The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review,Sports Medicine

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The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review
Sports Medicine ( IF 9.3 ) Pub Date : 2024-08-31 , DOI: 10.1007/s40279-024-02074-5
Candice MacMillan _{1,

2} , Benita Olivier _{3,

4} , Carel Viljoen ₅ , Dina Christa Janse van Rensburg ₆ , Nicola Sewry _{2,

7}

Affiliation

Background

The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated.

Objective

This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded.

Methods

This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to “menstrual cycle”, “hormonal contraception” and “injury.” Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form.

Results

The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated.

Conclusions

Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs.

Clinical Trial Registration

Scoping review registration number: Open Science Framework (https://doi.org/10.17605/OSF.IO/5GWBV).

中文翻译：

女运动员月经周期期、月经不调、避孕药具使用和肌肉骨骼损伤之间的关联：范围综述

背景

月经周期阶段（MCP）、月经不调（MI）和激素避孕药（HC）的使用对女运动员受伤的影响已经被仔细审查。现有的系统评价调查影响内源性生殖激素状态的暴露对运动损伤的影响，在纳入的研究类型和调查的损伤方面是有限的。

目的

本范围综述旨在总结与 MCP、MI 和 HC 使用对运动员肌肉骨骼损伤影响的程度、性质和特征相关的文献覆盖范围。它还旨在总结相关文献中的关键概念和定义。包括调查 MCP 、 MI 和 HC 对育龄女性个体肌肉骨骼损伤影响的观察和实验研究。特别指出孕妇、围绝经期/绝经后运动员或使用影响生殖激素谱或肌肉骨骼系统的药物（HC 除外）的研究被排除在外。

方法

本范围综述是根据系统综述和荟萃分析的首选报告项目、范围综述扩展和 JBI 范围综述指南进行的。已发表和未发表的研究来自多个数据库和资源。最初使用的关键词包括与 “月经周期”、“激素避孕 ”和 “伤害” 相关的术语。独立筛选已确定的引文的标题和摘要，并由两名独立评价员评估合格性。使用标准资料提取表提取纳入研究的数据。

结果

检索得到 10,696 篇文章，其中 96 篇符合资格标准。大多数研究调查了 MI （77%），49% 的研究将 MCP 列为促成损伤的危险因素。在过去的二十年里，出版物有所增加。总的来说，只有 16% 的研究是在非洲、亚洲和大洋洲进行的。没有来自南美洲的研究。75% 的研究调查了个人与团队（25%）运动运动员。大多数研究仅调查精英或专业（n = 24; 25%）水平的运动员。损伤、痛经和 MI 的定义在不同研究中差异很大。关于 MI，大多数研究（69%）调查了继发性闭经，其次是月经稀发（51%）和原发性闭经（43%）。关于 HC，主要调查口服避孕药的影响。

结论

与 MCP、MI 和 HC 作为导致肌肉骨骼损伤危险因素相关的研究正在增加;然而，已经确定了几个差距，包括来自北美和欧洲以外国家的研究，研究人群分别是非专业/精英水平的运动员、参加团队运动的运动员以及与 MCP、MI 和 HC 相关的特定损伤。损伤、MCP 和 MI 的方法和术语的差异阻碍了比较总结性研究，未来的研究在研究设计过程中应考虑当前发布的指南。确定遵循标准指南的障碍或研究调查最实用但最准确的方法来调查 MCP 对肌肉骨骼健康的影响，可能会为未来的研究设计提供有价值的见解。