ABSTRACT
Background: Women have reported increased menstrual irregularities during the COVID-19 pandemic. It is unknown if this is due to biological (i.e., the effect of SARS-CoV-2 infection or vaccination) and/or psychosocial factors. This study examined menstrual irregularities during the COVID-19 pandemic and the association of abnormal menses with the presence of SARS-CoV-2 antibodies, stress, and mental health among reproductive age women. Methods: A cross-sectional study of 182 HIV-negative, sexually active, 18-to 45-year-old cisgender women was conducted on biobehavioral factors influencing HIV risk. From January 2019 to September 2021, participants completed a survey of menstrual irregularities over the previous three months, previous month condomless vaginal intercourse, and plans to conceive. Starting October 2020, SARS-CoV-2 IgG antibodies were measured using an FDA EUA rapid test assay using whole blood, and participants completed the Centers for Epidemiological Studies Depression Scale, the Loneliness Brief Form, the Perceived Stress Scale. History of COVID-19 vaccination was self-reported. Menstrual irregularities were compared by recruitment date (pre-pandemic vs. during pandemic/after April 2020) and by IgG antibody status. Logistic regression models tested if the presence of antibodies was associated with menstrual irregularities when controlling for age (in all models) and stress, depression, and loneliness in separate models. Results: Key variables are illustrated in Table 1. Menstrual irregularities did not differ by enrollment date. About half of women (n=36) had detectable IgG;5 had been vaccinated. Controlling for age, women with detectable IgG had 7.3, 95% CI [1.5, 36.5], times the odds of menstrual irregularities. Neither age, stress, nor mental health were associated with irregular menstruation. Among unvaccinated women (n=31), 35% with IgG antibodies had irregular menstruation compared to 0% without IgG antibodies. Among women with no plans to conceive, 74% had condomless intercourse, of whom 11% had irregular menstruation. Conclusion: Findings suggest a relationship between SARS-CoV-2 infection and irregular menstruation that was not accounted for by stress or mental health. During the COVID-19 pandemic, increased condom use and routine pregnancy testing may be merited among women not intending to conceive.