Menstrual cycle changes among female athletes post a traumatic brain injury: A systematic review
Authors: Yussuf Abuelhaija  , Motasem Alzaqh  , Haneen A. Al-Bataineh  , Ahmad Mustafa  , Tareq Al-Bkoor  , Haya Omeish  , Yaman M. Jarrar  , Maria Obeidat  , Ali M. Khafaja  , Bashar M. Mistarihi  , Rama M. Matalqah  , Mohammad Alomari  , Aya Issa  , Waseem M. Halawani  , Mohammad Al-Hajjieh  , Farah Bawa'neh  , Ro'a I. Ababneh  , Zain Haddad  , Joanna Esau  , Shaima’ Al-Omari  , Ala E. Najjar  , Thurayya H. Hayajneh  , Sara Alzaglool  , Aws Al-Arman  , Lujain Y. Al-Arman  , Aya Mustafa  , Bouran M. Alkilany  , Faris I. Tawalbeh  , Rand Tarawneh  , Ahmad Al-Thunaibat  , Mu'taz Yousef Mahmoud  , Khaled Abubaker  , Mazhar Al Zoubi  
Published: July 2023

Introduction: Traumatic brain injury (TBI) commonly affects athletes and can lead to menstrual cycle changes in female athletes. This review highlights the existing literature on menstrual cycle changes post-TBI. TBI disrupts the hormonal regulation of the menstrual cycle, causing irregular or absent periods, hormonal imbalances, and related symptoms. These changes impact the physical and psychological well-being of athletes during recovery. However, research in this area is limited, necessitating further investigation into the mechanisms and implications of menstrual cycle changes in female athletes post-TBI. Healthcare providers and sports medicine professionals must be aware of these effects and provide appropriate care and support. Prioritizing overall health and well-being, including menstrual health, is crucial for female athletes post-TBI. This involves nutrition, stress management, and adjustments to training and competition schedules as necessary. Raising awareness and educating athletes, coaches, and stakeholders is vital for proper care and support. Additional research on menstrual cycle changes in female athletes post-TBI will inform clinical practice and enhance the health and performance outcomes of female athletes. Methods: A comprehensive literature search was conducted using databases including PubMed, Embase, Scopus, Web of Science, and SPORTDiscus. The search strategy employed relevant keywords and MeSH terms to identify observational and experimental studies published from the inception of each database until the present day. Inclusion criteria encompassed studies involving female athletes diagnosed with a concussion, assessing the physiological or pathological changes during the menstrual cycle, and reporting data on hormone fluctuations, symptomatology, cognitive function, mood, neuroimaging, or biomarkers. Independent reviewers screened articles, extracted data, and resolved disagreements through consensus. Results: The initial search yielded 500 articles, and after applying inclusion criteria, 108 studies were included. Menstrual cycle disruptions were assessed through self-reporting and hormonal analysis. Findings indicated potential links between sports-related concussions and irregularities in cycle length, alterations in hormone levels, and changes in menstrual symptoms. However, heterogeneity among the studies and lack of standardized methodologies limited definitive conclusions. Conclusion: This systematic review underscores the need for further research to elucidate the relationship between sports-related concussions and menstrual cycle disturbances in female soccer players. Future studies should employ standardized methodologies, including objective measures and larger sample sizes. Understanding the impact of concussions on the menstrual cycle is vital for holistic care and optimal performance of female athletes in contact sports. Identifying underlying mechanisms will facilitate the development of targeted interventions and preventive strategies to ensure long-term reproductive health and overall well-being after head injuries in female soccer players.