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Female athletes are severely understudied in the field of concussionresearch, despite higher prevalence for injuries and tendency to have longerrecovery time. Hormonal fluctuations due to normal menstrual cycle (MC) orhormonal contraceptive (HC) use have been shown to impact both post-injurysymptoms and neuroimaging measures, but have not been accounted for inconcussion studies. In this preliminary study, we compared arterial spinlabeling measured cerebral blood flow (CBF) between concussed female clubathletes 3-10 days post injury (mTBI) and demographic, HC/MC matched controls(CON). We test whether CBF mediates the relationship between progesteronelevels in blood and post-injury symptoms, which may be evidence forprogesterone`s role in neuroprotection. We found a significant three-wayrelationship between progesterone, CBF and perceived stress score (PSS) in theleft middle temporal gyrus. Higher progesterone was associated with lower (morenormative) PSS, as well as higher (more normative) CBF. CBF mediates 100% ofthe relationship between progesterone and PSS (Sobel`s p-value=0.017). Thesefindings suggest progesterone may have a neuroprotective role after concussionand highlight the importance of controlling for the effects of sex hormones infuture concussion studies.

Preliminary Report: Cerebral blood flow mediates the relationship  between progesterone and perceived stress symptoms among female club athletes  after mild traumatic brain injury