Study: Birth Control Pills May Ease Concussion Symptoms in Female Athletes

A new Northwestern Medicine pilot study has shown that when a female athlete has a concussion injury during the phase of her menstrual cycle when progesterone is highest and less stress is felt, which is a major sign of a concussion, according to the study authors.

Additionally, the study revealed for the first time the physiological reason for the neutral protection is increased blood flow to the brain as a result of higher levels of progesterone.

"Our findings suggest being in the luteal phase (right after ovulation) of the menstrual cycle when progesterone is highest-or being on contraceptives, which artificially increase progesterone—may mean athletes won't have as severe symptoms when they have a concussion injury," said co-author Amy Herrold, research assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, in a press release.

The athletes in the study were in soccer, ultimate frisbee, crew, triathlon, lacrosse, women’s rugby, and tennis clubs. The focus on club athletes is important because more college students take part in club athletics than varsity athletes, according to the study authors. In addition, club athletics are not as closely monitored, possibly leading to increased exposure and under-reporting of concussions, according to the study.

The research team found increased blood flow in the brain when a female athlete had a higher level of progesterone due to her menstrual cycle phase. The region, known as the middle temporal gyrus, is important for information processing and integrating visual and auditory stimuli.

"When they are recovering from a concussion, they get very stressed trying to keep up with coursework and making up for lost time," Herrold said in a press release. "Their ratings on perceived stress are really important for their overall recovery from the injury and getting back to normal."

The study’s objective was to focus on female athletes, since many of the past studies have been focused on male athletes. The study enrolled 30 female collegiate athletes and assessed them 3 to 10 days after a concussion or mTBI.

Assessments included an MRI scan to examine brain blood flow, a blood draw to examine progesterone levels, and self-reported mTBI symptom questionnaires, including the perceived stress questionnaire. Once an injured athlete was studied, the investigators enrolled a healthy control athlete that was matched based on age, ethnicity contraceptive use and type, and menstrual cycle phase, according to the study authors.

"Clinicians also may want to evaluate wider use of hormonal contraceptives that raise progesterone levels for athletes who are at risk for incurring a concussion or mild TBI as there could be potential for neuroprotection," Herrold said in a press release.

Future research plans to determine whether the study results can be replicated in a larger more heterogenous sample of female athletes while also comparing what they found in males and females competing in sports with concussion risk.

REFERENCE

Could birth control pills ease concussion symptoms in female athletes? EurekAlert! https://www.eurekalert.org/pub_releases/2021-03/nu-cbc031621.php. Published March 16, 2021. Accessed March 17, 2021.