The Real-World Impact of Concussions on the Neuropsychological and Menstrual Health of Women

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Abstract Introduction While most concussion patients recover within one month, approximately 15 to 30% of patients experience prolonged symptoms. Women are disproportionately affected and report greater physical, cognitive, and mood-related symptoms than men. To date, much research on concussion and sex differences relies on quantitative measures, with limited exploration of longer-term female experiences. This study uses a mixed-methods approach to assess “real-world” symptom morbidity in terms of neurological, mental, and menstrual health approximately 2 years post-concussion, compared to non-head injured controls. Materials and Methods Eligible participants were i) assigned female at birth, ii) aged 18–45 years, iii) not using hormonal birth control, and iv) (for the concussion group) diagnosed within 7 days of injury. Participants were recruited (April 2023–September 2025) across University of Pittsburgh Medical Center sites, including the Concussion Clinic, Emergency Departments, Student Health Clinic, and Pitt + Me registry. Follow-up assessments occurred October–November 2025. Measures & Analyses Post-concussion symptom morbidity was assessed using the Rivermead Post Concussion Symptoms Questionnaire (RPQ), depression with the Patient Health Questionnaire-9 (PHQ-9), and anxiety with the Generalized Anxiety Disorder-7 (GAD-7). Menstrual health was assessed using study-specific measures developed by the research team with expertise in concussion and women’s health. Qualitative data were collected via open-ended responses on perceived life impacts and recurring themes were illustrated using word clouds generated from the frequency of reported responses. Results A total of 45 concussion patients and 29 controls were recruited; 11 concussion patients (mean age 30.4 ± 8.4 years) and 16 controls (mean age 31.3 ± 7.4 years) completed follow-up. Compared to controls at follow-up, concussion patients reported greater symptom burden 2(RPQ: 31.6 ± 13.5 vs 9.4 ± 9.8; p=0.0002; Hedge’s g=1.90), depression (PHQ-9: 9.5 ± 6.5 vs 2.3 ± 2.2; p=0.0005; Hedge’s g=1.60), and anxiety (GAD-7: 9.8 ± 6.8 vs 2.8 ± 3.0; p=0.0057; Hedge’s g=1.42). Qualitative responses reinforced these findings: “No positive impacts. My relationship with my partner is downfall due to my lack of interest in intimacy and my lack of will. I’m drain[ed] every day of my life. I now use glasses as my vision is getting worse. My headaches are part of my everyday struggle. I can’t sleep at night as I have headaches or worries.” (C#9) Conclusions This mixed-methods study demonstrates significant long-term differences in symptom burden among women with concussions compared to controls. Findings highlight the importance of understanding real-world impacts to improve long-term care.

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