Physiological differences between biological male and female athletes have an effect on concussion recovery, impacting return-to-play, performance, and long-term health. Recent research by Dr. Meharvan Singh and others highlight the neuroprotective function of progesterone. Recently, a field exploring progesterone’s impact on concussion recovery has emerged, exploring potential implications for whether contraceptives affect concussion recovery in female athletes.
Dr. Singh and colleagues have examined the interaction of progesterone with brain-derived neurotrophic factor (BDNF). Their research explored the function of the regulation of BDNF by progesterone in favor of neuron survival and plasticity. While primarily exploring post-menopausal neuroprotection, their work also suggests that progesterone’s influence on BDNF could play a role in moderating the effects of brain injuries. However, if progesterone levels fluctuate or are artificially regulated, its neuroprotective properties might be altered.
Multiple studies within the past year have examined how endogenous progesterone levels impact concussion symptoms and recovery in female athletes. Ott et al. (2024) investigated post-menarchical adolescent female athletes and found that those in the luteal phase (which is when progesterone production is high) reported an increase in both concussion symptoms and cognitive deficits compared to those in the follicular phase. Similarly, Goeckner et al. (2025) examined progesterone and estradiol levels in female collegiate athletes and military cadets post-concussion. Their findings showed that concussed participants had significantly higher progesterone levels than controls across multiple time points. Their study also noted that hormonal contraceptive users exhibited more stable hormone levels, which seemed to be linked to improved recovery outcomes. These papers concluded that variance and increased levels of progesterone production may negatively influence post-concussion symptom severity and recovery duration. However, this relationship is complicated by the fact that the menstrual cycle itself appears to be disrupted following a concussion. Lorenz (2022) found that female athletes who suffered concussions experienced irregular menstrual cycles, likely due to neuroendocrine disruptions affecting the hypothalamic-pituitary-gonadal (HPG) axis. These disruptions could affect both recovery duration and symptom severity (Lorenz, 2022).
The relationship of progesterone and concussion recovery will likely create some interesting implications for sports medicine and concussion protocols in the coming decade. Multiple publications within the past year have started to question whether hormonal contraceptives should be considered a factor in concussion management. Contraceptives’ ability to stabilize progesterone fluctuations could serve as a protective factor against severe symptoms and prolonged recovery. However, this intervention challenges whether hormonal contraceptives’ interference with the body’s natural neuroprotective response to brain injury could serve some unintended consequences. Ultimately, this research is in its infancy and further research will be necessary to clarify this relationship. That being said, I do believe there is enough research for sports medicine professionals to test for, and at least consider, the impact of hormonal levels throughout the recovery process. If practitioners can better understand the relationship between hormonal levels and variance towards neuroprotection, it may lead to more individualized concussion management plans.
References
Goeckner, B. D., Huber, D. L., Van Bortel, K., Gill, J. M., Mannix, R., Master, C. L., ... & Meier, T. B. (2025). Progesterone and estradiol levels associated with concussion and clinical outcomes and recovery in female athletes and cadets. Medicine & Science in Sports & Exercise, 57(3), 524-534.
Lorenz, B. R. (2022). Investigating the relationships between menstrual cycle, progesterone, and concussion in female athletes (Master’s thesis). University of Toronto.
Ott, S., Redell, J., Cheema, S., Schatz, P., & Becker, E. (2024). Progesterone levels in adolescent female athletes may contribute to decreased cognitive performance during acute phase of sports-related concussion. Developmental Neuropsychology, 49(2), 86-97.
Singh, M., Krishnamoorthy, V. R., Kim, S., Khurana, S., & LaPorte, H. M. (2024). Brain-derived neurotrophic factor and related mechanisms that mediate and influence progesterone-induced neuroprotection. Frontiers in Endocrinology, 15, 1286066.
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