Incidence and Patterns of Menstrual Irregularities in Pediatric Patients After Concussion

Abstract

Objective Determine the incidence and patterns of menstrual irregularities in pediatric patients after a concussion and whether this is associated with prolonged recovery time. Background Abnormal menstrual patterns have been observed in women following a traumatic brain injury, which may be the result of disruption in the hypothalamic-pituitary-ovarian axis. The incidence and clinical significance of menstrual irregularities (MI) in pediatric patients after concussion is not well understood. Design/Methods A retrospective cohort chart review of female pediatric (11–20 years of age) concussion patients (n = 97). Questionnaire survey provided at each visit. The survey asked for number of years since first menses, hormonal contraceptive use, if any MI since the concussion, and type of MI if applicable. Data collected from 11/1/2018 to 5/30/2019. Patients with menarche less than 2 years and/or had experienced irregularities prior to concussion were excluded from study. Results MI was reported in 26.8% of pediatric patients. The majority of pediatric cases with MI were between the ages of 16 and 20 (73.1%). 84.6% of pediatric patients with reported MI had prolonged post concussive symptoms (PPCS). Other self-reported irregularities included painful dysmenorrhea, more frequent cycles in a short amount of time, or menstruation after prolonged period of amenorrhea due to hormonal contraceptive use. Recovered pediatric patients with reported MI had an average recovery time of 142 days, while recovered pediatric patients without reported MI had an average of 133 days of recovery time, which was not statistically significant (p = 0.825). Conclusions Menstrual irregularities are common after pediatric concussions and most common in the PPCS population with the highest rates in the older adolescent (16–20) age group. MI may be an important predictor of PPCS and should be reviewed by clinicians in the setting of head trauma. Recovery time after pediatric concussion was longer in the recovered menstrual irregularity group but was not statistically significant.