The entire cycle is a delicate balance. The continual ebb and flow of hormones is incredible, with a potential for disruption due to concussion. It wouldn’t – and doesn’t – surprise me to hear of people having difficulties with their menstrual cycles after a concussion.

With that in mind, here’s an overview of the hormones involved with the menstrual cycle. Where hormones originate are noteworthy.  Just remember: the entire process starts with signals from the pituitary gland. If that is damaged or negatively affected, it could throw everything else off. So it’s important to look at endocrine issues. The menstrual cycle can be a key analysis tool, I think. If you have a concussion and your periods and cycles were regular beforehand but now they’re not, then consider looking into the pituitary and related endocrine issues.

Hormones Related to the Menstrual Cycle

There are five female hormones in particular that are part of the menstrual cycle:

• Follicle-Stimulating Hormone (FSH)
• Gonadotropin-Releasing Hormone (GnRH)
• Leutinizing Hormone (LH)
• Estrogen
• Progesterone

Andogens (male hormones) may also have some impact on the menstrual cycle.

Starting Point: Pituitary

These three hormones are very important. Their actions result in the “pulse” or “surge” which sets ovulation in motion. That in turn affects everything else related to the menstrual cycle.

The pituitary gland sends signals to activate these hormones. The pituitary can also be damaged due to a brain injury. [1] For instance, one study found that 37.5% of patients in the study with a mild TBI had pituitary dysfunction. [2] This is something that’s not discussed as much. However, these pulse actions are very important for females. If they’re disrupted, so too are estrogen and progesterone levels. That can have far-reaching consequences.

Here are the three main hormones activated by the pituitary gland.

GnRH	Generates the FSH and LH pulse to initiate ovulation
FSH	Prepares ovarian follicles to mature and get ready to release an egg
LH	Releases an egg from an ovary

 

Pre-Ovulation: Estrogen

In addition to the term estrogen, you’ll also see references about estriadol and oestrogens.

Menstrual Cycle Levels	Estrogen levels rise just before ovulation In the Female Athlete Triad, estrogen levels remain low
Life Phases	Estrogen is vital for bone growth during early adolescence; bone mass doubles during puberty and peak bone mass occurs at about 17 years of age (why the triad is so important) Increased estrogen levels initiate breast development during puberty, which is one of the first milestones in development Estrogen levels vary during perimenopause Lower estrogen levels may impact cognitive functioning in post-menopausal women
Other	ACL injuries often occur at ovulation, when estrogen levels are at their highest

Post-Ovulation: Progesterone

Progesterone is of great importance with regard to brain injury. More information is coming out all the time. Here’s an overview of some of the key aspects of this hormone. It’s not a comprehensive list just yet, but I think you can see some of the main considerations for this important hormone as it relates to concussion and, to some degree, female athletes in particular.

Menstrual Cycle Levels	Ovulation produces natural progesterone Progesterone levels increase during the luteal phase (post-ovulation) Levels are low during the follicular stage (pre-ovulation)
Life Phases	Progesterone levels remain high during pregnancy Post-menopausal women don’t have high progesterone levels because ovulation no longer occurs. Progesterone is known to have neuroprotective properties and can be helpful in TBI and concussion recovery Low progesterone levels and hypothyroidism combined can cause problems during pregnancy
Birth Control Pills	Birth control pills can provide synthetic progesterone (progestins) “Synthetic progestin suppresses the hypothalamic-pituitary-gonadal axis” [3] Combination birth control pills can worsen bone mineral density (BMD) issues with the Female Athlete Triad

Related Posts

Menstrual Cycle Overview

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[1]  Agha A, Thompson C,   “Anterior pituitary dysfunction following traumatic brain injury (TBI)” Clinical Endocrinology Volume 64, Issue 5, Pages 481-488

[2]  Bondanelli M, De Marinis L, Ambrosio MR, Monesi M, Valle D, Zatgelli MC, Fusco A, Bianchi A, Farneti M, degli Uberti EC “Occurrence of pituitary dysfunction following traumatic brain injury” Journal of Neurotrauma 2004 Jun;21(6):685-96.

[3] Wunderle K, Hoeger K, Wasserman E, Bazarian J  “Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women” Journal of Head Trauma Rehabilitation

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