The short answer is: no.
The long answer is a bit more complicated – the menstrual cycle is significant to a woman’s physiology, however, it isn’t the source of injuries.
In reality, we will likely never know 100% why injuries take place. There are many contributing factors as to why, at that point in time, in those specific circumstances and in that particular environment your body was unable to handle the stress upon it, and something gave. It is the interaction between all of these factors that can put you at risk.
A visual example
The diagram above shows just how many factors can contribute to an ACL injury (Tsarbou et al 2024).
Contributing factors to injuries:
Things we cannot change – non-modifiable risk factors
- Sex
- Family history of musculoskeletal or other conditions
- Bone morphology – the shape and anatomical features of our bones
- The environment – Weather and field conditions
- Institutional factors including medical care access and facility access
- Prior injury
Things we can change – modifiable risk factors
- Exposure hours to the sport or activity / load management
- Energy requirements – monitoring and managing low energy availability (LEA) or relative energy deficiency in sport (REDs)
- Strengthening and resistance training to increase load tolerance and general preparation for sport demands
- Biomechanical movement to a certain extent* – practicing movements and learning neuromuscular control and coordination from a young age
How do these factors influence the female athlete?
Both the modifiable and non-modifiable factors will have an impact on how a female athlete is prepared for, trains and partakes in her sport and activities. This could look like:
- Decreased overall strength, in relation to bodyweight
- Differences in trunk, hip, and knee angles during jumping and landing
- Body changes during puberty and lack of awareness of helping youth athletes manage this period of change in their sport (such as education and neuromuscular training)
- Menstrual cycle impact including all phases of the cycle and symptoms during their cycle, ligament laxity, recovery and strength during specific phases
- There is currently (as of 2025), not enough evidence to support cycle phase-specific training
- Nutrition related to LEA and REDs – the loss of an athlete’s menstrual cycle can have massive impacts on the body indicating low energy availability
Studies show injury is much more complicated than just hormones and have looked at societal factors that may contribute to the reasons that “female-specific” risk factors are what they are (this was specifically looked at for ACL tears).
- Lack of opportunity for strength training and gendered biases around females and resistance/strength training
- Lack of awareness/delivery of neuromuscular training for female athletes, in-particular youth athletes
- Lack of implementation of injury prevention programs in youth athlete sports
- Gendered socialization regarding training and sports from a young age
- Lack of research done on females – less than 6% of this research is done on female athletes
- Differences in equipment and environment including wearing men’s soccer boots and turf vs. grass playing fields
- *There has not been research that looks into transgender athletes or non-binary athletes
All in all – injury is not one thing, and it is especially not just hormones!
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References:
Augustsson, S. R., & Ageberg, E. (2017). Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes. BMJ open sport & exercise medicine , 3(1), e000222
Bruder, A. M., Culvenor, A. G., King, M. G., Haberfield, M., Roughead, E. A., Mastwyk, J., … & Crossley, K. M. (2023). Let’s talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes. British journal of sports medicine.
“Effect of estrogen on musculoskeletal performance and injury risk.” Frontiers in physiology (2019): 1834.
Collings TJ, Diamond LE, Barrett RS, Timmins RG, Hickey J, Du Moulin WS, Williams MD, Beerworth KA, Bourne MN. Strength and biomechanical risk factors for noncontact ACL injury in elite female footballers: a prospective study. Medicine & Science in Sports & Exercise. 2022;54(8):1242-51.Ellison, T. M., Flagstaff, I., & Johnson, A. E. (2021).
Sexual dimorphisms in anterior cruciate ligament injury: A current concepts review. Orthopaedic Journal of Sports Medicine , 9(12), 23259671211025304
Larwa, J., Stoy, C., Chafetz, R. S., Boniello, M., & Franklin, C. (2021). Stiff landings, core stability, and dynamic knee valgus: a systematic review on documented anterior cruciate ligament ruptures in male and female athletes. International journal of environmental research and public health , 18 (7), 3826.
Parsons, J. L., Coen, S. E., & Bekker, S. (2021). Anterior cruciate ligament injury: towards a gendered environmental approach. British journal of sports medicine, 55(17), 984-990
Tsarbou, C., Liveris, N. I., Xergia, S. A., Papageorgiou, G., Kvist, J., & Tsepis, E. (2024). ACL Injury Etiology in Its Context: A Systems Thinking, Group Model Building Approach. Journal of Clinical Medicine, 13(16), 4928. (Image: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
