THE RELATIONSHIP BETWEEN PERCEIVED STRESS DURING THE COVID-19 PANDEMIC AND MENSTRUAL CYCLES AND SYMPTOMS

ABSTRACT

OBJECTIVE: The COVID-19 pandemic exacerbated existing and initiated new psychosocial, interpersonal, and environmental stressors. For menstruating people, these stressors may contribute to cycle irregularity and make family building an even more challenging journey. This study investigates the relationship between perceived stress and menstrual cycle and symptom changes during the COVID-19 pandemic. MATERIALS AND METHODS: A survey was administered to users of Ovia Health's Fertility mobile application in the United States from March 2020 to April 2021. Items captured changes in menstruation pattern and symptomology and included the Perceived Stress Scale 4-item version (PSS-4).1 A paired t-test was used to assess differences between groups. A p-value of < 0.05 was considered statistically significant. RESULTS: Out of a total of 12,302 respondents, 36% reported experiencing some menstrual cycle and/or symptom changes. Most commonly reported changes included cycle starting early or late (87%), stronger symptoms during menstruation (e.g. low back pain, cramping, discharge changes) (29%), and heavier bleeding during periods (27%). Respondents reporting menstrual cycle or symptom changes tended to score slightly higher on average on the PSS-4 compared to those who did not report any changes (8.5 v. 8.3, respectively, p < 0.05). PSS-4 scores in this sample were notably higher in all respondents, regardless of cycle/symptom irregularity, compared to pre-pandemic benchmarking in similar populations.2-3 CONCLUSIONS: These results demonstrate that this sample's reported stress levels during the pandemic were noticeably higher than pre-pandemic benchmarks, and that these stress levels may contribute to changes in reproductive physiological processes such as menstruation. These changes may be especially frustrating and impactful for individuals trying to conceive and those struggling with infertility. IMPACT STATEMENT Reproductive medicine specialists should be aware of the relationship between stress fostered by the COVID-19 pandemic and menstrual pattern disruption, especially for patients trying to conceive with irregular menstrual patterns or those struggling with infertility. Providers should work together with their patients to formulate strategies to mitigate the impact of stress on menstrual cycle changes in order to optimize conception and fertility treatment outcomes.