Effects of Menstrual Cycle Hormones on Anterior Cruciate Ligaments of Female Athletes


Effects of Menstrual Cycle Hormones on Anterior Cruciate Ligaments of Female Athletes 

Are you a female athlete who worries about tearing their ACL? If so, read on to find out about how your menstrual cycle hormones can affect your likelihood.





Introduction:

What is an ACL?

Anterior cruciate ligament (ACL) is a ligament that attaches your thigh to your calf and is most often torn during competitive sports, and most often torn by females. 

Why are ACLs more likely to be torn by females?

Tears are common among female athletes for many reasons, one of which is because of how increased hormones affect ligament structure. Research evaluated female athletes through taking blood samples to measure hormone levels and knee arthrometers to measure knee laxity. To do this, researchers simulated ligaments to test laxity effects of hormones on donor fibroblasts to create ACLs for males and females. They found that ACLs and other ligaments have hormone receptors on them, and when there are high amounts of hormones circulating in the blood stream during the menstrual cycle, more hormones attach to the receptors on the ligaments, increasing the laxity of the ACL. It becomes looser and more likely to tear.

 

Practical Applications:

  • There are hormone receptors on ligaments like the ACL for estrogen, relaxin, and others found in the menstrual cycle. When hormones attach here, it increases laxity and increases likelihood of tearing.
  • Most likely to tear during:
    • Late follicular phase just before ovulation due to high estrogen levels, as shown in graph above. 
    • Mid luteal phase before menstruation due to high relaxin levels. 
  • What’s important for you as a female athlete:
    • Track your cycle to provide hormone information to your doctors. 
    • Understand your menstrual cycle hormones and how they work.
  • What to bring up to your clinician:
    • That you want to create a training program to strengthen your legs at the right times to prevent tears of aid in rehabilitation of the tear.
    • Ask about the ACL; what is it, when you are most likely to tear it and what makes that ligament at risk.
  • However, more research needs to be completed on:
    • How nutrition affects ligament structure.
    • Effect on females with irregular menstrual cycles. 
    •  If hormonal manipulation is beneficial to a female athlete.

In Conclusion:

Due to high levels of hormones from the menstrual cycle, there is an increased likelihood of tearing an ACL because of how loose the ligament becomes. Therefore, you as a female athlete should pay attention to your body and what it needs to prevent a season ending injury to keep you active and successful in your respective sport. With knowing your body, you can help your clinician get your body prepared for competition as soon as possible through strengthening and rehabilitation programs. 

 

Additional Resources:

    1. View different ways to track your cycle here:                                https://www.womenshealthmag.com/health/g26787041/best-period-tracking-apps/ 

    2. Click here to learn more about ACL tears in female athletes from a Q&A:        https://www.hopkinsmedicine.org/health/conditions-and-diseases/acl-injury-or-tear/acl-tears-in-female-athletes-qa-with-a-sports-medicine-expert 


 About the Author:



Marissa Jacob is a senior at Westfield State, majoring in Sport and Human Performance with a concentration in Sports Medicine. Marissa is a four-year student athlete on the women’s soccer team, who aspires to attend a graduate physician assistant program after graduating from WSU. Marissa can be reached at marissajacob8@gmail.com.

 

References:

Chidi-Ogbolu, N., & Baar, K. (2019). Effect of Estrogen on Musculoskeletal Performance and Injury Risk.                                             Frontiers in physiology, 9, 1834. https://doi.org/10.3389/fphys.2018.01834.

Dragoo JL, Castillo TN, Braun HJ, Ridley BA, Kennedy AC, Golish SR. Prospective Correlation Between Serum Relaxin Concentration and Anterior Cruciate Ligament Tears Among Elite Collegiate Female Athletes. The American Journal of Sports Medicine. 2011;39(10):2175-2180. doi:10.1177/0363546511413378.

Lee, C. A., Surgery, Lee-Barthel, A., et al. (2015, May 15). Estrogen inhibits lysyl oxidase and decreases mechanical function in engineered ligaments. Journal of Applied Physiology. https://doi.org/10.1152/japplphysiol.00823.2014.


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