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Feb 21, 2021

Gender differences in Concussion: the truth about women and concussions

Concussion symptoms can vary, including depression, anxiety, irritability, sleep disorders, pain and learning or memory problems. While 80 to 85% of mild traumatic brain injury/concussion patients recover, some patients can experience prolonged symptoms or post-concussive syndrome.

In some cases, hormone imbalances may account for these ongoing symptoms. Drops in growth and sex hormones have seen in some patients, and there is some concern that the initial injury can disrupt the pituitary gland. Hormonal changes have bene associated with more moderate to severe injuries, but even mild brain injuries may have some form of hormonal dysfunction.

The hypothalamus and pituitary gland are the most vulnerable and can be affected by brain injury. The pituitary gland is a master gland, producing hormones that regulate other glands in the body, including the thyroid, adrenal glands, testes or ovaries.

For many years, doctors have treated concussions in men and women the same, but gender-based differences in TBI outcome have long been recognized … but are poorly understood.

Research has shown that women receive more concussions than men in similar sports and may take longer to recover from TBI. The physiology of women’s necks and upper body, and hormones are two possible reasons women may have a different post-concussion experience than men.

Most women are not as muscular in the shoulder girdle and neck area as their male counterparts. Similarly, children are more susceptible to concussion because they have a thinner and weaker necks compared to adults. In one study in the journal of Medicine & Science in Sports & Exercise found women in a controlled lab setting had greater head acceleration compared to males. This increased acceleration was despite activating neck muscles and trying to stabilize the head earlier (Tierney et al. 2005).

A study by Ripley et al showed women may miss menstrual periods or experience total amenorrhea after TBI, suggesting the brain injury may impact sex hormones (Ripley et al. 2008).

In a study published in 2014 in the Journal of Head Trauma Rehabilitation changes in progesterone and estrogen were found to influence recovery after a concussion. Researches analyzed 144 women with concussions, and measured their progesterone levels within 4 hours of the head trauma. Women during the last 2 weeks of the menstrual cycle when progesterone levels were high (luteal phase) had worse post-concussion symptoms compared to women in the first 2 weeks of when progesterone levels were low (follicular phase) (Wunderle et al. 2014). In this study women who received a blow to the head progesterone slowed and made concussion symptoms, such as headache, dizziness and nausea worse.

Progesterone has promise as a post-injury treatment for traumatic brain injury, but clinical safety and efficacy trials are limited.

Concussion related endocrine dysfunction is a widely missed diagnosis. Make sure you receive the appropriate, compassionate care and support. We would be happy to see you at Boston Sports & Biologics or find more information at

20 Walnut St. Suite 14

Wellesley MA 02481

P: (781) 591-7855


Ripley DL, Harrison-Felix C, Sendroy-Terrill M, et al. The impact of female reproductive function on outcomes after traumatic brain injury. Arch Phys Med Rehabil. 2008; 89(6):1090–1096.

Tierney RT, Sitler MR, Swanik CB, Swanik KA, Higgins M, Torg J. Gender differences in head-neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc. 2005 Feb;37(2):272-9.

Wunderle K, Hoeger KM, Wasserman E, Bazarian JJ. Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil. 2014;29(5):E1-E8.

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