Menstruation Significantly Raises Injury Frequency and Severity in Elite Female Soccer Players

Breaking: Elite Female Footballers Face Higher Injury Risk During Menstruation, Study Finds

The latest research tracking 33 professional players in the top tier of Spanish women’s football over four seasons shows a clear pattern: injuries surface more often during menstrual days. The team logged 852 cycles and 80 lower‑limb injuries, revealing a statistically significant spike in injury frequency during menstruation.

Injuries during this phase were not only more common but also more serious and slower to heal. Soft tissue injuries-affecting muscles, tendons, and ligaments-occurred more than three times as frequently enough when menstruation coincided with an injury event.

The researchers stress that hormones are not the sole culprit. Hormonal fluctuations can influence how severe an injury is and how long recovery takes, rather than directly causing the injury. Low estrogen may slow muscle repair, while fatigue, pain, and disrupted sleep can impair neuromuscular control. Iron deficiency can reduce endurance and slow recovery, and inflammation-potentially heightened during menstruation-may worsen tissue damage.

What the study found

A multi‑year,high‑level observation shows a consistent pattern: menstrual phases correlate with higher injury risk and longer recovery times. The data came from a cohort of players competing at Liga F’s elite level, with medical teams carefully recording period days and performance metrics.

Why it happens

The study emphasizes that multiple factors shape injury risk. While hormones play a role in severity and healing trajectories, they do not act alone. Fatigue, sleep quality, pain perception, and iron status all contribute to how the body sustains and recovers from injuries during different phases of the menstrual cycle. Inflammation during menstruation may compound tissue damage in certain specific cases.

Simple but effective adaptations

The authors suggest pragmatic adjustments can reduce risk and dampen impact. Small changes-longer warm‑ups, careful tuning of training loads, and enhanced recovery support-may help lessen the severity of injuries if they occur during menstruation.

Study backdrop

The inquiry involved medical teams from barcelona’s football program and collaborators at university College London, reflecting a cross‑institutional effort to understand how female athletes can train more safely at the highest levels.

Key data at a glance

Factor	Observation	Impact on Athletes
Cycle data	852 menstrual cycles tracked	Comprehensive view of period‑related patterns
Injury frequency	Higher during menstruation	Increased risk of injuries during period days
Injury type	Soft tissue injuries >3× more common during menstruation	Longer healing and return‑to‑play times
Biological factors	Hormones, fatigue, sleep, iron status, inflammation	Affects severity and recovery, not just occurence
Preventive measures	Longer warm‑ups, adjusted load, extra recovery	Potential reduction in injury impact

Evergreen insights for the field

While the study centers on Spain’s Liga F, its implications reach beyond a single league. Systematic tracking of menstrual cycle data could become a standard tool across women’s sports, informing individualized training plans, nutrition strategies, and recovery protocols. Teams may consider integrating period‑aware monitoring to optimize safety and performance. This work also underscores the need for broader research across sports and levels to establish evidence‑based guidelines for menstrual health and injury prevention.

For readers seeking background on menstrual health, official health resources offer comprehensive context: Menstruation and Menstrual Problems, and World Health Organization – Menstrual Health.

disclaimer: This report summarizes findings from a focused sports‑science study. It is indeed intended for informational purposes and should not replace medical advice. Athletes and teams should consult qualified professionals for personalized guidance.

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Question for readers: Should menstrual tracking become a standard component of athlete health programs across professional leagues?

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>frequency Increase Early follicular (low estrogen) Anterior cruciate ligament (ACL) tears, hamstring strains +18 % Mid‑Luteal (high progesterone) Ankle sprains, groin pulls +12 % Ovulation (estrogen peak) Minimal change; protective effect noted -5 %

*Based on pooled data from three longitudinal cohort studies of professional women’s leagues (2020‑2023) [3][4].

Hormonal Fluctuations Across teh Menstrual Cycle

• Follicular Phase (Days 1‑14) – Estrogen rises, progesterone remains low.
• ovulatory Window (Days 12‑16) – Estrogen peaks, ligament tensile strength is at its highest.
• Luteal Phase (Days 15‑28) – Progesterone dominates, estrogen declines, leading to increased joint laxity and altered neuromuscular control.

These hormonal shifts directly affect muscle‑tendon stiffness, proprioception, and pain perception-key factors that shape injury risk in elite female soccer players [1][2].

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Injury Frequency Linked to Menstrual timing

Menstrual Phase	Common Injuries	Frequency Increase
Early Follicular (low estrogen)	Anterior cruciate ligament (ACL) tears,hamstring strains	+18 %
Mid‑Luteal (high progesterone)	Ankle sprains,groin pulls	+12 %
Ovulation (estrogen peak)	Minimal change; protective effect noted	-5 %

*Based on pooled data from three longitudinal cohort studies of professional women’s leagues (2020‑2023) [3][4].

Key Insight: The early follicular phase consistently shows the highest injury incidence, especially for non‑contact knee injuries.

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Severity Patterns: Why some Injuries Are Worse

1. Reduced collagen Synthesis – Lower estrogen levels impair collagen turnover, weakening ligament matrix during the early follicular phase.
2. Altered Pain Threshold – Progesterone can lower pain tolerance, causing athletes to push through minor strains that later develop into severe injuries.
3. Delayed Recovery – Hormonal fluctuations affect inflammation regulation, extending rehabilitation time by an average of 7‑10 days during the luteal phase [5].

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Practical Tracking Strategies

• Menstrual Calendar Integration

1. Log cycle start, length, and symptom severity in a dedicated app (e.g., Clue, Flo).
2. Color‑code training intensity: green (low risk), yellow (moderate), red (high risk).

• Hormone‑Based Load Adjustment
• Follicular (low estrogen): Prioritize technical drills, reduce high‑impact plyometrics.
• Ovulatory (high estrogen): Schedule peak intensity sessions and sprint work.
• Luteal (high progesterone): Emphasize recovery modalities (compression, contrast therapy) and monitor joint stability exercises.

• Nutrition & Supplementation
• Increase omega‑3 fatty acids (anti‑inflammatory) during luteal phase.
• Ensure adequate vitamin D and calcium to support bone health throughout the cycle.

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case Study: 2023 Women’s World Cup Injury Audit

• Sample: 132 elite players from 12 national teams.
• Findings:
• 42 % of ACL injuries occurred in the first five days of menstruation.
• Teams that employed menstrual‑phase‑specific training plans reported a 23 % reduction in overall match‑day injuries.
• Source: FIFA Medical Assessment Report 2023 [6].

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Benefits of Phase‑Specific Conditioning

• Enhanced Performance Consistency – Aligning peak speed work with the ovulatory window capitalizes on optimal neuromuscular efficiency.
• Lowered Injury Costs – Reducing high‑risk exposure during vulnerable phases cuts medical expenses and lost playing time.
• Improved Player Well‑Being – Proactive management of menstrual symptoms reduces perceived fatigue and psychological stress.

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Evidence‑Based Recommendations for Coaches

1. Implement Routine Cycle Surveys – conduct confidential, monthly questionnaires to capture cycle data without breaching privacy.
2. Educate Staff on Hormonal Impacts – Provide workshops on biomechanics changes across the menstrual cycle.
3. Collaborate with Sports Medicine teams – Use blood or salivary hormone testing when feasible to fine‑tune training prescriptions.
4. adopt Flexible Scheduling – Allow for individualized rest or modified drills during high‑risk windows.

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Emerging Research & Future Directions

• Hormonal Contraceptive use: Preliminary findings suggest combined oral contraceptives may stabilize hormone levels, reducing injury spikes, but individual response varies [7].
• Wearable Technology: Sensors measuring joint laxity in real time are being piloted to alert staff when athletes enter high‑risk phases.
• Psychological Mapping: Ongoing studies link menstrual‑related mood fluctuations with risk‑taking behavior on the field, opening avenues for mental‑skill interventions.

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References

1. Britannica, “Menstrual cycle,” https://www.britannica.com/science/menstrual-cycle.
2. Hewett, T. E.,et al. (2020). *Hormonal influences on ligamentous injury risk in female athletes. Sports Med.
3. Kwiecinski, A., et al. (2022). Cycle‑phase injury incidence in elite women’s soccer. Journal of Orthopaedic & Sports Physical Therapy.
4. UEFA Women’s Football Medical Report (2023).
5. Smith, L., & Jones, M. (2021). Progesterone and post‑injury inflammation. Journal of Athletic Training.
6. FIFA Medical Assessment Report (2023).
7. van Wijk, J., et al.(2024). Oral contraceptives and ACL injury prevalence in professional soccer. British Journal of sports Medicine.