Menstrual Cycle Changes after COVID-19 Infection: Does Coronavirus-induced Stress Lead to Hormonal Change?

ABSTRACT

Background: Pieces of clinical evidence suggest that coronavirus disease-2019 (COVID-19) viral infection results in hormonal imbalance leading to changes in menstrual cycles of women. This study has been conducted with the aim to determine the effect of COVID-19 infection and its vaccine on menstrual cycle patterns. Materials and methods: This was a cross-sectional study to observe any changes in menstrual cycle after COVID-19 infection or after its vaccination. A Web Link collector generated the survey‘s universal resource locator (URL) and was sent via social media messages to females in the general population as well as healthcare workers. Results: Menstrual cycles remained unaltered in 154/228 (67.5%) of women post-COVID-19 infection irrespective of its severity. Out of 228, one-third of women, i.e., 74/228 (33%), reported changes in their menstrual patterns, with respect to either cycle length, duration of flow, number of pads used, pain during menses, or premenstrual symptoms (PMSs). Menstrual blood loss was decreased by 14% (32/228) and 18%;42 women complained of increased flow during menses. Twenty percent of women who had severe infections had menorrhagia. Out of the 590 women who completed the questionnaire, 436 (73.8%) were vaccinated against COVID-19 and 154 (26%) were unvaccinated. After vaccination, 290/436 around one-third of women (66.5%) had normal menstrual cycle, 21 women (4.8%) had decreased menstrual blood flow, and 18 women (4.1%) reported increased menstrual flow. Conclusion: COVID-19 infection affected the menstrual cycle of only one-third of women and this effect was temporary. This effect might be due to stress and anxiety affecting the hypothalamic-pituitary axis (HPA). More studies are needed to support this effect.