Researchers found that injuries sustained during menstruation took three times longer to recover from than injuries that occurred on non-bleeding days.
Monthly hormone fluctuations associated with the menstrual cycle affect multiple aspects of women’s bodies, from metabolism and the cardiovascular system to neuromuscular functions.1 Because the menstrual cycle has such a significant effect on physiology, researchers have long wondered how it affects female athletes and their risk of injury.
In a new study, researchers followed 33 professional female football (soccer) players over the course of four athletic seasons in Spain’s Liga F, tracking their periods and injuries.2 The scientists found that while the players sustained similar numbers of injuries on bleeding versus non-bleeding days, if they got hurt during their periods, the injuries took longer to heal.
“You do not necessarily need to avoid training during your period, but you may need to adapt it,” said study coauthor Eva Ferrer, a sports medicine clinician and researcher at Sant Joan de Déu Hospital Barcelona, in a statement. “Small modifications such as longer warm-ups, adjusted high-speed workload, or added recovery support may help reduce the severity of injuries if they occur.”
During the 2019/2020 to 2022/2023 seasons, football players on FC Barcelona Femení recorded the start and end dates of their periods in a club-managed app, overseen by the team doctor. The team doctor also diagnosed and recorded any lower limb injuries sustained during that time: muscle, tendon, and ligament ones.
The researchers found that of the 80 injuries that occurred, 11 happened during bleeding days and 69 took place during non-bleeding days. Accounting for differences in the length of time of the non-bleeding versus bleeding phase of the menstrual cycle, the team found that there was no difference in incidence of injuries between bleeding and non-bleeding days. However, the number of days players lost to medical leave was three-fold higher for injuries sustained during the menstrual period. In fact, the researchers noted that two out of the four total ligament injuries that occurred during the study happened during the bleeding phase. These kinds of soft tissue injuries are more severe and require longer recovery times than other common muscle-related injuries that players sustain.
“Hormonal levels may not cause the injury, but they may influence how severe the injury becomes and how long recovery takes,” said Ferrer. In addition to hormone changes, iron loss due to bleeding can also influence endurance and how tired players feel, affecting recovery times.
While the researchers did not track other variables known to affect injury risk such as sleep and nutrition or specific menstrual cycle biomarkers like hormone levels, they noted that these findings highlight the importance of understanding the role of the menstrual cycle on women’s bodies to improve training plans, including better recovery and injury-prevention strategies.
“It supports a growing movement toward female-specific sports science instead of applying male-based research models to women,” said Ferrer.
