Impact of SARS-CoV-2 infection on menstrual cycle

In a recent study published in the Journal of Clinical MedicineResearchers have systematically assessed the impact of 2019 coronavirus disease (COVID-19) on the menstrual cycle.

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has major consequences for human lives. Extensive research has been done on COVID-19 and its effects on the respiratory, nervous and circulatory systems; however, its impact on the reproductive system is relatively less known. Prior research has observed a link between viral infections and changes in the female reproductive system.

For example, one study found that the initial phase of hepatitis B (HBV) or C virus (HCV) infection was characterized by prolonged, heavy periods that gradually became short and infrequent. While there are substantial anecdotal reports on the effects of SARS-CoV-2 infection on the female reproductive system and changes in menstruation, these data are insufficient to draw firm conclusions.

About the study

In the current study, researchers conducted a systematic review to analyze the impact of COVID-19 on the menstrual cycle. Medline, Cochrane library and Scopus databases were systematically searched. The terms “menstrual cycle” and “viral diseases” were used to search medical topic sections in Medline.

In other databases, the search terms in all fields were ‘menstrual cycle’ and ‘COVID-19/COVID’. They considered articles published in the period 2020-22 and written in English. Two reviewers independently screened titles/abstracts for relevant studies. After the full-text screening, data on the study characteristics and outcomes were extracted. Studies were included if they described at least one menstrual function in participants with a history of COVID-19.

Characteristics of the menstrual cycle include: length of the menstrual cycle, length and volume of menstruation, regularity, abnormal bleeding/spotting between regular menstrual periods and the frequency and symptoms of premenstrual syndrome. Articles describing the effect of therapy, vaccination, lifestyle changes or pandemic stress were excluded. Only research studies were included, regardless of study design.

findings

Initially, 444 articles were identified and 424 were screened at title/abstract level after removing duplicates. After various stages of review, three articles were included in the systematic review. Two were cross-sectional studies and one was a cohort study. A cross-sectional study examined the effects of SARS-CoV-2 infection on changes in sex hormones and the menstrual cycle in infected women of reproductive age.

Approximately 237 adult women aged 18 to 45 years who were not breast-feeding/pregnant with no menstrual irregularities in the six months prior to infection were included. Ninety patients had severe cases of COVID-19 and the rest had mild illness. It noted that nearly 20% of the participants had a significant decrease in menstrual volume with no significant differences between mild and severe cases.

A fifth reported prolonged menstrual cycles relative to pre-infection menstrual cycle length. Statistically, there were no significant changes in menstrual irregularities between severe and mild COVID-19 patients. In contrast, menstrual cycle duration and menstrual volume differed significantly between infected women and controls. This study suggested that changes in the menstrual cycle were transient.

The other cross-sectional study was conducted in January-March 2020 in China. It assessed the association between ovarian function and COVID-19. This study included 78 women age 50 or younger with COVID-19. The participants were asked for information about the menstrual cycle of the past three months.

Approximately 22% of cases were seriously ill, 48% reported a recent mental disorder (depression/anxiety), 36% had gynecological surgery and 12% had a history of benign gynecological disorders. Severe COVID-19 patients showed higher amenorrhea, menstrual irregularities, menstrual volume and pain than non-severe cases, although the differences were not significant.

The cohort study was part of an ongoing Arizona CoVHORT study. Researchers conducted surveys about the symptoms of COVID-19 every six weeks. It included 127 COVID-19 patients, ages 18-45 who were neither pregnant at the time of admission nor recently pregnant. Of these patients, 20 patients reported changes in the menstrual cycle. The median duration between the positive test and the last reported menstrual change was 57.5 days.

The most common changes are menstrual irregularities, menstrual irregularities, and increased symptoms of premenstrual syndrome. Patients with menstrual cycle changes were more likely to experience more Covid-19 symptoms such as fatigue, shortness of breath, headache and body aches. Notably, the researchers were unable to adjust for possible confounders, and the study provided no information on the duration of menstrual changes.

conclusions

The current (systematic) assessment identified a prolonged menstrual cycle and decreased menstrual volume due to COVID-19. It noted that the severity of the disease did not significantly affect the changes in the menstrual cycle. Nevertheless, the insufficient amount of data limits the ability to draw firm conclusions and emphasizes the need for further research.