Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes

CONTEXT: The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (MI) and INJ in the high school population. OBJECTIVE: To determine the prevalence of and relationship between MI and INJ in high school athletes. DESIGN: Cross-sectional study. SETTING: High schools. PATIENTS OR OTHER PARTICIPANTS: The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season. MAIN OUTCOME MEASURE(S): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year. RESULTS: The prevalences of M I and INJ were 19.7% and 63.1 %, respectively. Athletes who reported MI sustained a higher percentage of severe injuries (missing ≥ 22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with MI were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio = 2.7, 95% confidence interval = 0.8, 8.8) than those who sustained an injury resulting in 7 or fewer days of time lost. CONCLUSIONS: The incidences of MI and INJ in this high school population during the study period were high. Athletes who reported MI sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management of MI and its potential effects on injury in female high school athletes are warranted.