idea that menstruation increases incidence of injuries. Instead, it highlights:
**Menstruation does not cause more injuries…
…but when injuries happen, they tend to be more severe.**
Key physiological factors contributing may include:
- Low estrogen (reduced tissue protection, slower recovery)
- Increased fatigue, DOMS, neuromuscular disruption
- Symptom burden (pain, cramps, low energy)
- Iron loss affecting performance and resilience
The authors emphasize the need for:
- Individualized menstrual tracking
- Integration with load, symptom, and recovery data
- Future studies measuring hormones directly
🏟️ Practical Applications
- Calendar tracking is a useful, low-cost tool to identify potential periods of increased injury burden.
- Staff should monitor players more closely during menstruation for:
- symptoms
- fatigue
- recovery quality
- readiness
- Adjustments may be needed in:
- training load
- recovery planning
- strength sequencing
- player monitoring conversations
