How COVID-19 can impact our menstrual cycle

The COVID-19 pandemic has affected every aspect of our lives, including our menstrual cycle. Emerging evidence suggests that COVID-19 can cause disruptions to the menstrual cycle, and may also impact fertility. 

While the majority of research on COVID-19 has focused on respiratory and cardiovascular short and long-term symptoms, emerging evidence suggests that the virus may also impact female reproductive health.

In this article, we will explore how COVID-19 can affect the menstrual cycle and fertility, and what steps individuals can take to manage these potential impacts. Read on to learn:

• Does research show COVID-19 can disrupt our menstrual cycles?
• Are these changes short or long-term?

COVID-19 and menstrual cycle disruption

It is well-accepted that stress and illness can disrupt the delicate balance of hormones that regulate the menstrual cycle, potentially leading to changes in bleeding patterns. Even prior to the pandemic, bacterial and viral illnesses have been shown for years to temporarily disrupt menstrual cycles.

COVID-19 is no exception. Anecdotally, many people have reported longer or shorter menstrual cycles following a COVID-19 infection.

In fact, a 2021 study published in Reproductive Biomedicine Online (RBMO) found that out of 177 menstruating people with COVID-19, 25% reported changes to the amount of blood they lost with their periods and 28% reported general menstrual cycle changes (1). 

Fortunately, COVID-19's impact on our menstrual cycle seems to be short-term. This same study found that 84% of study participants returned to normal menstrual volume and 99% returned to their normal cycle length within 1-2 months post-infection.

Other studies found that fewer individuals saw a disruption to their menstrual cycles following infection. Only 16% of female participants in the 2022 Arizona CoVHORT study, for example, reported a change to their menstrual cycle following an infection (2) and some studies have found no significant difference in menstrual cycle abnormalities following a COVID-19 infection (3).

The exact mechanism behind how COVID-19 can affect the menstrual cycle is still unknown, but it is thought to be related to the virus’ impact on the immune system, stress levels, and inflammation. We know much more about COVID-19 today in 2023 than we used to, and while much research is still needed, we know that this virus can have a lasting inflammatory and even autoimmune impact.

Overall, it may not surprise you that much more research on this topic is needed! 

How COVID-19 can impact female fertility

There is also emerging evidence that COVID-19 can impact our fertility. Fortunately, it is likely just in the short-term. While the long-term fertility implications of COVID-19 have yet to be studied, it is highly likely that these impacts were only temporary. 

For example, in the 2021 RBMO study mentioned earlier, a further analysis was conducted in 91 patients to take a deeper look at how sex hormones responded to COVID-19 infection. Anti-Müllerian hormone (AMH) levels showed no difference for COVID-19 patients compared to controls, indicating that the virus did not impact ovarian follicles or egg reserve (1).*

These researchers did find that follicle stimulating hormone (FSH) to luteinizing hormone (LH) ratios were abnormal during participants' follicular phase, potentially indicating ovarian suppression (i.e., resistance to ovulating). We do know that during emotionally or physically-stressful situations, female bodies will oftentimes skip ovulating because they do not feel safe getting pregnant.

While this finding had a gap in follow-up (FSH and LH levels were not taken again for recovered participants), the researchers deduced that "it is reasonable to assume that the change in [FSH and LH] were only temporary" because the percentage of participants who returned to their normal menstrual cycles was very high (1).

Interestingly, studies have also shown that a COVID-19 infection can also temporarily reduce fertility for men through significantly reduced sperm quality and sex hormone disruption (4,5).

*Note: AMH is an indicator of our ovarian reserve. While monitoring it over time can be helpful to keep tabs on your ovarian reserve, it is not the best indicator of our fertility for any given point-in-time.

COVID-19 vaccines and our reproductive health

COVID-19 vaccines, particularly the mRNA options developed by Moderna and Pfizer, raised concerns about their potential impact on fertility when they were first released.

We do know that COVID-19 vaccines can produce temporary menstrual cycle disruptions (6, 7). Studies discuss that the reason for this is likely due to the (intended) immune response that the vaccine provokes. Similar to catching a cold or flu virus or even COVID-19 itself, if our immune system is temporarily distracted by something, our reproductive function will sometimes take a back seat to divert energy to other functions.

Studies have shown that the vaccines are safe and highly recommended for both pregnant people and those who are trying to conceive. In fact, pregnancy significantly increases risk for severe illness from the virus (8, 9).

It is highly recommended that all people, especially pregnant people and those trying to conceive, remain up-to-date with their COVID vaccination status. 

What steps can individuals take to manage the potential impacts of COVID-19 on their menstrual cycle and fertility?

If you have been diagnosed with COVID-19 and are experiencing changes to your menstrual cycle, it is important to track these changes and discuss them with your healthcare provider. They may recommend monitoring your cycle for a few months to determine if the changes are temporary or indicative of an underlying condition.

If you are trying to conceive and have been diagnosed with COVID-19, it may be helpful to delay trying to conceive until you have fully recovered. Additionally, maintaining a healthy lifestyle, including eating a balanced diet, getting regular exercise, managing stress, and living a lifestyle that encourages low inflammation and balanced hormones can help support fertility.

Getting vaccinated against COVID-19 is also recommended for individuals who are trying to conceive. Recent studies have shown that the vaccines are safe for pregnant people and those who are trying to conceive, and can help prevent severe illness from the virus.

In conclusion, COVID-19 can impact both the menstrual cycle and fertility, potentially leading to changes in bleeding patterns and delays in conception. While there is a suspected link to the body's inflammatory response to the virus and subsequent hormone production and reproductive function, the exact mechanism behind these impacts is still unknown and more research is needed.

Sources

1. Li K, Chen G, Hou H, Liao Q, Chen J, Bai H, Lee S, Wang C, Li H, Cheng L, Ai J. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online. 2021 Jan;42(1):260-267. doi: 10.1016/j.rbmo.2020.09.020. Epub 2020 Sep 29. PMID: 33288478; PMCID: PMC7522626. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522626/.
2. Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, Jacobs ET, Farland LV. SARS-CoV-2 infection and subsequent changes in the menstrual cycle among participants in the Arizona CoVHORT study. Am J Obstet Gynecol. 2022 Feb;226(2):270-273. doi: 10.1016/j.ajog.2021.09.016. Epub 2021 Sep 20. PMID: 34555320; PMCID: PMC8452349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452349/.
3. Lebar V, Laganà AS, Chiantera V, Kunič T, Lukanović D. The Effect of COVID-19 on the Menstrual Cycle: A Systematic Review. J Clin Med. 2022 Jun 30;11(13):3800. doi: 10.3390/jcm11133800. PMID: 35807090; PMCID: PMC9267255. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267255/.
4. Harville EW. Invited Commentary: Vaccines and Fertility-Why Worry? Am J Epidemiol. 2023 Feb 1;192(2):154-157. doi: 10.1093/aje/kwac147. PMID: 35968679; PMCID: PMC9384762. https://pubmed.ncbi.nlm.nih.gov/35968679/.
5. Wang S, Zhang A, Pan Y, Liu L, Niu S, Zhang F, Liu X. Association between COVID-19 and Male Fertility: Systematic Review and Meta-Analysis of Observational Studies. World J Mens Health. 2023 Apr;41(2):311-329. doi: 10.5534/wjmh.220091. Epub 2022 Oct 4. PMID: 36326165; PMCID: PMC10042646. https://pubmed.ncbi.nlm.nih.gov/36326165/.
6. Rodríguez Quejada L, Toro Wills MF, Martínez-Ávila MC, Patiño-Aldana AF. Menstrual cycle disturbances after COVID-19 vaccination. Womens Health (Lond). 2022 Jan-Dec;18:17455057221109375. doi: 10.1177/17455057221109375. PMID: 35796571; PMCID: PMC9295013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9295013/.
7. Alvergne A, Kountourides G, Argentieri MA, Agyen L, Rogers N, Knight D, Sharp GC, Maybin JA, Olszewska Z. A retrospective case-control study on menstrual cycle changes following COVID-19 vaccination and disease. iScience. 2023 Apr 21;26(4):106401. doi: 10.1016/j.isci.2023.106401. Epub 2023 Mar 15. PMID: 36987520; PMCID: PMC10015085. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015085/.
8. Badell ML, Dude CM, Rasmussen SA, Jamieson DJ. Covid-19 vaccination in pregnancy. BMJ. 2022 Aug 10;378:e069741. doi: 10.1136/bmj-2021-069741. PMID: 35948352; PMCID: PMC9363819. https://pubmed.ncbi.nlm.nih.gov/35948352/.
9. Pratama NR, Wafa IA, Budi DS, Putra M, Wardhana MP, Wungu CDK. mRNA Covid-19 vaccines in pregnancy: A systematic review. PLoS One. 2022 Feb 2;17(2):e0261350. doi: 10.1371/journal.pone.0261350. PMID: 35108277; PMCID: PMC8809595. https://pubmed.ncbi.nlm.nih.gov/35108277/.

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