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

Snook, Meredith L.; Henry, Luke C.; Sanfilippo, Joseph S.; Zeleznik, Anthony J.; Kontos, Anthony P.

doi:10.1001/jamapediatrics.2017.1140

Cited by 55 publications

(46 citation statements)

References 44 publications

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“…We identified 6 studies that examined long-term neurometabolic and neurostructural alterations after concussion. 9 – 11 , 22 , 51 , 52 Recent neuroimaging studies used magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to identify axonal injury or neuronal loss in previously concussed collegiate and professional female athletes ( Table 4 ). 9 – 11 , 51 Studies by Chamard et al 9 – 11 found neurometabolic and neurostructural abnormalities present on MRS and DTI neuroimaging at least 6 months after athletes sustained a concussion.…”

Section: Resultsmentioning

confidence: 99%

Sport-Related Concussion in Female Athletes: A Systematic Review

McGroarty

Brown

Mulcahey

2020

Orthopaedic Journal of Sports Medicine

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Background: Female athletes are more susceptible to sport-related concussions (SRCs) and experience worse outcomes compared with male athletes. Although numerous studies on SRC have compared the outcomes of concussions in male and female athletes after injury, research pertaining to why female athletes have worse outcomes is limited. Purpose: To determine the factors that predispose female athletes to more severe concussions than their male counterparts. Study Design: Systematic review; Level or evidence, 3. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. The MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane Library databases were systematically searched on July 5 to July 20, 2018. Included were cohort, case-control, and cross-sectional studies that examined the effects of concussive and subconcussive head impacts in only female athletes of all ages, regardless of competition level. These studies were further supplemented with epidemiologic studies. Exclusion criteria included narrative reviews, single case reports, abstracts and letters to the editor, and studies related to chronic traumatic brain injury. Results: A total of 25 studies met the inclusion criteria. Female athletes appear to sustain more severe concussions than male athletes, due in part to a lower biomechanical threshold tolerance for head impacts. Additionally, concussions may alter the hypothalamic-pituitary-ovarian axis, resulting in worse symptoms and amenorrhea. Although females are more likely to report concussions than males, underreporting still exists and may result in concussions going untreated. Conclusion: This systematic review demonstrates that female athletes may be more susceptible to concussion, have prolonged symptoms after a concussion, and are more likely to report a concussion than their male counterparts. However, underreporting still exists among female athletes. Possible factors that put female athletes at a higher risk for concussions include biomechanical differences and hormonal differences. To effectively prevent, diagnose, and treat concussions in female athletes, more research is required to determine when and how such injuries are sustained. Despite sex-based differences in the clinical incidence, reporting behavior, and outcomes of SRCs, female athletes remain an understudied population, resulting in lack of sex-specific treatment guidelines for female athletes postinjury.

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Section: Resultsmentioning

confidence: 99%

Sport-Related Concussion in Female Athletes: A Systematic Review

McGroarty

Brown

Mulcahey

2020

Orthopaedic Journal of Sports Medicine

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“…When breaking this down to a week-by-week a posteriori analysis, the differences are a function of injury and not time, indicating that by 1 month post-injury normal cycling had not resumed ( Figure S2). Previous TBI reports in clinical and rodent studies have also showed disruption of normal hormonal cyclicity (25,29). Prolonged diestrus indicates longer secretion of progesterone with low levels of luteinizing hormone (LH) (72) that can interfere with ovulation.…”

Section: Sensory Hypersensitivity and Estrous Cyclicitymentioning

confidence: 99%

Traumatic Brain Injury-Induced Sex-Dependent Changes in Late-Onset Sensory Hypersensitivity and Glutamate Neurotransmission

et al. 2020

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Women approximate one-third of the annual 2.8 million people in the United States who sustain traumatic brain injury (TBI). Several clinical reports support or refute that menstrual cycle-dependent fluctuations in sex hormones are associated with severity of persisting post-TBI symptoms. Previously, we reported late-onset sensory hypersensitivity to whisker stimulation that corresponded with changes in glutamate neurotransmission at 1-month following diffuse TBI in male rats. Here, we incorporated intact age-matched naturally cycling females into the experimental design while monitoring daily estrous cycle. We hypothesized that sex would not influence late-onset sensory hypersensitivity and associated in vivo amperometric extracellular recordings of glutamate neurotransmission within the behaviorally relevant thalamocortical circuit. At 28 days following midline fluid percussion injury (FPI) or sham surgery, young adult Sprague-Dawley rats were tested for hypersensitivity to whisker stimulation using the whisker nuisance task (WNT). As predicted, both male and female rats showed significantly increased sensory hypersensitivity to whisker stimulation after FPI, with females having an overall decrease in whisker nuisance scores (sex effect), but no injury and sex interaction. In males, FPI increased potassium chloride (KCl)-evoked glutamate overflow in primary somatosensory barrel cortex (S1BF) and ventral posteromedial nucleus of the thalamus (VPM), while in females the FPI effect was discernible only within the VPM. Similar to our previous report, we found the glutamate clearance parameters were not influenced by FPI, while a sex-specific effect was evident with female rats showing a lower uptake rate constant both in S1BF and VPM and longer clearance time (in S1BF) in comparison to male rats. Fluctuations in estrous cycle were evident among brain-injured females with longer diestrus (low circulating hormone) phase of the cycle over 28 days post-TBI. Together, these findings add to growing evidence indicating both similarities and differences between sexes in a chronic response to TBI. A better understanding of the influence of gonadal hormones on behavior, Krishna et al. Sex Influences TBI-Induced Behavior and Neurotransmission neurotransmission, secondary injury and repair processes after TBI is needed both clinically and translationally, with potential impact on acute treatment, rehabilitation, and symptom management.

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“…Females also receive interventions such as medications and school accommodations at higher rates compared to males [118]. It is worth noting that females may experience abnormal menstrual patterns in the wake of a concussion, with one study reporting an odds ratio of 5.85 of having an abnormal menstrual cycle within the first 4 months after a concussion compared to females with orthopedic injuries [119,120].…”

Section: Sports Concussionmentioning

confidence: 99%

Sex Differences in Common Sports Injuries

Lin

Casey

Herman

et al. 2018

PM&R

109

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Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. LEVEL OF EVIDENCE: IV.

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

Cited by 55 publications

References 44 publications

Sport-Related Concussion in Female Athletes: A Systematic Review

Sport-Related Concussion in Female Athletes: A Systematic Review

Traumatic Brain Injury-Induced Sex-Dependent Changes in Late-Onset Sensory Hypersensitivity and Glutamate Neurotransmission

Sex Differences in Common Sports Injuries

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