(11) THE EFFECTS OF THE MENSTRUAL CYCLE AND CONTRACEPTIVE USE ON ATHLETIC PERFORMANCE AND JOINT LAXITY IN COLLEGIATE FEMALE ATHLETES – A CASE STUDY

Background: Various performance markers have been shown to decrease during the mid-luteal (ML) phase of the menstrual cycle, which is associated with decreased levels of estrogen and progesterone. There is a rise in estrogen and drop in progesterone during the mid-follicular (MF) phase, which precedes ovulation. Previous literature has found that the ligamentous structures of the knee have more laxity during the ML phase due to elevations in progesterone, estradiol, and relaxin and a decrease in estrogen.

Purpose: Because contraceptive use has been shown to stabilize hormonal fluctuations, our initial study aimed to determine the effects of the menstrual cycle and contraceptive use on athletic performance, and we hypothesized performance levels during ML would be lower. The purpose of this abstract is to share that two participants suffered non-contact ACL injuries during team activities, and were removed from the study.

Methods: We recruited athletes from the women’s soccer and women’s lacrosse teams. Participants self-reported contraceptive use, cycle length, and information related to menstruation dates using the Flo mobile app. Performance testing consisted of eight weekly assessments of: body composition measures utilizing air displacement plethysmography, two countermovement rebound jumps on force plates, and a 300-yard shuttle run.

Results: Two participants from women’s soccer suffered their injuries both sustained during week 6 of our study. Prior to injury, their performance values were consistent with average values for their team and testing group. Interestingly, the injury for both individuals coincided with the ML phase of their respective cycles, and both individuals were part of the group of athletes who reported no contraceptive use. Although fully cleared for participation in team activities prior to the study beginning, one of the injured participants reported a previous non-contact ACL injury and recalled it also occurring during ML.

Conclusions: Overall, our findings suggested no statistically significant differences in body composition or athletic performance between ML and MF, regardless of contraceptive use. Our study did not include a hormonal investigation for our participants, however, previous literature has reported high elevation of progesterone and relaxin are associated with increases in joint laxity, which could lead to greater injury risk during ML. Since both injured participants were not contraceptive users, it is possible they may have been susceptible to elevated levels of these hormones during ML, which is when both injuries occurred. PRACTICAL APPLICATION: While performance-based measures may not show significant differences during the menstrual cycle, hormonal fluctuations can potentially have an impact on athletic performance. Based on the non-contact ACL injuries observed during ML in our participants, more research should be conducted to determine factors associated with injury risk and occurrence in female athletes, particularly during ML. Identification of elevated hormonal markers could lead to training alterations and safer game management strategies to minimize injury risk. Interventions could include but are not limited to strength and conditioning, self-care, sleep and, nutrition. Further understanding of the role contraceptive use has in regulating progesterone and relaxin across the menstrual cycle could also be beneficial to female athletes. 

Acknowledgements: None