The long-term health of retired female football players

As participation in elite women’s football continues to expand globally, increasing attention is being directed toward the long-term health outcomes of retired female players. While football offers substantial physical, psychological, and social benefits, evidence indicates that retired female footballers face a distinct set of long-term health challenges.

These include musculoskeletal disorders, neurocognitive risks, mental health concerns, and reproductive health issues, many of which may manifest earlier or more severely than in the general population or compared with male players.

Understanding these outcomes is essential for developing effective prevention strategies, gender-specific care models, and post-retirement support systems.

Musculoskeletal health and osteoarthritis risk

Early-onset osteoarthritis 

Osteoarthritis (OA) represents one of the most prevalent long-term health conditions among retired female football players. OA most commonly affects the knees, ankles, and hips and often develops significantly earlier in the general population. Studies indicate that nearly 50-60% of retired female players develop knee osteoarthritis by the age of 50. This early onset is strongly associated with cumulative high-impact loading, intensive training volumes, and a high prevalence of severe knee injuries sustained during playing careers.

Injury-related risk factors

Prior traumatic injuries-particularly anterior cruciate ligament (ACL) ruptures and meniscal injuries-substantially increase the risk of developing post-traumatic OA. Women are known to have a higher incidence of ACL injuries than men, which further elevates their long-term risk. Meniscectomy, whether isolated or combined with ACL reconstruction, is especially detrimental, underscoring the importance of meniscal preservation and optimal rehabilitation strategies. MRI evidence demonstrates degenerative joint changes within ten years of retirement in many former players.  

Chronic pain and functional limitations

Persistent musculoskeletal pain is common following retirement, particularly in the knees, ankles, hips, and lower back. Approximately 47% of retired female football players report ongoing back problems, with many experiencing stiffness, reduced mobility, and functional limitations that negatively affect quality of life.

Neurocognitive health and dementia risk

Concussion exposure and heading

Retired female football players may face an elevated risk of long-term neurocognitive impairment due to repeated concussions and cumulative exposure to heading. Research suggests that women sustain concussions at higher rates than men and frequently report more severe and prolonged post-concussive symptoms. Recovery patterns in women may be influenced by neurovascular dysfunction rather than exertional factors alone.  

Cognitive and mental health outcomes

Studies indicate that retired female players with histories of repeated concussions or heavy heading exposure perform worse on tests of verbal memory and verbal fluency compared to non-contact athletes. A history of concussion has also been associated with increased subjective memory complaints. While some studies report lower depression scores in this population, concerns remain regarding long-term cognitive decline.

Chronic Traumatic Encephalopathy (CTE)

Repetitive head trauma, including both concussive and sub-concussive impacts such as heading, has been linked to an increased risk of chronic traumatic encephalopathy (CTE), a progressive neurodegenerative condition. However, research specifically examining CTE in female football players remains limited, highlighting a critical knowledge gap.

Mental Health and career transition

Anxiety and depression

Mental health challenges, including anxiety and depression, are frequently reported during and after the transition out of professional sport. These difficulties are often associated with identity loss, reduced physical activity, and changes in social support structures. While some evidence suggests that retired female athletes may have lower overall rates of anxiety and depression than the general population, up to 9% meet criteria for clinical depression within two years of retirement.

The ”exit” transition

The transition from elite sport to retirement is a vulnerable period marked by changes in routine, purpose, and financial stability. Many players report loneliness, reduced self-rated health, and psychological distress linked to the loss of athletic identity and team-based environments. These challenges are often compounded by limited access to structured post-retirement support compared to male footballers.

Hormonal and reproductive health

Menstrual dysfunction and RED-S

Menstrual irregularities, including amenorrhoea, have been commonly reported during playing careers and may have lasting implications for bone and reproductive health. Relative Energy Deficiency in sport (RED-S) can disrupt hormonal function, negatively affecting menstrual cycles, bone mineral density, and long-term metabolic health. Eating disorders may also persist beyond retirement in some individuals.  

Fertility and pregnancy outcomes

Research on reproductive health in retired female football players remains limited. Available evidence suggests varied fertility outcomes, with some players experiencing difficulties conceiving, while others have successful pregnancies, often at a later age. Studies indicate a lower incidence of certain pregnancy-related disorders, such as gestational diabetes, compared to the general population. However, further research is needed to fully understand the long-term effects of elite sport participation and motherhood on reproductive health, including the possibility of a narrower reproductive window or earlier menopause.

Bone health and osteoporosis prevention

Enhanced bone mineral density 

Despite elevated rates of musculoskeletal injuries and OA, lifelong participation in football-whether at elite or recreational levels-confers significant long-term benefits for bone health. Older women with long-term football training histories demonstrate higher bone mineral density (BMD) and bone mineral content compared to age-matched inactive peers.

Osteogenic effects of football

Football’s high-impact, multidirectional nature-characterized by jumping, sprinting, cutting, and rapid acceleration and deceleration-provides a powerful osteogenic stimulus. These benefits are particularly evident in clinically important regions such as the lumbar spine, femoral neck, and lower limbs. 

Protection during Menopause

Recreational football training has been shown to effectively preserve bone health during the menopausal transition, a critical period for accelerated bone loss. Importantly, these benefits appear largely independent of dietary intake or supplementation, highlighting the unique role of mechanical loading from sport participation.

Long-term physical function and cardiovascular health

Muscle mass and functional capacity

Retired female football players who remain physically active exhibit reduced risk of sarcopenia, maintaining greater muscle mass and favourable body composition despite age-related declines. Continued participation in football or structured physical activity improves balance, functional ability, and reduces fall risk in later life.  

Cardiovascular health

Lifelong football participation is associated with improved cardiovascular profiles, including lower body fat percentages-often approximately 26% lower than inactive counterparts-and better overall cardiorespiratory fitness. While many retired players report good cardiovascular health, the long-term effects of prolonged high-intensity training warrant further investigation.

Support systems and post-retirement care

Lack of systematic support

Compared to the men’s game, retired female football players often lack comprehensive, long-term post-career support. Many report unmet needs related to musculoskeletal care, mental health services, reproductive health, and career transition assistance.

Existing and emerging support

Organisations such as the Professional Footballers’ Association (PFA) are increasingly providing counselling, mental health services, and career transition programs. However, access and utilization vary, and many players emphasise the need for gender-specific post-retirement care.

Recommendations and future directions

Injury prevention and management

Preventative strategies during playing careers-particularly targeting ACL and knee injuries-are essential for reducing long-term joint degeneration. Continued monitoring and management of prior injuries after retirement are critical to maintaining quality of life.

Exit health examinations

Mandatory post-retirement health evaluations could facilitate early identification of musculoskeletal, cognitive, and mental health conditions, enabling timely intervention.

Gender-specific care 

There is a clear need for healthcare approaches tailored to female athletes, with greater emphasis on menopause, reproductive health, mental health, and long-term musculoskeletal management.

Research gaps

Substantial gaps remain in understanding the long-term neurocognitive consequences of football participation in women, as well as the effects of motherhood and menopause on retired athletes. Larger, longitudinal studies are required to fully characterize these outcomes and inform evidence-based policy and practice.

Conclusion

Retired female football players experience a complex combination of long-term health risks and benefits. While lifelong football participation provides substantial advantages for bone density, muscle mass, cardiovascular health, and functional ability, it is also associated with high rates of early-onset osteoarthritis, chronic pain, concussion-related neurocognitive concerns, and mental health challenges during career transition. 

Addressing these issues requires a comprehensive, gender-specific approach that integrates injury prevention, long-term monitoring, targeted healthcare, and robust post-retirement support systems. As women’s football continues to grow, prioritising the long-term health of its athletes is essential to ensuring sustainable participation and lifelong well-being.