Because there are many differences for each life phase, I’ve pulled together some key points to share. It’s important to keep these differences in mind as you review concussion information. If you’re a female and have a concussion, or are caring for someone who has one, review this information so you know some considerations for each phase. Hormone issues are different, causes of concussion vary, and there are unique aspects to each phase.
Puberty and Mid-Adolescence
| Age range | 11 – 14 (puberty); 15 – 17 (mid-adolescence) |
| Cycle duration | 21 – 45 days, except after the first period |
| Cycle characteristics | It’s more difficult to define “regular” periods as they’re not yet regular. This is especially true in the first year (first gynecological year). |
| Early periods | Characterized by some anovulatory cycles (no ovulation) |
| Concussion causes | Team sports concussions, bicyling, blunt trauma |
| Potential issues | Primary amenorrhea and Female Athlete Triad |
More > Menstrual Cycles: Puberty and Mid-Adolescence
Late Adolescent (Young Adult) and Childbearing Years
| Age range | 20 – 35 |
| Age at which cycles become regular per individual | 19 – 20 |
| Average cycle duration | 21 – 34 days |
| Concussion causes | Motor vehicle accidents (highest percentage), falls, bicycling, assaults, team sports concussions |
| Assault | Assaults can result in mTBI. Per a White House study, one in five college students are sexually assaulted. A percentage of female concussions in a study of emergency room visits were due to assault. |
| Pregnancy | Hypothyroidism in the first trimester can affect a baby’s growth and brain development. Pituitary issues can affect progesterone levels, which may in turn result in fertility issues or miscarriage. |
| Potential issues | Secondary amenorrhea, hypothyroidism, anovulation, Female Athlete Triad, PCOS, Luteal Phase Defect (LPD), PTSD and suicide, miscarriage |
More > Menstrual Cycles: Late Adolescent and Childbearing Years
Perimenopause
| Average age | Generally begins in 40s, and possibly in 30s |
| Perimenopause length | 2 – 10 years |
| Cycle duration | Variable |
| Average length of time between cycles | Up to 3 months |
| Characteristics | Pregnancy can occur. Menopause symptoms such as hot flashes and headaches might begin. Migraine headaches are common due to fluctuating estrogen levels. |
| Activity levels | Females in this age group are often very physically active. In recreational events such as 10k running events, marathons, and triathlons, the 40-44 age range has the highest or second-highest participation rate. |
| Considerations | Time between periods can be up to three months (generally), secondary amenorrhea can also result in longer cycles, and post-concussion pituitary issues can occur. This begs the question: are disruptions in cycles normal perimenopause or due to a concussion? |
| Potential issues | Secondary hypothalamic and athletic amenorrhea, Female Athlete Triad |
More > Menstrual Cycles: Perimenopause
Postmenopause
| Age ranges | Between 45 and 55 (generally). Maybe to age 60. |
| Average age | 51 |
| Early menopause | Before age 40 |
| Late menopause | After age 55 |
| Concussion causes | Falls: most common cause of TBIs after age 45 and 81% of TBIs after age 65 |
| Potential issues | Cognitive issues, dementia, “critical window” estrogen issues, gait and balance instability, osteoperosis (may be affected if there are bone mineral density issues during puberty) |
More > Menstrual Cycles: Postmenopause
