Background: Female participation in sports has continued to increase substantially since the Title IX Act was passed in the 1970s. Female athletes experience higher rates of Musculoskeletal (MSK) injuries than males at similar levels (ACL tears 2-8x more frequently). Injuries carry significant physical, psychological, and financial burdens. Hormonal fluctuations across menstrual cycle phases (MCP) have been proposed as contributors to sports injuries. Understanding hormonal influences on injury risk is essential as female participation in athletics continues to rise.
Purpose: To evaluate the relationship between MCP and sports injury incidence in female athletes, while identifying methodological limitations and areas for future research.
Methods: A narrative review of PubMed, EMBASE, OpenEvidence, and Clinical Key identified systematic reviews, meta-analyses, randomized trials, and cross-sectional studies (2016-2026), with 2 foundational studies 20 years old (total n=21). Search terms included MCP, female athletes, sports injuries. Included studies examine injury incidence or risk factors across MCP.
Results: Evidence demonstrates inconsistent findings regarding which MCP is associated with greatest injury risk. Several studies report increased injury incidence during high estrogen phases, related to increased LL and altered NMC. Several report higher rates during the luteal phase, related to altered proprioception, fatigue, connective tissue modulation. Other studies demonstrate no significant relationship. Methodological variability limits cross-study comparisons.
Conclusions: Current evidence does not support phase-specific injury prevention. Gaps include inconsistent MCP definitions, limited hormonal verification, small sample sizes, and focus on elite athletes. Future research should standardize MCP tracking, objectify hormonal measurements, and diversify cohorts to clarify hormonal effects on injury risk and guide injury prevention strategies.
Purpose: To evaluate the relationship between MCP and sports injury incidence in female athletes, while identifying methodological limitations and areas for future research.
Methods: A narrative review of PubMed, EMBASE, OpenEvidence, and Clinical Key identified systematic reviews, meta-analyses, randomized trials, and cross-sectional studies (2016-2026), with 2 foundational studies 20 years old (total n=21). Search terms included MCP, female athletes, sports injuries. Included studies examine injury incidence or risk factors across MCP.
Results: Evidence demonstrates inconsistent findings regarding which MCP is associated with greatest injury risk. Several studies report increased injury incidence during high estrogen phases, related to increased LL and altered NMC. Several report higher rates during the luteal phase, related to altered proprioception, fatigue, connective tissue modulation. Other studies demonstrate no significant relationship. Methodological variability limits cross-study comparisons.
Conclusions: Current evidence does not support phase-specific injury prevention. Gaps include inconsistent MCP definitions, limited hormonal verification, small sample sizes, and focus on elite athletes. Future research should standardize MCP tracking, objectify hormonal measurements, and diversify cohorts to clarify hormonal effects on injury risk and guide injury prevention strategies.