The effects of Traumatic Brain Injuries on Women
By Bavukile Magagula
Modern medicine is constantly evolving, and we are continually learning about the human anatomy. Up until recently, the treatment of Traumatic Brain Injuries (TBIs) has been non-sex specific, however, recent research has shown that even mild TBIs may affect women differently as females take longer to recover from TBIs, report worse symptoms,[1] and report effects on their menstrual cycle. It is important to take into consideration the effects of trauma on the female anatomy and to highlight developments in medical research that considers the female experience.
Studies have shown that TBIs can have long-lasting effects on cognition and functioning and that even individuals who have sustained mild TBIs (typically known as concussive head injuries) report long-term sequalae, such as memory and concentration deficits[2]. However, it is important to consider the difference in how females and males biologically react to concussive TBIs.
Research has found that females have higher post-concussive symptom scores, greater cognitive decline and poorer reaction time compared to their male counterparts.[3] Dr Tracey Covassin, an associate professor and director of the undergraduate athletic program at Michigan State University, studies concussions in female athletes. Covassin has found that females have more severe symptoms and have neurocognitive impairment for a longer period than males after suffering a concussion[4].
Dr Covassin explains further that the changes in estrogen and progesterone levels during a menstrual cycle can lead to poorer outcomes in females who have experienced a concussion. Progesterone is known to have calming effects and can improve cognition, memory, and mood. Dr Covassin refers to a study published in 2014 in the Journal of Head Trauma Rehabilitation, which found that females who were injured in the last two weeks of their menstrual cycle, where progesterone is highest, had worse symptoms than those who were injured in the first two weeks of their cycle, where progesterone is lower (this was especially the case with those who were taking contraceptive pills).
It is therefore suggested that females that have sustained TBIs experience worse outcomes than males because males have a consistently lower concentration of progesterone.[7] Studies further conclude that females who have suffered concussions, particularly young adolescents, were more likely to have abnormal menstrual bleeding[8], which provides a further indication that TBIs have a severe impact on the daily lives of females.[9].
The above research has indicated that there is a possibility that TBIs may have a major impact on the menstrual cycle and reproductive system of a female and that hormonal levels play a major role in a female’s recovery after suffering a TBI. However, it is important to note that the above is not the sole cause of these problems but makes the recovery process more difficult and the long-lasting effects worse. Therefore, it would not only be insightful but imperative that more research is conducted in order to determine why women experience irregular menstrual cycles after a TBI in order to ensure that females are aware of the additional effects of their TBI and as such have access to the necessary treatments and support.
References:
[1] Mia Garchitorena ‘5 Ways Concussion is Different in Women’ available at https://www.everydayhealth.com/neurology/ways-concussions-are-different-women-why/ accessed on 6 September 2021.
[2] Kathryn Wunderle, Kathleen M. Hoegar & Erin Wasserman et al ‘Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women’ available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237582/, accessed on 17 February 2021.
[3] Ibid.
[4] Ibid.
[5] Ibid note 1.
[6] Supra note 2.
[7] Ibid.
[8] Meredith Snook, Luke Henry & Joseph Sanfilippo et al ‘Association of Concussion with Abnormal Menstrual Patterns in Adolescent and Young Women’ available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710410/, accessed on 17 February 2021.
[9] Daniella Emanuel ‘Study links concussions to irregular menstrual cycles’ available at https://edition.cnn.com/2017/07/03/health/concussions-irregular-menstruation-study/index.html, accessed on 17 February 2021.
