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Can Estrogen Impact Injury?

While Gwyneth Paltrow was having her ski accident court drama, I was having some of my own. Ski drama, not court drama, and I didn't collide with a human; I hit a pile of what my friend calls "Sierra cement."

Like anyone else, when bad things happen, I wonder why? In these moments, I try to remind myself that things don't happen to you. They just happen. I kept telling myself this as I sat in the ER crying on my first day of skiing in Lake Tahoe.

My husband and I were only five runs in on an easy, breezy, blue trail when my left ski got stuck in the aforementioned cement, and my right ski did not. One ski went one way, and the other one didn't follow. That's when I heard the POP and knew it was over. A thousand thoughts went through my mind, starting with, "I've ruined our entire vacation!" and ending with, "F****ck, this is going to be surgery and months of rehab!"

As I feared, it wasn't good. I tore my left ACL. The ER doc sent me home in a brace, and we tried to make the best of the remainder of our week, with my husband getting out a few days to snowboard (no point in both of us suffering) and me resting in the condo and getting a lot of work done.

Thank God I paid for this trip with miles.

As I went down the torn ACL rabbit hole, I stumbled across a PubMed article titled, Effects of Estrogen on Musculoskeletal Performance and Injury Risk, where it states: "...unlike bone and muscle where estrogen improves function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. High estrogen levels can decrease power and performance and make women more prone to catastrophic ligament injury."

This blew my mind.

To summarize: the natural hormonal changes across the menstrual cycle do play a role in injury. With that, common running injuries, like ACL tears and Runner’s knee, can occur more often during hormonal change - specifically during a surge in estrogen. Muscles, tendons, and ligaments all have estrogen receptors, and during the menstrual cycle, the structure and function of these tissues change. When estrogen increases, ligaments and tendons loosen, which can cause instability in the knee, and that is not a thing you want when you're skiing.

Le sigh.

Most of these studies have been done on young women and teenage girls, leaving many unknowns for us mid-lifers born with ovaries. This is an essential consideration for trans women as well. I'm not a doctor, but with the fluctuation of perimenopausal hormones and their unpredictable surges, I have to wonder, was it the Sierra cement, the estrogen, or both? We'll never know, but I'd sure as sh*t like more studies to be done!

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