Summary: A new study reveals young women who sustained concussions are at greater risk of having two or more abnormal menstrual bleeding patterns. The findings suggest more subtle forms of brain injury could adversely affect the HPO axis function, which leads to abnormal menstrual patterns.
Source: JAMA Network.
A study of nearly 130 girls and young women suggests concussion was associated with increased risk of having two or more abnormal menstrual bleeding patterns, according to an article published by JAMA Pediatrics.
The study by Anthony P. Kontos, Ph.D., of the University of Pittsburgh Medical Center Sports Medicine Concussion Program, Pennsylvania, and coauthors included adolescent and young women (ages 12 to 21) with a sports-related concussion or a nonhead sports-related orthopedic injury for comparison. They were followed up for 120 days after injury and menstrual patterns were assessed using a text message link to an online survey about bleeding patterns.
Survey responses resulted in 487 menstrual patterns in 128 patients (average age about 16). The authors report that 57 of 128 patients (44.5 percent) had at least one abnormal bleeding pattern during the study, with no difference between the injury groups.
Among the 68 patients with concussion, 16 (23.5 percent) experienced two or more abnormal menstrual patterns during the study compared with 3 of the 60 patients (5 percent) with a nonhead orthopedic injury, according to the results.
The findings suggest more subtle forms of brain injury, such as concussion, may adversely affect HPO [hypothalamic-pituitary-ovarian] axis function (this governs the menstrual cycle) and therefore menstrual cycles through a number of proposed mechanisms leading to disrupted gonadotropin secretion, according to the article.
Limitations of the study include self-reported menstrual patterns. The authors also could not account for other factors that could affect menstrual patterns.
“We recommend monitoring menstrual patterns after concussion. … Larger studies with hormonal assessments and long-term follow-up are needed to better understand the effect of concussion on the HPO axis and potential implications for menstrual patterns, estrogen production and any persistent consequences,” the article concludes.
Source: Rick Pietzak – JAMA Network
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Original Research: Abstract for “Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women” by Meredith L. Snook, MD; Luke C. Henry, PhD; Joseph S. Sanfilippo, MD, MBA; Anthony J. Zeleznik, PhD; Anthony P. Kontos, PhD in JAMA Pediatrics. Published online July 3 2017 doi:10.1001/jamapediatrics.2017.1140
Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women
Importance Brain injury may interrupt menstrual patterns by altering hypothalamic-pituitary-ovarian axis function. Investigators have yet to evaluate the association of concussion with menstrual patterns in young women.
Objective To compare abnormal menstrual patterns in adolescent and young women after a sport-related concussion with those after sport-related orthopedic injuries to areas other than the head (nonhead).
Design, Setting, and Participants This prospective cohort study of adolescent and young women with a sport-related concussion (n = 68) or a nonhead sport-related orthopedic injury (n = 61) followed up participants for 120 days after injury. Patients aged 12 to 21 years who presented within 30 days after a sport-related injury to a concussion or sports medicine clinic at a single academic center were eligible. Menstrual patterns were assessed using a weekly text message link to an online survey inquiring about bleeding episodes each week. The first patient was enrolled on October 14, 2014, and follow-up was completed on January 24, 2016. Inclusion criteria required participants to be at least 2 years postmenarche, to report regular menses in the previous year, and to report no use of hormonal contraception.
Exposures Sport-related concussion or nonhead sport-related orthopedic injury.
Main Outcomes and Measures Abnormal menstrual patterns were defined by an intermenstrual interval of less than 21 days (short) or more than 35 days (long) or a bleeding duration of less than 3 days or more than 7 days.
Results A total of 1784 survey responses were completed of the 1888 text messages received by patients, yielding 487 menstrual patterns in 128 patients (mean [SD] age, 16.2 [2.0] years). Of the 68 patients who had a concussion, 16 (23.5%) experienced 2 or more abnormal menstrual patterns during the study period compared with 3 of 60 patients (5%) who had an orthopedic injury. Despite similar gynecologic age, body mass index, and type of sports participation between groups, the risk of 2 or more abnormal menstrual bleeding patterns after injury was significantly higher among patients with concussion than among those with an orthopedic injury (odds ratio, 5.85; 95% CI, 1.61-21.22).
Conclusions and Relevance Adolescent and young women may have increased risk of multiple abnormal menstrual patterns after concussion. Because abnormal menstrual patterns can have important health implications, monitoring menstrual patterns after concussion may be warranted in this population. Additional research is needed to elucidate the relationship between long-term consequences of concussion and the function of the hypothalamic-pituitary-ovarian axis.
“Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women” by Meredith L. Snook, MD; Luke C. Henry, PhD; Joseph S. Sanfilippo, MD, MBA; Anthony J. Zeleznik, PhD; Anthony P. Kontos, PhD in JAMA Pediatrics. Published online July 3 2017 doi:10.1001/jamapediatrics.2017.1140