The risk of injury is higher during menstruation in professional female soccer players.

The risk of injury is higher during menstruation in professional female soccer players.

The menstrual cycle and its importance for female athletes

The menstrual cycle is an important physiological process in women: it influences performance, neuromuscular control, metabolism and immune response. For professional athletes, the hormonal fluctuations that occur throughout the menstrual cycle can influence the risk of injury.

Researchers in Spain and the United Kingdom have examined whether menstruation determines the frequency or severity of injuries in professional female soccer players. Their results were published in the scientific journalFrontiers in Sports and Active Livingpublished.

"We show that menstruation itself does not increase the incidence of injury," said first author Dr. Eva Ferrer, who specializes in sports medicine at the Sant Joan de Déu Hospital and treats female health aspects at the Barça Innovation Hub in Barcelona. "Although female athletes were not more likely to be injured during their period, injuries that occurred during menstruation caused three times as many days lost compared to injuries that occurred at other times in the cycle."

Observations of the study series

Over four seasons, from 2019/20 to 2022/23, the team monitored the self-reported menstrual cycle data of 33 elite soccer players playing at the highest level of competition (League F) in women's soccer in Spain. 11 players were included in all four seasons. The players listed days with and without menstruation, the only phases of the menstrual cycle that can be reliably identified without blood tests. A total of 852 menstrual cycles and 80 lower limb injuries were documented, 11 of which occurred during menstrual bleeding.

The results showed that the injury burden was significantly higher during the bleeding phases, indicating a greater burden of injury during menstruation. These injuries were more severe and took longer to heal. For example, the burden of soft tissue injuries - to muscles, tendons and ligaments - was more than three times higher when injuries were sustained on bleeding days compared to non-bleeding days, with 684 versus 206 days lost per 1,000 hours of exercise.

Injuries are caused by multiple factors and hormonal influences cannot be considered the only cause. "Hormone levels may not cause the injury, but they can affect how severe the injury becomes and how long recovery takes," Ferrer explained. Low estrogen levels can reduce muscle repair and increased fatigue, pain and sleep problems can affect neuromuscular control. Likewise, iron deficiency can reduce endurance and slow recovery, and Inflammation, which can occur more frequently during menstruation, can lead to more severe tissue damage if injured.

Prevention of injuries during menstruation

To prevent injuries during menstruation and reduce their impact on players' health, small adjustments can have a big impact. "Small changes such as longer warm-up times, modified high-intensity exercise, or additional recovery support can help reduce the severity of injuries when they occur," Ferrer noted.

Adaptation of training

The team said their results have implications beyond professional football. Women who exercise can use these insights to tailor their exercise plans to the phases of their menstrual cycle.

You don't necessarily have to avoid exercising during your period, but you should adapt it. Tracking your cycle and symptoms can help guide exercise intensity and recovery strategies.”

Dr. Eva Ferrer, first author

Although the athletes who took part in the study followed consistent injury prevention protocols, had access to professional medical support and trained under standardized methods, the results could not be easily generalized to all female soccer players because the participants all belonged to the same club. The unequal ratio of bleeding to non-bleeding days, four to 27 in a month, may limit the statistical power to detect differences in frequency. In addition, no hormone measurements were carried out and external factors such as stress, sleep, diet and the severity of symptoms were not recorded. Still, the observed trends, along with the significant difference in injury burden, underscore the importance of further research, the authors said.

The study also highlights the importance of individual menstrual cycle tracking, at least with a calendar-based method, for injury prevention. It also represents an important step toward integrating menstrual cycle awareness into athlete health monitoring. “It supports a growing movement toward sports science approaches designed specifically for women, rather than applying male research models to women,” concluded Ferrer.

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