Menstrual Cycle Phase and Injury Risk in Team Sport: Evidence Quality Behind a Popular Claim
DOI:
https://doi.org/10.5281/zenodo.22549117Keywords:
Menstrual cycle, Anterior cruciate ligament, Injury risk, Female athletes, Team sport, Evidence qualityAbstract
The claim that anterior cruciate ligament and other injury risk varies by menstrual cycle phase,
particularly around ovulation, has become widely repeated in sports medicine practice and media
coverage of women's sport. The underlying evidence base, however, is markedly heterogeneous: a large
majority of included studies estimate cycle phase by calendar counting alone rather than confirmatory
serum hormone assay, sample sizes are frequently small, and systematic reviews pooling this literature
report inconsistent direction and magnitude of effect across studies. This review synthesises the
case-control, cohort, and systematic review literature on menstrual cycle phase and injury risk in team
sport, examining specifically the methodological quality underlying a claim that has outpaced the
certainty of its evidence base.
References
Wojtys EM, Huston LJ, Lindenfeld TN, Hewett TE, Greenfield ML. "Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes". Am J Sports Med 26(1998):614-619.
Wojtys EM, Huston LJ, Boynton MD, Spindler KP, Lindenfeld TN. "The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels". Am J Sports Med 30(2002):182-188.
Slauterbeck JR, Fuzie SF, Smith MP, et al. "The menstrual cycle, sex hormones, and anterior cruciate ligament injury". J Athl Train 37(2002):275-278.
Hewett TE, Zazulak BT, Myer GD. "Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review". Am J Sports Med 35(2007):659-668.
Herzberg SD, Motuapuaka ML, Lambert W, Fu R, Brady J, Guise JM. "The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis". Orthop J Sports Med 5(2017):2325967117718781.
Balachandar V, Marciniak JL, Wall O, Balachandar C. "Effects of the menstrual cycle on patients with anterior cruciate ligament injury: a systematic review". Muscles Ligaments Tendons J 7(2017):136-146.
Martin D, Timmins K, Cowie C, et al. "Injury Incidence Across the Menstrual Cycle in International Footballers". Front Sports Act Living 3(2021):616999.
Ekenros L, Hirschberg AL, Heijne A, Friden C. "Oestradiol and progesterone in relation to muscle strength, muscle soreness and injury in female football players". Football Sci 10(2013):1-9.
Bruinvels G, Burden RJ, McGregor AJ, et al. "Sport, exercise and the menstrual cycle: where is the research?". Br J Sports Med 51(2017):487-488.
Bruinvels G, Goldsmith E, Blagrove RC, et al. "Prevalence and frequency of menstrual cycle symptoms are associated with self-reported sports and exercise training performance in a survey of 1,437 women". J Sports Sci 39(2021):1129-1136.
Elliott-Sale KJ, Minahan CL, de Jonge XAKJ, et al. "Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women". Sports Med 51(2021):843-861.
Colenso-Semple LM, DSouza AC, Elliott-Sale KJ, Phillips SM. "Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training". Front Sports Act Living 5(2023):1054542.
McNulty KL, Elliott-Sale KJ, Dolan E, et al. "The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis". Sports Med 50(2020):1813-1827.
Belanger L, Burt D, Callaghan J, Clifton S, Gleberzon BJ. "Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review and meta-analysis". J Can Chiropr Assoc 57(2013):76-86.
Zazulak BT, Paterno M, Myer GD, Romani WA, Hewett TE. "The effects of the menstrual cycle on anterior knee laxity: a systematic review". Sports Med 36(2006):847-862.
Beynnon BD, Johnson RJ, Braun S, et al. "The relationship between menstrual cycle phase and anterior cruciate ligament injury: a case-control study of recreational alpine skiers". Am J Sports Med 34(2006):757-764.
Beynnon BD, Bernstein IM, Belisle A, et al. "The effect of estradiol and progesterone on knee and ankle joint laxity". Am J Sports Med 33(2005):1298-1304.
Renstrom P, Ljungqvist A, Arendt E, et al. "Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement". Br J Sports Med 42(2008):394-412.
Ruedl G, Ploner P, Linortner I, et al. "Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers?". Knee Surg Sports Traumatol Arthrosc 17(2009):1065-1069.
Adachi N, Nawata K, Maeta M, Kurozawa Y. "Relationship of the menstrual cycle phase to anterior cruciate ligament injuries in teenaged female athletes". Arch Orthop Trauma Surg 128(2008):473-478.
Moller-Nielsen J, Hammar M. "Women's soccer injuries in relation to the menstrual cycle and oral contraceptive use". Med Sci Sports Exerc 21(1989):126-129.
Park SK, Stefanyshyn DJ, Ramage B, Hart DA, Ronsky JL. "Relationship between knee joint laxity and knee joint kinetics during the menstrual cycle". Br J Sports Med 43(2009):174-179.
Chidi-Ogbolu N, Baar K. "Effect of Estrogen on Musculoskeletal Performance and Injury Risk". Front Physiol 9(2019):1834.
Shultz SJ, Schmitz RJ, Nguyen AD. "Research Retreat IV: ACL injuries--the gender bias: April 3-5, 2008 Greensboro, NC". J Athl Train 43(2008):530-531.
Shultz SJ, Wideman L, Montgomery MM, Beasley KN, Nindl BC. "Changes in serum collagen markers, IGF-I, and knee joint laxity across the menstrual cycle". J Orthop Res 30(2012):1405-1412.
Bell DR, Blackburn JT, Ondrak KS, et al. "The effects of oral contraceptive use on muscle stiffness across the menstrual cycle". Clin J Sport Med 21(2011):467-473.
Martin D, Sale C, Cooper SB, Elliott-Sale KJ. "Period Prevalence and Perceived Side Effects of Hormonal Contraceptive Use and the Menstrual Cycle in Elite Athletes". Int J Sports Physiol Perform 13(2018):926-932.
Sung E, Han A, Hinrichs T, Vorgerd M, Manchado C, Platen P. "Effects of menstrual cycle on exercise-induced physiological performance responses in women". Sci Rep 12(2022):9976.
Janse de Jonge XAK. "Effects of the menstrual cycle on exercise performance". Sports Med 33(2003):833-851.
Bruinvels G, Hackney AC, Pedlar CR. "Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance". Sports Med 52(2022):1457-1460.
