TDNet Discover

Background: Menstrual fluctuations can be common in premenopausal women and can be associated with both acute and chronic injuries, increasing both patient morbidity and financial burden, while decreasing quality of life. Menstrual irregularities have been linked to musculoskeletal injuries among female athletes as well as females participating in everyday physical activity and recreational sports. Current literature suggests an association between menstrual fluctuations and musculoskeletal injuries in premenopausal women. In order to prevent these injuries and ensure the best possible quality of life, it is important to understand the relationship between menstrual fluctuations and the impact it has on susceptibility to musculoskeletal injury. Objective: To determine if there is an association between menstrual fluctuations/irregularities and musculoskeletal injuries in premenopausal females. Methods: An evidence-based medicine systematic literature review study design was completed by using specific search terms/phrases and utilizing databases such as Medscape, PubMed, MEDLINE Complete, and Google Scholar. The following limits were used: English language, highest level of evidence, scholarly (peer-reviewed journals), within the last ten years, free full text only, and studies using human subjects only. Exclusion criteria included: post-menopausal women, pregnant females, females with Primary Amenorrhea, females with a history of previous musculoskeletal injury, and studies of “fair” or “poor” quality. An induplicate search and review process were conducted to select the included studies. A quality assessment, level of evidence, and data extraction were utilized to qualitatively analyze each included article. Results: Two systematic reviews and one observational cohort study were included in this review. All three studies were rated as “good” for internal validity. One systematic review assessed the effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate 5 ligament (ACL) injury risk and found that females with greater ACL laxity during this phase experienced greater knee valgus and greater tibial external rotation during functional activity. Both systematic reviews reported evidence to support that ACL injury and ligament laxity was greatest in the pre-ovulatory phase. The observational cohort study examined how hormone levels (estradiol) and temperature affect ACL laxity and found that the ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) fluctuated in the non-OCP users but remained constant in the OCP users. This study also noted that ACL elasticity to be highest at ovulation and lowest at menstruation and also found elasticity to be significantly lower in the OCP users when compared to the non-OCP users. Conclusion: Current and previous literature and research state that women are at an increased risk for musculoskeletal injuries as a result of the fluctuations of hormones throughout the menstrual cycle. While the studies in this review confirm that there is a correlation between the hormonal fluctuations throughout the menstrual cycle and musculoskeletal injury, more research is needed to determine the precise phase premenopausal women are most susceptible to injury.