Abstract:
INTRODUCTION: The hormonal withdrawal hypothesis suggests that reduction of progesterone in women following concussion may lead to greater symptom burden and longer recoveries. Current evidence indicates that hormonal stability following head injury may be an important moderator of post-concussive recovery. Thus, female athletes using hormonal contraceptives (HCs) may exhibit better recovery profiles as their hormone levels are artificially stabilized. Our investigation sought to examine the relation between HC use and concussion outcomes in female student-athletes. METHODS: This longitudinal study examined concussion outcomes from female student athletes participating in the NCAA-DoD CARE Consortium Research Initiative, including academic years 2014 to 2020. Eighty-six female collegiate athletes reporting HC use (HC+) were group matched on age, body mass index, race/ethnicity, sport contact level, concussion history, and current injury characteristics (i.e., amnesia, loss of consciousness) to 86 female collegiate athletes reporting no HC use (HC-). All participants had sustained a concussion and completed the Sport Concussion Assessment Tool – 3rd edition Symptom Scale (SCAT-3), Brief Symptom Inventory-18 (BSI-18) and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) at pre-injury baseline, 24 to 48 hours post-injury, and when cleared for unrestricted return-to-play. To provide an index of recovery trajectory, days between injury and unrestricted return-to-play were calculated. RESULTS: Groups did not differ on length of recovery, post-concussion symptoms, psychological health, nor cognitive assessments. No differences were observed between groups on any measure when accounting for baseline levels of performance. CONCLUSIONS: Our findings suggest that HC use does not influence recovery trajectory, symptoms, nor recovery of cognitive function following concussion.