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Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women

Wunderle, Kathryn BA; Hoeger, Kathleen M. MD, MPH; Wasserman, Erin BA; Bazarian, Jeffrey J. MD, MPH

The Journal of Head Trauma Rehabilitation: September/October 2014 - Volume 29 - Issue 5 - p E1–E8
doi: 10.1097/HTR.0000000000000006
Original Articles

Objective: To determine whether menstrual cycle phase in women at the time of mild traumatic brain injury (mTBI) predicts 1-month outcomes.

Setting: Six emergency departments; 5 in Upstate New York, and 1 in Pennsylvania.

Participants: One hundred forty-four female participants (age, 16–60) who presented to participating emergency departments within 4 hours of mTBI.

Design: Nested cohort study with neurologic and quality-of-life outcome assessment, 1 month after enrollment. Female subjects aged 16 to 60 enrolled in the parent cohort study, with 1-month neurological determination data available, were classified into menstrual cycle groups by serum progesterone concentration and self-reported contraceptive use.

Main Measures: Rivermead Post Concussion Questionnaire and EuroQoL/EQ5D.

Results: Women injured during the luteal phase of their menstrual cycle, when progesterone concentration is high, had significantly lower EuroQoL General Health Ratings and Index Scores than women injured during the follicular phase of their cycle or women taking oral contraceptives. Multivariate analysis confirmed a significant independent effect of menstrual cycle phase on EuroQoL Index Score and the Rivermead Post Concussion Questionnaire Somatic Subscore.

Conclusion: Menstrual cycle phase and progesterone concentration at the time of mTBI affect 1-month quality-of-life and neurologic outcomes. This association has important implications for treatment and prognosis after mTBI.

(Ms Wunderle); Department of Obstetrics and Gynecology, (Dr Hoeger); Division of Epidemiology, Department of Public Health Sciences, (Ms Wasserman); Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Bazarian).

Corresponding Author: Jeffrey J. Bazarian, MD, MPH, Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 655, Rochester, NY 14642 (

Jeffrey J. Bazarian has received consulting fees from Banyan Biomarkers and Roche Diagnostics. Jeffrey J. Bazarian was supported by funds from the New York State Department of Health, the Academic Health Center Consortium, and the Emergency Research Network of the Empire State (ERNIES). ERNIES is supported by the Pilot Research Collaborative Program of the Foundation for Healthy Living, the University of Rochester's Clinical and Translational Science Award, the Upstate New York Translational Research Network (UNYTRN) and the Upstate New York Consortium for Healthcare Research and Quality (UNYCHRQ).

The authors thank Liana Dypka, Nancy Robak, MPH, RN, Donna Tyburczy, BSN, RN, Kamie Hoey, RN, and Coleen Vesely, RN, for their assistance and coordination in enrollment activities, and Akshata Nayak, Ming Ji, and Emily Tuttle, for processing serum samples.

The remaining authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins