Menstruation and COVID-19

Did you notice any changes in your menstrual cycle after having COVID-19? Several researchers have been studying these hormonal distributions after COVID-19, since other viruses like the ones producing hepatitis B and C can affect normal ovarian function (1). The research team lead by Dr. Li, gynecologist at the Department of Gynecology and Obstetrics in Wuhan, Hubei, China, studied the sex hormones and menstruation of 237 women between the ages of 18 and 45 years with COVID-19. These women weren’t pregnant or lactating, and had regular menses in the 6 months before having the disease. The group of researchers found that the most common menstrual deregulation within women with COVID-19 was longer cycles and low menstrual volume, and less frequently shortened menstrual cycles and increased volume (2). Interestingly, the more severe the disease’s complications, the stronger the correlation with the menstrual changes, a finding that could be important in clinical practice because variations in the menstruation could be a sign of a more systemic dysfunction in the patients (2).

Menstruation is a discharge of tissue and blood from inside the uterus generated by a falling of progesterone levels (3). It is regulated by the ovary and can be easily affected by external factors like infections, drug treatments, among others (4). Under stressful situations, like malnutrition or in this case a disease, the body prioritizes the operation of essential organs such as the heart or liver, and suppresses the function of the ovaries (4). The ovarian suppression in the patients with COVID-19 was also found in Dr. Li’s study by identifying high concentrations of FSH and LH during the early follicular phase. However, the changes in the menstrual cycle were reversible after 1-2 months of having suffered from the disease, suggesting that the menstrual disturbances were solved in a short time. By measuring the Anti-Müllerian Hormone (AMH), which is an indicator of the ovarian reserve, they concluded that the virus SARS-CoV-2 may have little impact on the ovarian reserve in the long term (2). Another study, in this case from Al-Najjar and colleagues, assessed 483 women who were infected previously with COVID-19 and found that almost half of them experienced changes in the menstrual cycle after the infection. These changes were either in the length of the menstrual cycle, duration of the menstruation or on the amount of blood. Interestiling, they discovered that stress and depression had a major impact in these disturbances (5).

Related to this topic, numerous women have reported that the SARS-CoV-2 vaccination affected their menstrual cycle, especially by an increase in the bleeding volume. is common after the vaccination, probably not because alterations in the ovarian hormone pathways, but due an increase in the inflammatory response (6,7).

More studies and follow-up are needed to elucidate the effects that COVID-19 may have in the menstrual cycle in the short and long term.

References: 1.Kurmanova, A.M. Reproductive dysfunctions in viral hepatitis. Gynecological Endrocrinology, 2016. 32

2.Li, K.; Chen, G.; Hou, H.; Li, H.; Cheng, L.; Ai, J.; Analysis of sex hormones and mesntruation in COVID-19 women of child-bearing age. Reproductive Biomedicine Online. 2021, 42(1): 260-267.

3.MedlinePlus. Menstruation. Obtained form https://medlineplus.gov/menstruation.html

4.Kragiannis, A. & Harsoulis, F. Gonadal dysfunction in systemic diseases. European Journal of Endrocinology 2005, 152(4): 501-513.

5.Al-Najjar MAA, Al-alwany RR, Al-Rshoud FM, Abu-Farha RK, Zawiah M (2022) Menstrual changes following COVID-19 infection: A cross-sectional study from Jordan and Iraq. PLOS ONE 17(6): e0270537.

6.Male, V. Menstruation and covid-19 vaccination. 2022 BMJ, 376:o142

7.Lee, K.; Junkins, E.; Luo, C; Urooba, F.; Cox, M.; Clancy, K. Investigating trends in those who experience menstrual bleeding changes after SARS-CoV-2 vaccination. Sci. Adv. 2022, eabm7201: 1-15.