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Sakurada Y, Matsuda Y, Motohashi K, Hasegawa T, Otsuka Y, Nakano Y, Tokumasu K, Yamamoto K, Sunada N, Honda H, Hagiya H, Ueda K, Otsuka F. Clinical characteristics of female long COVID patients with menstrual symptoms: a retrospective study from a Japanese outpatient clinic. J Psychosom Obstet Gynaecol 2024; 45:2305899. [PMID: 38270210 DOI: 10.1080/0167482x.2024.2305899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE To elucidate the impact of long COVID on menstruation and mental health, medical records of patients with long COVID were evaluated. METHODS Symptoms of long COVID, QOL, mental health, and related endocrine data were compared between two groups with and without menstrual disturbances. RESULTS Of 349 female patients who visited our clinic between February 2021 and March 2023, 223 patients with long COVID (aged 18-50 years) were included. Forty-four (19.7%) of the patients had menstrual symptoms associated with long COVID. The patients with menstrual symptoms were older than those without menstrual symptoms (42.5 vs. 38 years). The percentage of patients with menstrual symptoms was higher during the Omicron phase (24%) than during the Preceding (13%) and Delta (12%) phases. Cycle irregularity was the most frequent (in 63.6% of the patients), followed by severe pain (25%), heavy bleeding (20.5%), perimenopausal symptoms (18.2%), and premenstrual syndrome (15.9%). Fatigue and depression were the most frequent complications. Scores for fatigue and for QOL were significantly worse in long COVID patients with menstrual symptoms. Results of endocrine examinations showed significantly increased cortisol levels in patients with menstrual complaints. CONCLUSION Long COVID has an impact on menstrual conditions and on QOL related to menstrual conditions.
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Affiliation(s)
- Yasue Sakurada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yui Matsuda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kanon Motohashi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koichiro Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Naruhiko Sunada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Honda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, Okayama, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Infectious Diseases, Okayama University Hospital, Okayama, Japan
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Küçükerdem HS, Özdemir TD. Evaluation of menstrual irregularities following COVID-19 infection or vaccination: The impact of COVID anxiety and associated risk factors. Medicine (Baltimore) 2024; 103:e38771. [PMID: 38941384 DOI: 10.1097/md.0000000000038771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
There has been significant interest in the changes in menstrual cycles following coronavirus disease 2019 (COVID-19) infection or vaccination. This study aimed to investigate the evidence for such changes and their potential risk factors. We used a descriptive study design and gathered data by sharing an online survey questionnaire on social media platforms. The questionnaire included questions regarding sociodemographic factors, menstrual cycle changes, and COVID-19 anxiety. The study population comprised women aged 18 to 49 years from Izmir. All data analyses were performed using Statistical Package for the Social Sciences 21.0. The risk factors influencing menstrual irregularities were determined after the COVID binary logistic regression analysis, including univariate and multivariate models. Among the 465 participants, those with an associate's degree had a significantly higher risk of menstrual irregularities than those with a high school diploma (P = .012). Anxiety scores emerged as a significant risk factor for menstrual cycle irregularities (P = .026). However, neither COVID-19 infection nor vaccination resulted in significant changes in the menstrual cycle characteristics (P > .05). Other sociodemographic variables, such as age, body mass index, and smoking, were not significantly associated with menstrual cycle changes(P > .05). The study findings suggest that educational level and anxiety may play a role in menstrual irregularities, whereas COVID-19 infection or vaccination itself may not directly affect menstrual cycle.
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Affiliation(s)
- Halime Seda Küçükerdem
- Department of Family Medicine, Health Science University, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Tuğçe Doğa Özdemir
- Department of Radiology, Health Science University, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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Abu-Lubad MA, Abu-Helalah MA, QawaQzeh MS, Alahmad EF, Al-Tamimi MM, Ruba'I MK, Etoom SH, Alfayoumi RK, Aldaoudeyeh FE, AlAbabneh EA, Al-Kharabsheh AM, Alshraideh H. Impact of COVID-19 infections and vaccination on menstrual cycle symptoms in the south of Jordan: a cross-sectional study. J Egypt Public Health Assoc 2024; 99:8. [PMID: 38594493 PMCID: PMC11004099 DOI: 10.1186/s42506-024-00153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Several recent studies have highlighted the need for more evaluation of the impact of COVID-19 infections and vaccines on the reproductive system and menstruation. This study aimed to assess the impact of COVID-19 infection and vaccines on menstrual symptoms. METHODS A cross-sectional survey utilizing face-to-face interviews from January 1 to 31 March 2022 was conducted in the city of Al-Karak in southern Jordan. The questionnaire included sociodemographic characteristics, medical and reproductive history, the contraceptive method used if any, menstrual cycle (MC) status, previous medical and drug history, and the impact of infection and vaccination on the MC. RESULTS The study questionnaire was completed by 400 participants with a mean age of 32.1±12.6 years. Regarding the history of COVID-19 infections, 33.8% of the participants reported a history of confirmed COVID-19 infections, 77.8% of them did not report any menstrual changes following the infection, while the remaining 22.2% reported changes in menstruation. The most commonly reported post-COVID-19 manifestations were irregular (27.6%) and light menstrual cycle (MC) (24.15) or dysmenorrhea (24.1%). Heavy menstruation was reported by 17.2% of participants post-COVID-19 infection. Two-thirds of the study participants (66.6%) reported no changes in the MC following the administration of the COVID-19 vaccine. The most reported symptoms for those who experienced changes in the MC following the vaccination were irregular cycle (13.1%), heavy menstruation (7%), and light menstruation (7%). Other reported symptoms were dysmenorrhea (4.6%), intermenstrual bleeding (1.2%), and amenorrhea (0.5%). CONCLUSION This study revealed minor changes in the MC following COVID-19 infections and administration of the COVID-19 vaccine. These findings are consistent with published reports. It is recommended that future clinical trials for new vaccines for women of childbearing age include outcomes related to sex hormones and MC. Women should be encouraged to take the vaccines and report symptoms to healthcare professionals for further assessment.
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Affiliation(s)
- Mohammad A Abu-Lubad
- Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, P.O. Box 7 Mutah, Al-Karak, 61710, Jordan.
| | - Munir A Abu-Helalah
- Department of Family and Community Medicine, School of Medicine, University of Jordan, Public Health Institute, Amman, Jordan
| | | | - Esra'a F Alahmad
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | - Malak M Al-Tamimi
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | - Mohammad K Ruba'I
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | - Sahm H Etoom
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | - Rawan K Alfayoumi
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | | | - Ekram A AlAbabneh
- Medical Students at Mutah University, Faculty of Medicine, Al-Karak, Jordan
| | - Ahlam M Al-Kharabsheh
- Department of Obstetrics and Gynecology Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Hussam Alshraideh
- Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah, United Arab Emirates
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Edelman A, Boniface ER, Male V, Cameron S, Benhar E, Han L, Matteson KA, van Lamsweerde A, Pearson JT, Darney BG. Timing of Coronavirus Disease 2019 (COVID-19) Vaccination and Effects on Menstrual Cycle Changes. Obstet Gynecol 2024; 143:585-594. [PMID: 38412506 PMCID: PMC10953681 DOI: 10.1097/aog.0000000000005550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To assess whether menstrual cycle timing (follicular or luteal phase) of coronavirus disease 2019 (COVID-19) vaccine administration is associated with cycle length changes. METHODS We used prospectively collected (2021-2022) menstrual cycle tracking data from 19,497 reproductive-aged users of the application "Natural Cycles." We identified whether vaccine was delivered in the follicular or luteal phase and also included an unvaccinated control group. Our primary outcome was the adjusted within-individual change in cycle length (in days) from the average of the three menstrual cycles before the first vaccination cycle (individuals in the unvaccinated control group were assigned a notional vaccine date). We also assessed cycle length changes in the second vaccination cycle and whether a clinically significant change in cycle length (8 days or more) occurred in either cycle. RESULTS Most individuals were younger than age 35 years (80.1%) and from North America (28.6%), continental Europe (33.5%), or the United Kingdom (31.7%). In the vaccinated group, the majority received an mRNA vaccine (63.8% of the full sample). Individuals vaccinated in the follicular phase experienced an average 1-day longer adjusted cycle length with a first or second dose of COVID-19 vaccine compared with their prevaccination average (first dose: 1.00 day [98.75% CI, 0.88-1.13], second dose: 1.11 days [98.75% CI, 0.93-1.29]); those vaccinated in the luteal phase and those in the unvaccinated control group experienced no change in cycle length (respectively, first dose: -0.09 days [98.75% CI, -0.26 to 0.07], second dose: 0.06 days [98.75% CI, -0.16 to 0.29], unvaccinated notional first dose: 0.08 days [98.75% CI, -0.10 to 0.27], second dose: 0.17 days [98.75% CI, -0.04 to 0.38]). Those vaccinated during the follicular phase were also more likely to experience a clinically significant change in cycle length (8 days or more; first dose: 6.8%) than those vaccinated in the luteal phase or unvaccinated (3.3% and 5.0%, respectively; P <.001). CONCLUSION COVID-19 vaccine-related cycle length increases are associated with receipt of vaccination in the first half of the menstrual cycle (follicular phase).
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Affiliation(s)
- Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, and Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon; the Department of Metabolism Digestion and Reproduction, Imperial College London, London, United Kingdom; Obstetrics and Gynaecology, University of Edinburgh and Chalmers Centre, Edinburgh, Scotland; Natural Cycles USA Corp, New York, New York; the Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts; and the National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
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5
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Shin SY, Kim JH, Kim JH, Kwon H, Park C, Choi DH, Cho SM, Shin JE. Effect of COVID-19 infection and vaccination on SARS-CoV-2 antibody titer change following ovarian stimulation: Prospective analysis of IVF outcomes. Medicine (Baltimore) 2024; 103:e37349. [PMID: 38489720 PMCID: PMC10939662 DOI: 10.1097/md.0000000000037349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/28/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) has affected various medical fields worldwide. However, relatively few studies have examined the impact of COVID-19 infection and vaccination on in vitro fertilization (IVF) outcomes and changes in SARS-CoV-2 antibody concentration in follicular fluid (FF). A total of 45 women were prospectively recruited and assigned to 3 groups: uninfected and non-vaccinated control group (Control group), infected group (COVID + group), and vaccinated group (Vaccination group). Serum and follicular fluid (FF) estradiol, progesterone, and SARS-CoV-2 antibody concentrations were measured. There were no statistical differences in the total number of retrieved oocytes (P = .291), mature oocytes (P = .416), and good-quality embryos (P = .694) among the 3 groups. In the vaccination group, BNT162b2 exhibited a significantly lower trigger-day serum estradiol/MII oocyte level (110.6 pg/mL) than other vaccines (289.5 pg/mL) (P = .006). No statistical differences in serum (P = .687) and FF (P = .108) SARS-CoV-2 antibody changes were noted among the 3 groups. Only FF antibody changes exhibited statistically significant differences between the BNT162b2 and other vaccine subgroups (P = .047). COVID-19 infection and vaccination do not affect IVF outcomes. However, the effect of BNT162b2 on steroidogenesis of the mature oocyte and FF SARS-CoV2 antibody titer should be further investigated.
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Affiliation(s)
- So Yeon Shin
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Jee Hyun Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Ji Hyang Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Chan Park
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Dong Hee Choi
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
| | - Sun-mi Cho
- Department of Laboratory Medicine, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea
| | - Ji Eun Shin
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, Gyeonggi-do, Korea
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Maybin J, Watters M, Rowley B, Walker C, Sharp G, Alvergne A. COVID-19 and abnormal uterine bleeding: potential associations and mechanisms. Clin Sci (Lond) 2024; 138:153-171. [PMID: 38372528 PMCID: PMC10876417 DOI: 10.1042/cs20220280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
The impact of COVID-19 on menstruation has received a high level of public and media interest. Despite this, uncertainty exists about the advice that women and people who menstruate should receive in relation to the expected impact of SARS-CoV-2 infection, long COVID or COVID-19 vaccination on menstruation. Furthermore, the mechanisms leading to these reported menstrual changes are poorly understood. This review evaluates the published literature on COVID-19 and its impact on menstrual bleeding, discussing the strengths and limitations of these studies. We present evidence consistent with SARS-CoV-2 infection and long COVID having an association with changes in menstrual bleeding parameters and that the impact of COVID vaccination on menstruation appears less significant. An overview of menstrual physiology and known causes of abnormal uterine bleeding (AUB) is provided before discussing potential mechanisms which may underpin the menstrual disturbance reported with COVID-19, highlighting areas for future scientific study. Finally, consideration is given to the effect that menstruation may have on COVID-19, including the impact of the ovarian sex hormones on acute COVID-19 severity and susceptibility and reported variation in long COVID symptoms across the menstrual cycle. Understanding the current evidence and addressing gaps in our knowledge in this area are essential to inform public health policy, direct the treatment of menstrual disturbance and facilitate development of new therapies, which may reduce the severity of COVID-19 and improve quality of life for those experiencing long COVID.
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Affiliation(s)
- Jacqueline A. Maybin
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Marianne Watters
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Bethan Rowley
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Catherine A. Walker
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | | | - Alexandra Alvergne
- ISEM, Univ Montpellier, CNRS, IRD, Montpellier, France
- School of Anthropology and Museum Ethnography, Oxford, U.K
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Ghaemi M, Hantoushzadeh S, Shafiee A, Gargari OK, Fathi H, Eshraghi N, Razavi J, Habibi GR, Jafarabady K. The effect of COVID-19 and COVID-19 vaccination on serum anti-Mullerian hormone: A systematic review and meta-analysis. Immun Inflamm Dis 2024; 12:e1136. [PMID: 38270314 PMCID: PMC10777886 DOI: 10.1002/iid3.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE The current study aims to evaluate the impact of COVID-19 infection and vaccination on ovarian reserve by detecting the anti-Mullerian hormone (AMH) level. METHOD PubMed, Embase, Web of Science, and Scopus has been searched for studies assessing the effect of COVID-19 infection and/or vaccination on AMH levels up to February 27, 2023. Based on PRISMA 2020 statement criteria, a systematic review and meta-analysis of included studies were performed. The studies' quality was assessed by the National Institute of Health (NIH) quality assessment tool. The standardized mean difference (MD) of the AMH level was used and the quantitative values of each study were pooled separately by using a random effect model. RESULTS Out of 246 studies screened, 18 were included in the systematic review and 14 in the meta-analysis. Included studies were published between 2021 and 2022 and were conducted in different countries, including the USA (n = 3), China (n = 2), Russia (n = 2), Turkey (n = 5), Israel (n = 3), Czech (n = 2), and Spain (n = 1). Eight studies investigated the effect of SARS-CoV-2 infection on AMH levels, and ten studies investigated the possible effect of COVID-19 vaccination on AMH levels. The pooled analysis showed a statistically significant decrease in AMH levels after COVID-19 infection (SMD: -0.24; 95% CI: -0.36 to -0.11; I2 = 0%; p = .0003). Vaccination analysis showed a nonstatistically significant change in AMH levels after COVID-19 vaccination (SMD: -0.11; 95% CI: -0.25 to 0.04; I2 = 35%; p = .14). CONCLUSION COVID-19 infection can result in ovarian reserve injury by reducing the AMH level but getting vaccinated against COVID-19 has no impact on the AMH level.
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Affiliation(s)
- Marjan Ghaemi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Sedigheh Hantoushzadeh
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Arman Shafiee
- Student Research Committee, School of MedicineAlborz University of Medical SciencesKarajIran
- Department of Psychiatry and Mental HealthAlborz University of Medical SciencesKarajIran
| | - Omid Kohandel Gargari
- Student Research Committee, School of MedicineAlborz University of Medical SciencesKarajIran
| | - Hanieh Fathi
- Student Research Committee, School of MedicineAlborz University of Medical SciencesKarajIran
| | - Nasim Eshraghi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Jafar Razavi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Gholam Reza Habibi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Kyana Jafarabady
- Student Research Committee, School of MedicineAlborz University of Medical SciencesKarajIran
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Alvergne A, Boniface E, Darney B, Shea A, Weber K, Ventola C, Vitzthum VJ, Edelman A. Associations Among Menstrual Cycle Length, Coronavirus Disease 2019 (COVID-19), and Vaccination. Obstet Gynecol 2024; 143:83-91. [PMID: 37562052 PMCID: PMC10715707 DOI: 10.1097/aog.0000000000005343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To assess whether coronavirus disease 2019 (COVID-19) is associated with menstrual cycle length changes and, if so, how that compares with those undergoing vaccination or no event (control). METHODS We conducted a retrospective cohort analysis in which we analyzed prospectively tracked cycle-length data from users of a period tracker application who also responded to a survey regarding COVID-19 symptoms and vaccination. We restricted our sample to users aged 16-45 years, with normal cycle lengths (24-38 days) and regular tracking behavior during the five cycles around COVID-19 symptoms or vaccination or a similar time period for those experiencing no event (control group). We calculated the within-user change in cycle length (days) from the three consecutive cycles preevent average (either vaccination, disease, or neither; cycles 1-3) to the event (cycle 4) and postevent (cycle 5) cycles. We used mixed-effects models to estimate the age- and country-adjusted difference in change in cycle length across the groups. RESULTS We included 6,514 users from 110 countries representing 32,570 cycles (COVID-19 symptoms: 1,450; COVID-19 vaccination: 4,643; control: 421). The COVID-19 cohort experienced a 1.45-day adjusted increase in cycle length during cycle 4 (COVID-19) compared with their three preevent cycles (95% CI 0.86-2.04). The vaccinated group experienced a 1.14-day adjusted increase in cycle length during cycle 4 (COVID-19 vaccine) compared with their preevent average (95% CI 0.60-1.69). The control group (neither vaccine nor disease) experienced a 0.68-day decrease (95% CI -1.18 to -0.19) in a similar time period. Post hoc tests showed no significant differences in the magnitude of changes between the COVID-19 and vaccination cohorts. In both cohorts, cycle length changes disappeared in the postevent cycle. CONCLUSION Experiencing COVID-19 is associated with a small change in cycle length similar to COVID-19 vaccination. These changes resolve quickly within the next cycle.
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Affiliation(s)
- Alexandra Alvergne
- Institute for Evolutionary Sciences, Montpellier University, Montpellier, France; the School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom; the Department of Obstetrics and Gynecology, Oregon Health & Science University, and the OHSU-PSU School of Public Health, Portland, Oregon; the National Institute of Public Health (INSP), Center for Population Health (CISP), Cuernavaca, Morelos, Mexico; and Clue by BioWink GmbH, Berlin, Germany
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9
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Li J, Bai J, Xiang X, Guo Y, Yu H. Effect of COVID-19 on Menstruation and Lower Reproductive Tract Health. Int J Womens Health 2023; 15:1999-2013. [PMID: 38152614 PMCID: PMC10752023 DOI: 10.2147/ijwh.s433516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023] Open
Abstract
Background To evaluate the dynamically impact of the coronavirus disease 2019 (COVID-19) on the female reproductive system. Methods An online survey was shared to women of reproductive age who had been infected with COVID-19 and recovered in China between January and March 2023. Results In total, 610 women of childbearing age completed the menstrual component of the survey and 82.6% (n=504) women self-purchased medications without hospitalization. 254 women were menstruating during COVID-19 infection. 66.9% of them reported changes in menstruation, including cycle length (64.7%), menstrual flow (72.4%), and duration (53%), compared to pre-COVID-19. COVID-19-related chest tightness (OR: 9.5; 95% CI: 1.9-46.3), COVID-19-related stress (OR: 18.4; 95% CI: 1.4-249.7), and COVID-19-related low mood (OR: 6.2; 95% CI: 1.4-28.2) were associated with these menstrual changes. However, over 73% of women who menstruated during and after COVID-19 regained their pre-infection menstrual cycle (73%), duration (79.6%), and flow (75.2%) during their first menstruation after COVID-19 recovery. Compared to pre-infection, 19.7% (n=124) women reported changes in lower reproductive tract during COVID-19, including volume and color of vaginal discharge, vulvar pruritus, and vaginitis. These changes were significantly increased in those with a history of pelvic inflammatory disease (OR: 12.1; 95% CI: 3.1-48.2), ovarian cysts (OR: 4.9; 95% CI: 1.2-19.4), and vaginitis (OR: 5.5; 95% CI: 2.1-14.4) prior to COVID-19. However, 52.4% reported that their lower reproductive tract health had returned to its pre-infection within the first month after recovery from COVID-19, while 73.5% reported a return to the pre-infection within 2 months. Conclusion Changes in menstruation and lower reproductive tract associated with COVID-19 are transient. Menstruation and lower reproductive tract health will gradually return to pre-COVID-19 status within 2 months of recovery, which can help alleviate excessive concerns about the effects of COVID-19 on the reproductive system.
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Affiliation(s)
- Jiaosheng Li
- Department of Gynecology and Obstetrics, Central People’s Hospital of Zhanjiang, Zhanjiang, People’s Republic of China
| | - Jiaojiao Bai
- Department of Gynecology and Obstetrics, Hebei North University, Zhangjiakou, People’s Republic of China
| | - Xuanxuan Xiang
- Department of Gynecology and Obstetrics, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Yifan Guo
- Department of Gynecology and Obstetrics, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Haotian Yu
- Department of Gynecology and Obstetrics, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
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Cheng AL, Anderson J, Didehbani N, Fine JS, Fleming TK, Karnik R, Longo M, Ng R, Re'em Y, Sampsel S, Shulman J, Silver JK, Twaite J, Verduzco-Gutierrez M, Kurylo M. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of mental health symptoms in patients with post-acute sequelae of SARS-CoV-2 infection (PASC). PM R 2023; 15:1588-1604. [PMID: 37937672 DOI: 10.1002/pmrj.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Washington University, St. Louis, Missouri, USA
| | | | - Nyaz Didehbani
- Departments of Psychiatry and Physical Medicine & Rehabilitation at UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey S Fine
- Department of Rehabilitation Medicine, Rusk Rehabilitation, NYU Langone Health, New York, New York, USA
| | - Talya K Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey, USA
| | - Rasika Karnik
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Michele Longo
- Department of Clinical Neurosciences, Tulane University, New Orleans, Louisiana, USA
| | - Rowena Ng
- Neuropsychology Department, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yochai Re'em
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Sarah Sampsel
- SLSampsel Consulting, LLC, Albuquerque, New Mexico, USA
| | - Julieanne Shulman
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jamie Twaite
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Monica Kurylo
- Neurorehabilitation Psychology Services, University of Kansas Medical Center (KUMC) & Kansas University Health System, Kansas City, Kansas, USA
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11
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Li S, Liu H, Li D, Chen F. Female reproductive health during the COVID-19 pandemic: latest evidence and understanding. Arch Gynecol Obstet 2023; 308:1691-1696. [PMID: 36856820 PMCID: PMC9976669 DOI: 10.1007/s00404-023-06976-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has imposed a heavy burden on medical systems. In addition to the respiratory system, the virus also causes injuries to other organs and systems such as the gastroenteric system, kidneys, and reproductive system. Female reproductive health requires more attention in this context. METHODS We have performed a thorough review of the relevant literature that addresses the impacts of SARS-CoV-2 infection and COVID-19 vaccination on the female reproductive system. RESULTS Most evidence shows that SARS-CoV-2 does not infect the female reproductive system. However, the virus may indirectly influence sex hormone concentrations through inflammation associated with cytokine storms and nervous system damage. Menstrual disorders in women infected with SARS-CoV-2 may be caused by down-regulation of angiotensin-converting enzyme 2, abnormal hormone levels, medications, and stress. There is no significant difference in ovarian follicle quality and in vitro fertilization parameters between the pre- and post-COVID-19 vaccination groups. In addition, most symptoms due to side effects of vaccination could recover within a short period of time. CONCLUSION SARS-CoV-2 infection affects female reproductive system function through multiple mechanisms. It is recommended that women of childbearing age be vaccinated with COVID-19 vaccine.
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Affiliation(s)
- Shuhui Li
- Department of Physiology, Jining Medical University, 133 Hehua Road, Jining, 272067, China
| | - Hongxin Liu
- Department of Physiology, Jining Medical University, 133 Hehua Road, Jining, 272067, China
| | - Di Li
- Department of Physiology, Jining Medical University, 133 Hehua Road, Jining, 272067, China
| | - Fei Chen
- Department of Physiology, Jining Medical University, 133 Hehua Road, Jining, 272067, China.
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12
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Pankiewicz K, Chotkowska E, Nowakowska B, Gos M, Issat T. COVID-19-related premature ovarian insufficiency: case report and literature review. Climacteric 2023; 26:601-604. [PMID: 37647929 DOI: 10.1080/13697137.2023.2246878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/15/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The aim of this study is to present the case report of a 36-year-old woman developing premature ovarian insufficiency (POI) after COVID-19 and review the literature referring to the possible impact of SARS-CoV-2 infection on female reproduction. METHODS A 36-year-old nulligravida with normal menstrual cycles, non-smoker, with a normal body mass index and no pelvic surgery or oncological treatment in her medical history presented to the Infertility Center of the Institute of Mother and Child in Warsaw after a year of unsuccessful attempts to get pregnant. During diagnostic process she was affected by COVID-19 with a mild manifestation and thereafter she presented amenorrhea with intense hot flushes. Further diagnostic confirmed the diagnosis of POI. RESULTS There is a strong molecular basis for a possible effect of SARS-CoV-2 infection on the female reproductive system; however, the results of available research are conflicting. All of these aspects are discussed in detail. CONCLUSIONS SARS-CoV-2 infection may cause serious complications that cast a long shadow on a patient's future life and health. Further research is needed to assess the real impact of SARS-CoV-2 infection on female reproductive health, as well as potential preventive and therapeutic strategies for women affected with COVID-19.
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Affiliation(s)
- K Pankiewicz
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland
| | - E Chotkowska
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland
| | - B Nowakowska
- Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - M Gos
- Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - T Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland
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13
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Aftab N, Fahad A, Al Hammadi S, Tahlak M, Badawi F, Al Mulai I, Faraz S, Malik S, Mohammed P, Maqbool S, Fatima Z, Osman E. Effects of the COVID-19 Infection on Women's Menstrual Cycle: A Retrospective Study at Latifa Hospital, Dubai, United Arab Emirates. Cureus 2023; 15:e51391. [PMID: 38292982 PMCID: PMC10825384 DOI: 10.7759/cureus.51391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background The COVID-19 pandemic has affected all of us in one way or another. The menstrual cycle is a reflection of the female reproductive system, and it is influenced by various factors including stress and infections. Although there is little information available about how the COVID-19 pandemic has affected women's reproductive health, it has had a significant impact on women. Objective The main objective of our study is to identify if there are any menstrual disturbances following COVID-19 infection in women. Study design Our study is a retrospective study wherein 700 women recovering from COVID-19 infection were asked about any new menstrual disturbances after the infection. We collected the data using questionnaires and analyzed the data using Statistical Product and Service Solutions (SPSS, version 26) (IBM SPSS Statistics for Windows, Armonk, NY). Results Our study showed no dysmenorrhea in 90% of the participants, 81% reported no change in menstrual flow rate, a vast majority (93%) denied experiencing amenorrhea, only 4% reported a new onset of intermenstrual bleeding, and 1% reported postmenopausal bleeding. Conclusion There was no significant change in the participants' menstrual cycle following COVID-19 infection.
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Affiliation(s)
- Nighat Aftab
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Asma Fahad
- Obstetrics and Gynaecology, Dubai Academic Health Corporation, Dubai, ARE
| | | | - Muna Tahlak
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Faiza Badawi
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Israa Al Mulai
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai, ARE
| | - Saima Faraz
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Sofia Malik
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Parveen Mohammed
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Sadia Maqbool
- Obstetrics and Gynaecology, Dubai Academic Health Corporation, Dubai, ARE
| | - Zoiya Fatima
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Esraa Osman
- Obstetrics and Gynaecology, Latifa Women and Children Hospital, Dubai Academic Health Corporation, Dubai, ARE
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14
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Zhong X, Lu K, Liang W, Jihu L, Zeng A, Ding M, Chen D, Xie M. The impact of SARS-COV-2 infection on menstruation. BMC Womens Health 2023; 23:611. [PMID: 37974147 PMCID: PMC10655360 DOI: 10.1186/s12905-023-02697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Recent study has demonstrated that the GnRH system in patients with post-COVID syndrome may be influenced by SARS-CoV-2. However, the impact of COVID-19 infection on women's menstruation is still unknown. OBJECTIVE We aimed to investigate the the relationship between coronavirus disease 2019 (COVID-19) and menstruation in premenopausal women. METHODS This was a retrospective cohort study. Pre-menopausal women were invited to participate in the online questionnaire on wechat. Participants were divided into four groups according to whether they were infected with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) and whether they had menstrual changes during the pandemic. Sociodemographic characteristics, history of COVID-19, menstruation and menstrual changes of the participants were collected. Statistical analyses were performed using SPSS, version 25.0 (SPSS Inc., Chicago, IL, USA). RESULTS A total of 1946 women were included in the study. 1800 participants had been or were currently infected with SARS-COV-2, and 146 people had not been infected. Among 1800 patients with COVID-19, 666 (37.0%) had changes in menstruation, and 1134 (63.0%) did not, which was significantly higher than the uninfected participants (c2 = 12.161, P = 0.000). The proportion of participants with menstrual cycle changes (450/67.6%) is larger than that of uninfected participants (c2 = 6.904, P = 0.009). COVID-19 vaccination was associated with lower odds of menstrual cycle change (OR, 0.855; 95% CI, 0.750-0.976). Participants who reported chest pain (OR, 1.750, 95% CI, 1.209-2.533) and dyspnea (OR, 1.446; 95% CI, 1.052-1.988) during infection had greater odds of changes to their menstrual cycle compared with the participants who did not. CONCLUSIONS The association between the COVID-19 and increased prevalence of menstrual cycle irregularity. COVID-19 vaccination is a protective factor in the long term, and participants with chest pain and dyspnea are more likely to develop AUB.
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Affiliation(s)
- Xiaozhu Zhong
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Keji Lu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Weiying Liang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Luozi Jihu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Anqi Zeng
- Department of Obstetrics & Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, China
| | - Miao Ding
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China
| | - Dongmei Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China.
| | - Meiqing Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, 510120, China.
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15
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Li J, Zhou Y, Ma J, Zhang Q, Shao J, Liang S, Yu Y, Li W, Wang C. The long-term health outcomes, pathophysiological mechanisms and multidisciplinary management of long COVID. Signal Transduct Target Ther 2023; 8:416. [PMID: 37907497 PMCID: PMC10618229 DOI: 10.1038/s41392-023-01640-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/04/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023] Open
Abstract
There have been hundreds of millions of cases of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the growing population of recovered patients, it is crucial to understand the long-term consequences of the disease and management strategies. Although COVID-19 was initially considered an acute respiratory illness, recent evidence suggests that manifestations including but not limited to those of the cardiovascular, respiratory, neuropsychiatric, gastrointestinal, reproductive, and musculoskeletal systems may persist long after the acute phase. These persistent manifestations, also referred to as long COVID, could impact all patients with COVID-19 across the full spectrum of illness severity. Herein, we comprehensively review the current literature on long COVID, highlighting its epidemiological understanding, the impact of vaccinations, organ-specific sequelae, pathophysiological mechanisms, and multidisciplinary management strategies. In addition, the impact of psychological and psychosomatic factors is also underscored. Despite these crucial findings on long COVID, the current diagnostic and therapeutic strategies based on previous experience and pilot studies remain inadequate, and well-designed clinical trials should be prioritized to validate existing hypotheses. Thus, we propose the primary challenges concerning biological knowledge gaps and efficient remedies as well as discuss the corresponding recommendations.
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Affiliation(s)
- Jingwei Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhou
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Jiechao Ma
- AI Lab, Deepwise Healthcare, Beijing, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Department of Postgraduate Student, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jun Shao
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Shufan Liang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yizhou Yu
- Department of Computer Science, The University of Hong Kong, Hong Kong, China.
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China.
| | - Chengdi Wang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Med-X Center for Manufacturing, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China.
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16
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Jacobs ET, Cordova-Marks FM, Farland LV, Ernst KC, Andrews JG, Vu S, Heslin KM, Catalfamo C, Chen Z, Pogreba-Brown K. Understanding low COVID-19 booster uptake among US adults. Vaccine 2023; 41:6221-6226. [PMID: 37666694 DOI: 10.1016/j.vaccine.2023.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort. METHODS A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. RESULTS The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11-0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03-0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08-4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69-3.43). CONCLUSIONS Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.
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Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Felina M Cordova-Marks
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leslie V Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jennifer G Andrews
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sage Vu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kelly M Heslin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Collin Catalfamo
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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17
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Janket SJ, Fraser DD, Baird AE, Tamimi F, Sohaei D, Conte HA, Prassas I, Diamandis EP. Tachykinins and the potential causal factors for post-COVID-19 condition. THE LANCET. MICROBE 2023; 4:e642-e650. [PMID: 37327802 PMCID: PMC10263974 DOI: 10.1016/s2666-5247(23)00111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 06/18/2023]
Abstract
The most prevalent symptoms of post-COVID-19 condition are pulmonary dysfunction, fatigue and muscle weakness, anxiety, anosmia, dysgeusia, headaches, difficulty in concentrating, sexual dysfunction, and digestive disturbances. Hence, neurological dysfunction and autonomic impairments predominate in post-COVID-19 condition. Tachykinins including the most studied substance P are neuropeptides expressed throughout the nervous and immune systems, and contribute to many physiopathological processes in the nervous, immune, gastrointestinal, respiratory, urogenital, and dermal systems and participate in inflammation, nociception, and cell proliferation. Substance P is a key molecule in neuroimmune crosstalk; immune cells near the peripheral nerve endings can send signals to the brain with cytokines, which highlights the important role of tachykinins in neuroimmune communication. We reviewed the evidence that relates the symptoms of post-COVID-19 condition to the functions of tachykinins and propose a putative pathogenic mechanism. The antagonism of tachykinins receptors can be a potential treatment target.
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Affiliation(s)
- Sok-Ja Janket
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Douglas D Fraser
- Paediatric Critical Care, Western University and Lawson Health Research Institute, London, ON, Canada
| | - Alison E Baird
- Department of Neurology, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Faleh Tamimi
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Dorsa Sohaei
- McGill University School of Medicine, Montreal, QC, Canada
| | - Harry A Conte
- Department of Infectious Diseases, Johnson Memorial Hospital, Stafford Springs, CT, USA
| | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
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18
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Błażejewski G, Witkoś J. The Impact of COVID-19 on Menstrual Cycle in Women. J Clin Med 2023; 12:4991. [PMID: 37568393 PMCID: PMC10419606 DOI: 10.3390/jcm12154991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has become the largest and most diverse to threaten the health of humanity since the 1918 influenza pandemic. METHODS This study involved 113 women who had suffered from COVID-19. The study was conducted as interviews with each woman during visits to a clinic prior to the start of their post-COVID-19 physiotherapy treatment cycle. The aim of this study was to assess the prevalence of changes in the women's monthly cycles related to COVID-19, as well as to analyse correlations between dependent variables relating to changes in the monthly cycle and independent variables relating to other factors, such as age, weight, number and type of vaccinations, and time since illness. Additionally, the study assesses correlations between the monthly cycle and COVID-19 symptoms persisting after the illness (long COVID). RESULTS Women who reported more symptoms of COVID-19 were more likely to report changes in their menstrual cycle occurring after the SARS-CoV-2 infection, compared with women whose disease course was mild. Women who declared that COVID-19 affected their monthly cycles most often indicated increases in abdominal, lower abdominal, and joint and muscle pain, as well as in the severity of headaches during monthly bleeding. A small percentage of women indicated that their monthly cycles were longer and their regularity disrupted. CONCLUSIONS This study shows that the more COVID-19 symptoms a woman had, the more often there were noted changes in monthly cycle. The same relationship was also found for persistent long COVID symptoms. The longer the time lapse since the COVID-19 infection, the less frequently changes in the monthly cycle were recorded.
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Affiliation(s)
- Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, G. Herlinga-Grudzińskiego, Street 1, 30-705 Kraków, Poland
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19
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Abstract
The COVID-19 pandemic has had a profound global impact, affecting people's physical and mental health, and their social and economic circumstances. Mitigation measures have disproportionately affected women. Studies have reported menstrual cycle and psychological disturbance associated with the pandemic. Pregnancy is a risk factor for severe COVID-19 disease. Reports have also demonstrated associations between COVID-19 infection, vaccination and Long COVID syndrome and reproductive health disturbance. However, studies are limited and there may be significant geographical variation. Also there is bias amongst published studies, and menstrual cycle data was not included in COVID-19 and vaccine trials. Longitudinal population based studies are required. In this review we discuss existing data, along with recommendations for further research required in this area. We also discuss a pragmatic approach to women presenting with reproductive health disturbance in the era of the pandemic, encompassing a multi-system assessment of psychological, reproductive health and lifestyle.
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Affiliation(s)
- Michelle Maher
- Department of Endocrinology, St James's Hospital, Dublin, Ireland; Department of Medicine, Trinity College Dublin, Ireland
| | - Lisa Owens
- Department of Endocrinology, St James's Hospital, Dublin, Ireland; Department of Medicine, Trinity College Dublin, Ireland.
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20
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Wesselink AK, Lovett SM, Weinberg J, Geller RJ, Wang TR, Regan AK, Willis MD, Perkins RB, Yland JJ, Koenig MR, Rothman KJ, Hatch EE, Wise LA. COVID-19 vaccination and menstrual cycle characteristics: A prospective cohort study. Vaccine 2023; 41:4327-4334. [PMID: 37301706 PMCID: PMC10239900 DOI: 10.1016/j.vaccine.2023.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
We prospectively examined the association between COVID-19 vaccination and menstrual cycle characteristics in an internet-based prospective cohort study. We included a sample of 1,137 participants who enrolled in Pregnancy Study Online (PRESTO), a preconception cohort study of couples trying to conceive, during January 2021-August 2022. Eligible participants were aged 21-45 years, United States or Canadian residents, and trying to conceive without fertility treatment. At baseline and every 8 weeks for up to 12 months, participants completed questionnaires on which they provided information on COVID-19 vaccination and menstrual cycle characteristics, including cycle regularity, cycle length, bleed length, heaviness of bleed, and menstrual pain. We fit generalized estimating equation (GEE) models with a log link function and Poisson distribution to estimate the adjusted risk ratio (RR) for irregular cycles associated with COVID-19 vaccination. We used linear regression with GEE to estimate adjusted mean differences in menstrual cycle length associated with COVID-19 vaccination. We adjusted for sociodemographic, lifestyle, medical and reproductive factors. Participants had 1.1 day longer menstrual cycles after receiving the first dose of COVID-19 vaccine (95 % CI: 0.4, 1.9) and 1.3 day longer cycles after receiving the second dose (95 % CI: 0.2, 2.5). Associations were attenuated at the second cycle post-vaccination. We did not observe strong associations between COVID-19 vaccination and cycle regularity, bleed length, heaviness of bleed, or menstrual pain. In conclusion, COVID-19 vaccination was associated with a ∼1 day temporary increase in menstrual cycle length, but was not appreciably associated with other menstrual cycle characteristics.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
| | - Sharonda M Lovett
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | | | - Mary D Willis
- Department of Obstetrics & Gynecology, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, United States
| | - Rebecca B Perkins
- Department of Obstetrics & Gynecology, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, United States
| | - Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Martha R Koenig
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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21
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Pollack B, von Saltza E, McCorkell L, Santos L, Hultman A, Cohen AK, Soares L. Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1122673. [PMID: 37234076 PMCID: PMC10208411 DOI: 10.3389/fresc.2023.1122673] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/03/2023] [Indexed: 05/27/2023]
Abstract
Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation. Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID. These associated illnesses, whose patients are 70%-80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth. Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.
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Affiliation(s)
- Beth Pollack
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Lisa McCorkell
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Lucia Santos
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Ashley Hultman
- Patient-Led Research Collaborative, Washington, DC, United States
| | - Alison K. Cohen
- Patient-Led Research Collaborative, Washington, DC, United States
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Letícia Soares
- Patient-Led Research Collaborative, Washington, DC, United States
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22
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Sun W, Xia L, Ji C, Wei Q, Zhang J, He S, Wang X, Shen X, Zhang X, Li C. Relationship between covid-pandemic anxiety and sleep disorder with menstrual disorders among female medical workers. BMC Womens Health 2023; 23:210. [PMID: 37118730 PMCID: PMC10147349 DOI: 10.1186/s12905-023-02314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND It has been more than 2 years since the 2019 novel coronavirus disease (COVID-19) pandemic destabilized the world, adversely affecting not only physical health, but also mental health. During this time, frontline medical workers were at a greater health risk, especially female medical workers. Changes or abnormalities in the menstrual cycle-an important indicator of women's health-may jeopardize female reproductive functioning. Considering that emotional health and sleep status may be related to the menstrual cycle, this study aimed to investigate the association between menstrual cycle changes, anxiety, sleep dysfunction, and other factors among female medical workers during the COVID-19 pandemic. METHODS A cross-sectional survey was conducted by distributing online questionnaires to female medical workers in China from February to May 2022. The study included 160 women aged 18-45 years old. The questionnaires covered data related to the participants' sociodemographic characteristics, medical and reproductive history, and lifestyle. The Rating Scale for Clinical Manifestations of Menopathy (SCMM), Self-Rating Anxiety Scale (SAS), and Sleep Dysfunction Rating Scale (SDRS) were utilized. Data were analyzed using chi-square tests, t-tests, and linear regression analysis. RESULTS A total of 160 female medical staff were randomly selected in this research, of whom seven scored less than 3 points, 85 scored 3-11 points, and 68 scored more than 11 points on the total score of the SCMM. Compared to pre-pandemic scores, scores of dizziness and tinnitus were significantly higher during the COVID-19 pandemic. Scores corresponding to the following clinical symptoms were also higher during the pandemic: Menopathy, including hypaphrodisia, dim complexion, abnormal urination, languidness, dim menstruation, thin menstruation, dysmenorrhea, and empty or saggy lower abdomen (p < 0.05). However, pre-pandemic scores of vaginal bleeding quantity were significantly higher than those found during the COVID-19 pandemic (p < 0.05). Scores of vaginal bleeding quantity were significantly lower in cabin hospitals than other types of hospitals, and a similar finding was observed for vaginal bleeding duration (all p < 0.05). Moreover, the findings of the univariable and multivariable linear regression analysis revealed a link between consistent exercise, the underlying illness, the SDRS score, the SAS score, and the total score of SCMM (p < 0.05). CONCLUSIONS In this study, we found that menstruation in female medical workers was affected by the COVID-19 pandemic. Furthermore, regular exercise and good physical condition were protective factors, while anxiety and insomnia were risk factors for menstrual abnormalities.
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Affiliation(s)
- Wenxi Sun
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Liping Xia
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Caifang Ji
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Qianqian Wei
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Jun Zhang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Sidi He
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Xuqin Wang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Xueqin Shen
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, 215100, Jiangsu Province, China
| | - Xiaobin Zhang
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China.
| | - Chuanwei Li
- Psychiatry department of Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China.
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23
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The effects of Covid-19 mRNA vaccine on adolescence gynecological well-being. Arch Gynecol Obstet 2023; 307:1625-1631. [PMID: 36871101 PMCID: PMC9985514 DOI: 10.1007/s00404-023-06981-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
KEY MESSAGE Menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, however, the ovarian reserve estimated by AMH is not compromised. BACKGROUND Recent studies have suggested that the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine causes menstrual abnormalities which led to concerns regarding its influence on the reproductive system. This study aims to investigate the influence of the SARS-CoV-2 mRNA vaccine on gynecologic well-being and future fertility of adolescent girls. METHODS This is a prospective cohort study conducted at a university affiliated medical center between June and July 2021. Adolescent girls aged 12-16 years who were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart) were included in the study. All participants completed a computerized questionnaire regarding their general medical and gynecological background at recruitment and 3 months later. Blood samples were collected for AMH levels before and 3 months following the first mRNA vaccine RESULTS: The study group consisted of 35 girls, and of them, follow-up was completed by questionnaire and AMH sampling in 35 (90%) and 22 (56%) girls, respectively. Among the 22/35 girls who reported regular menstruation before vaccination, seven (31.8%) experienced irregularities post-vaccination. Four of the eight pre-menarche girls included in the study reported on menarche on follow-up. Median AMH levels were 3.09 (IQR 1.96-4.82) μg/L and 2.96 (2.21-4.73) μg/L at baseline and after 3 months, respectively (p = 0.07). After controlling for age, BMI and presentation of side effects, no association was demonstrated to the change in AMH levels (AMH2-AMH1). CONCLUSIONS Although menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, it seems that the ovarian reserve estimated by AMH is not compromised. CLINICAL TRIAL REGISTRATION National Institutes of Health (NCT04748172).
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24
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Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21:133-146. [PMID: 36639608 PMCID: PMC9839201 DOI: 10.1038/s41579-022-00846-2] [Citation(s) in RCA: 1088] [Impact Index Per Article: 1088.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/15/2023]
Abstract
Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations. Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process.
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Affiliation(s)
| | | | - Julia Moore Vogel
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA.
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25
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Farland LV, Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, Herbst-Kralovetz MM, Mahnert ND, Pogreba-Brown K, Ernst KC, Jacobs ET. COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertil Steril 2023; 119:392-400. [PMID: 36539055 PMCID: PMC9758067 DOI: 10.1016/j.fertnstert.2022.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination. DESIGN Longitudinal study. PATIENT(S) We recruited a volunteer sample with and without a history of SARS-CoV-2 infection who enrolled in the Arizona COVID-19 Cohort (CoVHORT) study and participated in a reproductive sub-cohort who were pre-menopausal, not pregnant, and had received a COVID-19 vaccine in 2021 (n = 545). EXPOSURE(S) Demographic and reproductive characteristics were collected via self-reports. MAIN OUTCOME MEASURE(S) Information on self-reported changes in the menstrual cycle after COVID-19 vaccination was collected from May 2021 to December 2021. We looked at demographic and reproductive characteristics as predictors of menstrual cycle change. RESULT(S) The majority of our vaccinated sample received the Pfizer-BioNTech vaccine (58%), and were 26-35 years old (51%), non-Hispanic (84%), and White (88%). Approximately 25% of vaccinated participants reported a change in their menstrual cycle after vaccination; the majority reported changes after their second dose (56%) as compared with their first (18%) and third (14%) doses. The most commonly reported changes were irregular menstruation (43%), increased premenstrual symptoms (34%), increased menstrual pain or cramps (30%), and abnormally heavy or prolonged bleeding (31%). High self-reported perceived stress levels compared with low perceived stress (OR, 2.22; 95% CI 1.12-4.37) and greater body mass index (OR, 1.04; 95% CI 1.00-1.07) were associated with greater odds of experiencing the menstrual cycle changes after the vaccination. Participants having a history of SARS-CoV-2 infection were less likely to report changes in their menstrual cycle after vaccination compared with the participants with no history of SARS-CoV-2 infection (OR, 0.58; 95% CI 0.32-1.04). CONCLUSION(S) Among vaccinated participants, approximately 25% of them reported predominantly temporary changes in the menstrual cycle, however, we are unable to determine whether these changes are due to normal cycle variability. The COVID-19 vaccines are safe and effective for everyone, including pregnant people and people trying to conceive; hence, these findings should not discourage vaccination.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona; University of Arizona Cancer Center, University of Arizona
| | - Sana M Khan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alexandra Shilen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Providence Ishimwe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alicia M Allen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona
| | - Melissa M Herbst-Kralovetz
- University of Arizona Cancer Center, University of Arizona; Department of Basic Medical Sciences, College of Medicine-Phoenix, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Nichole D Mahnert
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; University of Arizona Cancer Center, University of Arizona.
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26
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Ata B, Vermeulen N, Mocanu E, Gianaroli L, Lundin K, Rautakallio-Hokkanen S, Tapanainen JS, Veiga A. SARS-CoV-2, fertility and assisted reproduction. Hum Reprod Update 2023; 29:177-196. [PMID: 36374645 PMCID: PMC9976972 DOI: 10.1093/humupd/dmac037] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2020, SARS-CoV-2 and the COVID-19 pandemic had a huge impact on the access to and provision of ART treatments. Gradually, knowledge of the virus and its transmission has become available, allowing ART activities to resume. Still, questions on the impact of the virus on human gametes and fertility remain. OBJECTIVE AND RATIONALE This article summarizes published data, aiming to clarify the impact of SARS-CoV-2 and the COVID-19 disease on human fertility and assisted reproduction, as well as the impact of vaccination, and from this, provide answers to questions that are relevant for people contemplating pregnancy and for health care professionals. SEARCH METHODS PUBMED/MEDLINE and the WHO COVID-19 database were searched from inception to 5 October 2022 with search terms focusing on 'SARS-CoV-2' and gametes, embryos, reproductive function, fertility and ART. Non-English studies and papers published prior to 2020 were excluded, as well as reviews and non-peer reviewed publications. Full papers were assessed for relevance and quality, where feasible. OUTCOMES From the 148 papers included, the following observations were made. The SARS-CoV-2-binding proteins, angiotensin-converting enzyme 2 (ACE2) and type II transmembrane serine protease (TMPRSS2), are expressed in the testis, but co-expression remains to be proven. There is some evidence of SARS-CoV-2 RNA in the ejaculate of COVID-19 patients with severe disease, but not in those with mild/moderate disease. SARS-CoV-2 infection can impair spermatogenesis, but this seems to resolve after one spermatogenic cycle. Testosterone levels seem to be lower during and after COVID-19, but long-term data are lacking; disease severity may be associated with testosterone levels. COVID-19 cannot be considered a sexually transmitted disease. There is no co-expression of ACE2 and TMPRSS2 in the myometrium, uterus, ovaries or fallopian tubes. Oocytes seem to have the receptors and protease machinery to be susceptible to SARS-CoV-2 infection; however, viral RNA in oocytes has not been detected so far. Women contemplating pregnancy following COVID-19 may benefit from screening for thyroid dysfunction. There is a possible (transient) impact of COVID-19 on menstrual patterns. Embryos, and particularly late blastocysts, seem to have the machinery to be susceptible to SARS-CoV-2 infection. Most studies have not reported a significant impact of COVID-19 on ovarian reserve, ovarian function or follicular fluid parameters. Previous asymptomatic or mild SARS-CoV-2 infection in females does not seem to negatively affect laboratory and clinical outcomes of ART. There are no data on the minimum required interval, if any, between COVID-19 recovery and ART. There is no evidence of a negative effect of SARS-CoV-2 vaccination on semen parameters or spermatogenesis, ovarian function, ovarian reserve or folliculogenesis. A transient effect on the menstrual cycle has been documented. Despite concerns, cross reactivity between anti-SARS-CoV-2 spike protein antibodies and Syncytin-1, an essential protein in human implantation, is absent. There is no influence of mRNA SARS-CoV-2 vaccine on patients' performance during their immediate subsequent ART cycle. Pregnancy rates post-vaccination are similar to those in unvaccinated patients. WIDER IMPLICATIONS This review highlights existing knowledge on the impact of SARS-CoV-2 infection or COVID-19 on fertility and assisted reproduction, but also identifies gaps and offers suggestions for future research. The knowledge presented should help to provide evidence-based advice for practitioners and couples contemplating pregnancy alike, facilitating informed decision-making in an environment of significant emotional turmoil.
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Affiliation(s)
- Baris Ata
- Obstetrics and Gynecology Department, Koc University, Istanbul, Turkey.,ART Fertility Clinics, Dubai, United Arab Emirates
| | | | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luca Gianaroli
- Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynaecology, Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, Oulu, Finland
| | - Anna Veiga
- Barcelona Stem Cell Bank, IDIBELL Programme for Regenerative Medicine, Barcelona, Spain
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27
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Saadedine M, El Sabeh M, Borahay MA, Daoud G. The influence of COVID-19 infection-associated immune response on the female reproductive system†. Biol Reprod 2023; 108:172-182. [PMID: 36173920 PMCID: PMC9620712 DOI: 10.1093/biolre/ioac187] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a multi-system disease that has led to a pandemic with unprecedented ramifications. The pandemic has challenged scientists for the past 2 years and brought back previously abandoned research topics. COVID-19 infection causes a myriad of symptoms ranging from mild flu-like symptoms to severe illness requiring hospitalization. Case reports showed multiple systemic effects of COVID-19 infection, including acute respiratory distress syndrome, fibrosis, colitis, thyroiditis, demyelinating syndromes, and mania, indicating that COVID-19 can affect most human body systems. Unsurprisingly, a major concern for women all over the globe is whether a COVID-19 infection has any long-term effects on their menstrual cycle, fertility, or pregnancy. Published data have suggested an effect on the reproductive health, and we hypothesize that the reported reproductive adverse effects are due to the robust immune reaction against COVID-19 and the associated cytokine storm. While the COVID-19 receptor (angiotensin converting enzyme, ACE2) is expressed in the ovaries, uterus, vagina, and placenta, we hypothesize that it plays a less important role in the adverse effects on the reproductive system. Cytokines and glucocorticoids act on the hypothalamo-pituitary gonadal axis, arachidonic acid pathways, and the uterus, which leads to menstrual disturbances and pregnancy-related adverse events such as preterm labor and miscarriages. This hypothesis is further supported by the apparent lack of long-term effects on the reproductive health in females, indicating that when the cytokine storm and its effects are dampened, the reproductive health of women is no longer affected.
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Affiliation(s)
- Mariam Saadedine
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Malak El Sabeh
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Georges Daoud
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
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28
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Kajiwara S, Akiyama N, Baba H, Ohta M. Association between COVID-19 vaccines and the menstrual cycle in young Japanese women. J Infect Chemother 2023; 29:513-518. [PMID: 36623727 PMCID: PMC9822555 DOI: 10.1016/j.jiac.2023.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although several studies have investigated the association between coronavirus disease 2019 (COVID-19) vaccines and the menstrual cycle, available data are limited. Therefore, this study investigated the effect of COVID-19 vaccines on the menstrual cycle and the effect of the menstrual cycle phase on the vaccine side effects during vaccine administration in Japan. METHODS A self-administered questionnaire was used to collect data on the date of vaccination; type of vaccine; type, grade, and duration of the side effects; regularity of menstruation; normal length of the menstrual cycle; and the day one date of menstruation around vaccination. The survey was conducted from October 2021 to March 2022. RESULTS The difference between the predicted and actual menstrual cycle length was 1.9 ± 3.0, 1.6 ± 2.8 (p = 0.557), and 2.5 ± 3.8 (p = 0.219) days before vaccination and after the first and second dose of the vaccine, respectively. In participants who received vaccinations twice within a single menstrual cycle, this difference was 1.3 ± 3.5 and 3.9 ± 3.3 (p = 0.045) days before and after vaccination, respectively. The grade and proportion of the side effects after the second dose of the vaccine was highest during the menstrual period and lowest during the ovulation period, with a significant effect on headache and chills. CONCLUSION COVID-19 vaccines tended to prolong the menstrual cycle. The side effects of the COVID-19 vaccine tended to be at a maximum when vaccination occurred during the menstrual period and minimal during the ovulation period.
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Affiliation(s)
- Shihoko Kajiwara
- School of Nursing, Gifu University of Health Science, 2-92 Higashiuzura, Gifu-city, Gifu, 500-8281, Japan.
| | - Naomi Akiyama
- School of Nursing, Gifu University of Health Science, 2-92 Higashiuzura, Gifu-city, Gifu, 500-8281, Japan
| | - Hisashi Baba
- Center for Nutrition Support and Infection Control, Gifu University Hospital, 1-1 Yanagido, Gifu-city, Gifu, 501-1194, Japan
| | - Michio Ohta
- School of Rehabilitation, Gifu University of Health Science, 2-92 Higashiuzura, Gifu-city, Gifu, 500-8281, Japan
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29
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Delamuta LC, Monteleone PAA, Ferreira-Filho ES, Heinrich-Oliveira V, Soares-Júnior JM, Baracat EC, Maciel GAR. SARS-CoV-2 infection and COVID-19 and human reproduction - A changing perspective - A 2022 update. Clinics (Sao Paulo) 2023; 78:100166. [PMID: 36745950 PMCID: PMC9870757 DOI: 10.1016/j.clinsp.2023.100166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
• SARS-CoV-2 can temporarily reduce male fertility and alter sperm parameters. • Reversible menstrual disturbances happened after infection and vaccination. • IVF outcomes and laboratory parameters were not affected by SARS-CoV-2.
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Affiliation(s)
- Luciana C Delamuta
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pedro A A Monteleone
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Edson S Ferreira-Filho
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Vanessa Heinrich-Oliveira
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Edmund C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Gustavo Arantes Rosa Maciel
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
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30
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Lessans N, Rottenstreich A, Stern S, Gilan A, Saar TD, Porat S, Dior UP. The effect of BNT162b2 SARS-CoV-2 mRNA vaccine on menstrual cycle symptoms in healthy women. Int J Gynaecol Obstet 2023; 160:313-318. [PMID: 35856178 PMCID: PMC9349849 DOI: 10.1002/ijgo.14356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA BNT162b2 vaccine on women's menstrual cycle. METHODS In this questionnaire-based cross-sectional study, we assessed menstrual pattern and changes in women who completed the SARS-CoV-2 mRNA BNT162b2 vaccine 3 months before and after receiving the vaccine. Included were women aged 18-50 years without known gynecologic comorbidities who regularly monitor their menstruation through electronic calendars. All participants competed a detailed questionnaire on their menstrual symptoms including information on any irregular bleeding. To minimize bias, each woman served as a self-control before and after vaccination. Primary outcome was rate of irregular bleeding following vaccination and secondary outcome was presence of any menstrual change, including irregular bleeding, mood changes, or dysmenorrhea following the vaccine. RESULTS A total of 219 women met the inclusion critieria. Of them, 51 (23.3%) experienced irregular bleeding following the vaccine. Almost 40% (n = 83) of study participants reported any menstrual change following vaccination. Parity was positively asssociated with irregular bleeding with 26 (50%) of those suffering from irregular bleeding being multiparous compared with only 53 (31.5%) of women with no irregular bleeding (nulliparous 46% vs 60%, multiparous 50% vs 31%, rest 4% vs 8%, P = 0.049). The presence of medical comorbidities was also significantly higher among patients who experienced irregular bleeding (20.0% vs 6.0%, P = 0.003). CONCLUSION Our study shows relatively high rates of irregular bleeding and menstrual changes after receiving the SARS-CoV-2 mRNA BNT162b2 vaccine. Further research is needed to confirm our findings and to better characterize the magnitude of change and any possible long-term implications.
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Affiliation(s)
- Naama Lessans
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Amihai Rottenstreich
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Shira Stern
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Adi Gilan
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Tal D. Saar
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Shay Porat
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Uri P. Dior
- Department of Obstetrics and GynecologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
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Molina-López A, Ocón Hernández O, Baena García L. [Association of SARS-CoV-2 infection and administration of COVID-19 vaccines with alterations in the menstrual cycle. Literature review]. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023; 50:100822. [PMID: 36337070 PMCID: PMC9618423 DOI: 10.1016/j.gine.2022.100822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
A number of factors can affect a woman's menstrual cycle, including diseases or drugs, such as COVID-19 disease and vaccinations. The aim of this review is to explore the studies published to date that have studied the presence of alterations that may be related to COVID-19 or vaccination against the SARS-CoV-2 virus.We conducted a review in the PubMed database, selecting 10 articles in which the menstrual cycle of adult women of childbearing age was studied, 3 of them in which the participants had been diagnosed with COVID-19 and 7 in which the participants had been vaccinated against the SARS-CoV-2 virus.Regarding COVID-19-related disturbances, 16%-47.2% of the participants presented a prolongation of their cycle, which was more frequent in those who reported more COVID-19 symptoms, and which normalised after 1-2 cycles.Regarding the alterations described after SARS-CoV-2 vaccination, 45%-78% of participants reported menstrual cycle alterations, with disparate results for the different parameters analysed, except that the alterations resolved in about 2 months.Both COVID-19 disease and vaccination appear to be associated with the occurrence of menstrual disturbances, which are limited in time and not severe. However, studies are scarce to date, and it is important to continue to develop studies that provide scientific evidence.
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Affiliation(s)
- A. Molina-López
- UGC Ginecología y Obstetricia Hospital Universitario San Cecilio, Granada, España,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España
| | - O. Ocón Hernández
- UGC Ginecología y Obstetricia Hospital Universitario San Cecilio, Granada, España,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España,Autor para correspondencia
| | - L. Baena García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, España,Departamento de Enfermería, Facultad de Ciencias de la Salud, Ceuta, España
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Abdel-Moneim YAS, Alghamdi HY, Alrashed AM, Jawhari AM, Bukhari SMM, Bukhari NMM, Abdel-Moneim AS. Menstrual cycle changes: A cross-sectional study of Saudi females following SARS-CoV-2 infection. PLoS One 2022; 17:e0279408. [PMID: 36538566 PMCID: PMC9767340 DOI: 10.1371/journal.pone.0279408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Temporary changes in the menstrual cycle have recently been reported following SARS-CoV-2 vaccination. In the current study, we aimed to screen menstrual cycle changes following SARS-CoV-2 infection in Saudi Arabia. The type and duration of these changes have been screened in relation to the severity of coronavirus disease symptoms and vaccination status. In total, 956 individuals responded: sixty-nine did not get the COVID-19 vaccine, while the remaining were vaccinated with either a single dose of ChAdOx1 vaccine (n:45) or BNT162b2 vaccine (n: 142) or two doses of the vaccine (n:700) using BNT162b2 (n:477), ChAdOx1 (n:89) or ChAdOx1/ BNT162b2 (n:134). Approximately 26.1% (18/69) of the subjects who did not receive the SARS-CoV-2 vaccine and 15.3% (29/188) and 26.4% (185/700) of the subjects who received single and double doses of the vaccines, respectively, reported menstrual cycle changes. The persistence of menstrual cycle changes for more than six months was reported by 6.4% (61/956) of the participants. These changes were significantly correlated with the severity of COVID-19 infection. We concluded that menstrual cycle changes, associated with COVID-19 infection, increase due to the severity of COVID-19 infection. Thus, menstrual cycle changes are among the long-term effects associated with COVID-19 infection.
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Male V. COVID-19 vaccination and menstruation. Science 2022; 378:704-706. [DOI: 10.1126/science.ade1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
COVID-19 vaccination causes small changes to menstruation that quickly resolve
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Affiliation(s)
- Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Gibson EA, Li H, Fruh V, Gabra M, Asokan G, Jukic AMZ, Baird DD, Curry CL, Fischer-Colbrie T, Onnela JP, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Covid-19 vaccination and menstrual cycle length in the Apple Women's Health Study. NPJ Digit Med 2022; 5:165. [PMID: 36323769 PMCID: PMC9628464 DOI: 10.1038/s41746-022-00711-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
COVID-19 vaccination may be associated with change in menstrual cycle length following vaccination. We estimated covariate-adjusted differences in mean cycle length (MCL), measured in days, between pre-vaccination cycles, vaccination cycles, and post-vaccination cycles within vaccinated participants who met eligibility criteria in the Apple Women's Health Study, a longitudinal mobile-application-based cohort of people in the U.S. with manually logged menstrual cycles. A total of 9652 participants (8486 vaccinated; 1166 unvaccinated) contributed 128,094 cycles (median = 10 cycles per participant; inter-quartile range: 4-22). Fifty-five percent of vaccinated participants received Pfizer-BioNTech's mRNA vaccine, 37% received Moderna's mRNA vaccine, and 8% received the Johnson & Johnson/Janssen (J&J) vaccine. COVID-19 vaccination was associated with a small increase in MCL for cycles in which participants received the first dose (0.50 days, 95% CI: 0.22, 0.78) and cycles in which participants received the second dose (0.39 days, 95% CI: 0.11, 0.67) of mRNA vaccines compared with pre-vaccination cycles. Cycles in which the single dose of J&J was administered were, on average, 1.26 days longer (95% CI: 0.45, 2.07) than pre-vaccination cycles. Post-vaccination cycles returned to average pre-vaccination length. Estimated follicular phase vaccination was associated with increased MCL in cycles in which participants received the first dose (0.97 days, 95% CI: 0.53, 1.42) or the second dose (1.43 days, 95% CI: 1.06, 1.80) of mRNA vaccines or the J&J dose (2.27 days, 95% CI: 1.04, 3.50), compared with pre-vaccination cycles. Menstrual cycle change following COVID-19 vaccination appears small and temporary and should not discourage individuals from becoming vaccinated.
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Affiliation(s)
- Elizabeth A. Gibson
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Huichu Li
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Victoria Fruh
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Malaika Gabra
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Gowtham Asokan
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Anne Marie Z. Jukic
- grid.280664.e0000 0001 2110 5790Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC USA
| | - Donna D. Baird
- grid.280664.e0000 0001 2110 5790Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC USA
| | | | | | - Jukka-Pekka Onnela
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Michelle A. Williams
- grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Russ Hauser
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Brent A. Coull
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Shruthi Mahalingaiah
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
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Wang S, Mortazavi J, Hart JE, Hankins JA, Katuska LM, Farland LV, Gaskins AJ, Wang YX, Tamimi RM, Terry KL, Rich-Edwards JW, Missmer SA, Chavarro JE. A prospective study of the association between SARS-CoV-2 infection and COVID-19 vaccination with changes in usual menstrual cycle characteristics. Am J Obstet Gynecol 2022; 227:739.e1-739.e11. [PMID: 35841938 PMCID: PMC9277995 DOI: 10.1016/j.ajog.2022.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite anecdotal reports, the impacts of SARS-CoV-2 infection or COVID-19 vaccination on menstrual health have not been systemically investigated. OBJECTIVE This study aimed to examine the associations of SARS-CoV-2 infection and COVID-19 vaccination with menstrual cycle characteristics. STUDY DESIGN This study prospectively observed 3858 premenopausal women in the Nurses' Health Study 3 living in the United States or Canada who received biannual follow-up questionnaires between January 2011 and December 2021 and completed additional monthly and quarterly surveys related to the COVID-19 pandemic between April 2020 and November 2021. History of positive SARS-CoV-2 test, COVID-19 vaccination status, and vaccine type were self-reported in surveys conducted in 2020 and 2021. Current menstrual cycle length and regularity "before COVID-19" were reported at baseline between 2011 and 2016, and current menstrual cycle length and regularity "after COVID-19" were reported in late 2021. Pre- to post-COVID change in menstrual cycle length and regularity was calculated between reports. Logistic or multinomial logistic regression models were used to assess the associations between SARS-CoV-2 infection and COVID-19 vaccination and change in menstrual cycle characteristics. RESULTS The median age at baseline and the median age at end of follow-up were 33 years (range, 21-51) and 42 years (range, 27-56), respectively, with a median follow-up time of 9.2 years. This study documented 421 SARS-CoV-2 infections (10.9%) and 3527 vaccinations (91.4%) during follow-up. Vaccinated women had a higher risk of increased cycle length than unvaccinated women (odds ratio, 1.48; 95% confidence interval, 1.00-2.19), after adjusting for sociodemographic and behavioral factors. These associations were similar after in addition accounting for pandemic-related stress. COVID-19 vaccination was only associated with change to longer cycles in the first 6 months after vaccination (0-6 months: odds ratio, 1.67 [95% confidence interval, 1.05-2.64]; 7-9 months: odds ratio, 1.43 [95% confidence interval, 0.96-2.14]; >9 months: odds ratio, 1.41 [95% confidence interval, 0.91-2.18]) and among women whose cycles were short, long, or irregular before vaccination (odds ratio, 2.82 [95% confidence interval, 1.51-5.27]; odds ratio, 1.10 [95% confidence interval, 0.68-1.77] for women with normal length, regular cycles before vaccination). Messenger RNA and adenovirus-vectored vaccines were both associated with this change. SARS-CoV-2 infection was not associated with changes in usual menstrual cycle characteristics. CONCLUSION COVID-19 vaccination may be associated with short-term changes in usual menstrual cycle length, particularly among women whose cycles were short, long, or irregular before vaccination. The results underscored the importance of monitoring menstrual health in vaccine clinical trials. Future work should examine the potential biological mechanisms.
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Affiliation(s)
- Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jasmine Mortazavi
- Department of Obstetrics, Gynecology, and Reproductive Biologym, Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer A Hankins
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Laura M Katuska
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rulla M Tamimi
- Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Kathryn L Terry
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biologym, Michigan State University College of Human Medicine, Grand Rapids, MI; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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36
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Association between RNAm-Based COVID-19 Vaccines and Permanency of Menstrual Cycle Alterations in Spanish Women: A Cross-Sectional Study. BIOLOGY 2022; 11:biology11111579. [PMID: 36358280 PMCID: PMC9687584 DOI: 10.3390/biology11111579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Introduction: The purpose of this study was to delve more deeply into the medium and long-term relation between mRNA-based vaccines and changes in menstrual pain, cycle length, and amount of bleeding in Spanish women. Material and Methods: A total of 746 women (63% between 18−30 and 37% between 31−45 years old) participated in the study. A numerical rating scale was used for recording pain intensity, a pictorial chart for menstrual bleeding, and data from menstrual cycle duration, type of vaccine, number of doses and time from vaccination. Results: Sixty-five per cent of the women perceived changes in their menstrual cycle after receiving the vaccines, irrespective of type of vaccine or number of doses; all p values were >0.05. Most of them (n = 316 out of 484) reported more than one alteration in their menstrual cycle. Almost half of the participants had been vaccinated over 5 months (45%), 3−4 months (15%) 2−3 months (26%), and one month or less (13%) before. The percentage of women that reported alterations remained strongly constant across time, p > 0.05, ranging from 64 to 65%. Conclusions: Reported alterations in Spanish women after COVID vaccination remained more than 5 months after the last dose.
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Tayyaba Rehan S, Imran L, Mansoor H, Sayyeda Q, Hussain HU, Cheema MS, Tahir MJ, Asghar MS, Mahmmoud Fadelallah Eljack M, Islam MS. Effects of SARS-CoV-2 infection and COVID-19 pandemic on menstrual health of women: A systematic review. Health Sci Rep 2022; 5:e881. [PMID: 36248348 PMCID: PMC9547349 DOI: 10.1002/hsr2.881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The menstrual cycle in women is the main indicator of their reproductive health which is affected by the ongoing coronavirus disease 2019 (COVID-19) pandemic. This review aims to summarize the effects of the COVID-19 infection and the global pandemic on the menstrual health of women. Methods The literature search was conducted in PubMed, Cochrane library, and Google Scholar using keywords "COVID-19," "Menstrual Cycle," "Menstrual Cycle Irregularities," "Amenorrhea," "Polymenorrhea," and "Dysmenorrhea." The articles were selected according to the following inclusion criteria: (i) cross-sectional studies, (ii) cohort studies, (iii) surveys, and (iv) other observational studies observing the effects of SARS-CoV-2 infection or COVID-19 pandemic on menstrual health of women. Exclusion criteria included: case reports, gray literature, and website articles regarding menstrual health. Results A total of 30,510 articles were shortlisted after a comprehensive search. Sixteen articles were included out of which 13 studies investigated the effects of the COVID-19 pandemic on the menstrual cycle while 3 evaluated the possible effects of COVID-19 infection on the menstrual health of women. Menstrual disorders or irregularities were a more common finding during the pandemic as compared to before (p = 0.008). Women affected by pandemic-related stress were more prone to changes in the duration of their menses (p = 0.0008), reported heavier bleeding (p = 0.028), and increased incidence of painful periods (p < 0.0001). COVID-19 infected women also reported changes in their menstrual cycle including irregular menstruation, increased symptoms of premenstrual syndrome, and infrequent menstruation. Conclusions Women suffering from COVID-19 infection or pandemic-associated stress and anxiety were more likely to experience irregular menstruation, dysmenorrhea, amenorrhea, and other menstrual abnormalities compared to those who were less exposed.
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Affiliation(s)
| | - Laiba Imran
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Hussain Mansoor
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Qudsia Sayyeda
- Department of MedicineRed Crescent of Tampa BayTampaFloridaUSA
| | - Hassan ul Hussain
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | | | | | - Muhammad Sohaib Asghar
- Department of Internal MedicineDow University of Health Sciences–Ojha CampusKarachiPakistan,Division of Nephrology and HypertensionMayo ClinicRochesterMinnesotaUSA
| | | | - Md. Saiful Islam
- Department of Public Health and InformaticsJahangirnagar UniversitySavarDhakaBangladesh,Centre for Advanced Research Excellence in Public HealthSavarDhakaBangladesh
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Saçıntı KG, Oruç G, Şükür YE, Koç A. COVID-19 vaccine has no impact on the menstrual cycle. J OBSTET GYNAECOL 2022; 42:3403-3404. [PMID: 36154356 DOI: 10.1080/01443615.2022.2124853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Koray Görkem Saçıntı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Gizem Oruç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Acar Koç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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COVID-19, Vaccination, and Female Fertility in the Czech Republic. Int J Mol Sci 2022; 23:ijms231810909. [PMID: 36142820 PMCID: PMC9501189 DOI: 10.3390/ijms231810909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022] Open
Abstract
The fast-track process to approve vaccines against COVID-19 has raised questions about their safety, especially in relation to fertility. Over the last 2 years, studies have appeared monitoring female fertility, especially from assisted reproduction centers or in animal experiments. However, studies monitoring healthy populations are still limited. The aim of our study was to monitor the relevant parameters of female fertility (sex and other steroids, LH, FSH, SHBG, Antimüllerian hormone and antral follicle count) before and then 2-4 months after the third dose of vaccination against COVID-19 in a group of 25 healthy fertile woman. In addition, anti-SARS-CoV-2 and anti-SARS-CoV-2S antibodies were determined. We did not observe significant changes in the measured parameters before and after the third dose of vaccination. By comparing levels of the analytes with antibodies indicating a prior COVID-19 infection, we found that women who had experienced the disease had statistically lower levels of estrone, estradiol, SHBG and 5α-dihydroprogesterone, and conversely, higher levels of androgen active dehydroepiandrosterone and dihydrotestosterone. Our results confirm that vaccination does not affect female fertility, and that what fertile women should be worried about is not vaccination, but rather COVID-19 infection itself.
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Wong KK, Heilig CM, Hause A, Myers TR, Olson CK, Gee J, Marquez P, Strid P, Shay DK. Menstrual irregularities and vaginal bleeding after COVID-19 vaccination reported to v-safe active surveillance, USA in December, 2020–January, 2022: an observational cohort study. Lancet Digit Health 2022; 4:e667-e675. [PMID: 35961858 PMCID: PMC9363036 DOI: 10.1016/s2589-7500(22)00125-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 10/24/2022]
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Alvergne A, Woon EV, Male V. Effect of COVID-19 vaccination on the timing and flow of menstrual periods in two cohorts. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:952976. [PMID: 36303656 PMCID: PMC9580734 DOI: 10.3389/frph.2022.952976] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 01/14/2023] Open
Abstract
COVID-19 vaccination protects against the potentially serious consequences of SARS-CoV-2 infection, but some people have been hesitant to receive the vaccine because of reports that it could affect menstrual bleeding. To determine whether this occurs we prospectively recruited a cohort of 79 individuals, each of whom recorded details of at least three consecutive menstrual cycles, during which time they each received at least one dose of COVID-19 vaccine. In spontaneously cycling participants, COVID-19 vaccination was associated with a delay to the next period, but this change reversed in subsequent unvaccinated cycles. No delay was detected in those taking hormonal contraception. To explore hypotheses about the mechanism by which these menstrual changes occur, we retrospectively recruited a larger cohort, of 1,273 people who had kept a record of their menstrual cycle and vaccination dates. In this cohort, we found a trend toward use of combined hormonal contraception being protective against reporting a delayed period, suggesting that menstrual changes following vaccination may be mediated by perturbations to ovarian hormones. However, we were unable to detect a clear association between the timing of vaccination within the menstrual cycle and reports of menstrual changes. Our findings suggest that COVID-19 vaccination can lengthen the menstrual cycle and that this effect may be mediated by ovarian hormones. Importantly, we find that the menstrual cycle returns to its pre-vaccination length in unvaccinated cycles.
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Affiliation(s)
- Alexandra Alvergne
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Ee Von Woon
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
- *Correspondence: Victoria Male
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Lee KMN, Junkins EJ, Luo C, Fatima UA, Cox ML, Clancy KBH. Investigating trends in those who experience menstrual bleeding changes after SARS-CoV-2 vaccination. SCIENCE ADVANCES 2022; 8:eabm7201. [PMID: 35857495 PMCID: PMC9286513 DOI: 10.1126/sciadv.abm7201] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Early in 2021, many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. We investigated this emerging phenomenon of changed menstrual bleeding patterns among a convenience sample of currently and formerly menstruating people using a web-based survey. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change after being vaccinated. Among respondents who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of postmenopausal people reported breakthrough bleeding. We found that increased/breakthrough bleeding was significantly associated with age, systemic vaccine side effects (fever and/or fatigue), history of pregnancy or birth, and ethnicity. Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine.
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Affiliation(s)
- Katharine M. N. Lee
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Anthropology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Studies of Women, Gender, and Sexuality, Harvard University, Cambridge, MA, USA
| | - Eleanor J. Junkins
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Urooba A. Fatima
- Department of Anthropology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Maria L. Cox
- Program in Ecology, Evolution, and Conservation, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kathryn B. H. Clancy
- Department of Anthropology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Program in Ecology, Evolution, and Conservation, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Corresponding author.
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Gibson EA, Li H, Fruh V, Gabra M, Asokan G, Jukic AMZ, Baird DD, Curry CL, Fischer-colbrie T, Onnela J, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Covid-19 vaccination and menstrual cycle length in the Apple Women’s Health Study.. [PMID: 35860226 PMCID: PMC9298140 DOI: 10.1101/2022.07.07.22277371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractBackgroundCOVID-19 vaccination may be associated with change in menstrual cycle length following vaccination.MethodsWe conducted a longitudinal analysis within a subgroup of 14,915 participants in the Apple Women’s Health Study (AWHS) who enrolled between November 2019 and December 2021 and met the following eligibility criteria: were living in the U.S., met minimum age requirements for consent, were English speaking, actively tracked their menstrual cycles, and responded to the COVID-19 Vaccine Update survey. In the main analysis, we included tracked cycles recorded when premenopausal participants were not pregnant, lactating, or using hormonal contraceptives. We used conditional linear regression and multivariable linear mixed-effects models with random intercepts to estimate the covariate-adjusted difference in mean cycle length, measured in days, between pre-vaccination cycles, cycles in which a vaccine was administered, and post-vaccination cycles within vaccinated participants, and between vaccinated and unvaccinated participants. We further compared associations between vaccination and menstrual cycle length by the timing of vaccine dose within a menstrual cycle (i.e., in follicular or luteal phase). We present Bonferroni-adjusted 95% confidence intervals to account for multiple comparisons.ResultsA total of 128,094 cycles (median = 10 cycles per participant; interquartile range: 4-22) from 9,652 participants (8,486 vaccinated; 1,166 unvaccinated) were included. The average within-individual standard deviation in cycle length was 4.2 days. Fifty-five percent of vaccinated participants received Pfizer-BioNTech’s mRNA vaccine, 37% received Moderna’s mRNA vaccine, and 7% received the Johnson & Johnson/Janssen vaccine (J&J). We found no evidence of a difference between mean menstrual cycle length in the unvaccinated and vaccinated participants prior to vaccination (0.24 days, 95% CI: −0.34, 0.82).Among vaccinated participants, COVID-19 vaccination was associated with a small increase in mean cycle length (MCL) for cycles in which participants received the first dose (0.50 days, 95% CI: 0.22, 0.78) and cycles in which participants received the second dose (0.39 days, 95% CI: 0.11, 0.67) of mRNA vaccines compared with pre-vaccination cycles. Cycles in which the single dose of J&J was administered were, on average, 1.26 days longer (95% CI: 0.45, 2.07) than pre-vaccination cycles. Post-vaccination cycles returned to average pre-vaccination length. Estimates for pre vs post cycle lengths were 0.14 days (95% CI: −0.13, 0.40) in the first cycle following vaccination, 0.13 days (95% CI: −0.14, 0.40) in the second, −0.17 days (95% CI: −0.43, 0.10) in the third, and −0.25 days (95% CI: −0.52, 0.01) in the fourth cycle post-vaccination. Follicular phase vaccination was associated with an increase in MCL in cycles in which participants received the first dose (0.97 days, 95% CI: 0.53, 1.42) or the second dose (1.43 days, 95% CI: 1.06, 1.80) of mRNA vaccines or the J&J dose (2.27 days, 95% CI: 1.04, 3.50), compared with pre-vaccination cycles.ConclusionsCOVID-19 vaccination was associated with an immediate short-term increase in menstrual cycle length overall, which appeared to be driven by doses received in the follicular phase. However, the magnitude of this increase was small and diminished in each cycle following vaccination. No association with cycle length persisted over time. The magnitude of change associated with vaccination was well within the natural variability in the study population. Menstrual cycle change following COVID-19 vaccination appears small and temporary and should not discourage individuals from becoming vaccinated.
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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; 11:jcm11133800. [PMID: 35807090 PMCID: PMC9267255 DOI: 10.3390/jcm11133800] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
Researchers have been studying COVID-19 from day one, but not much is known about the impact of COVID-19 on the reproductive system, specifically the female reproductive system. There has been substantial anecdotal and media coverage on the effect of COVID-19 on the female reproductive system and changes in the menstrual cycle, but so far available data are not robust enough to draw firm conclusions about the topic. This article was carried out to present already published studies on the correlation between SARS-CoV-2 infection and menstrual cycle changes. A systematic literature search was conducted on the Medline, Scopus, and Cochrane Library databases in accordance with the PRISMA guidelines. Three studies were finally included in the review. The findings of the studies indicate changes in menstrual volume and changes in menstrual cycle length as consequences of SARS-CoV-2 infection; the latter was also the most common menstrual irregularity reported by the included studies. Women have mainly reported decreased menstrual volume and a prolonged cycle. The findings also indicate that the severity of COVID-19 does not play a role in menstrual cycle changes. However, the research on this topic is still too scarce to draw definitive conclusions, and there is a need for further research. The relevant conclusions, which could be drawn only from a well-constructed study, would have a major effect on defining the impact of SARS-CoV-2 infection on the menstrual cycle.
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Affiliation(s)
- Vojka Lebar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.S.L.); (V.C.)
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.S.L.); (V.C.)
| | - Tina Kunič
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia;
| | - David Lukanović
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +38-615-226-005
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45
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Bouchard TP, Schneider M, Schmidt M, Manhart M, Fehring RJ. Menstrual Cycle Parameters Are Not Significantly Different After COVID-19 Vaccination. J Womens Health (Larchmt) 2022; 31:1097-1102. [PMID: 35723654 DOI: 10.1089/jwh.2022.0097] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Some studies have suggested minor changes in the menstrual cycle after COVID-19 vaccination, but more detailed analyses of the menstrual cycle are needed to evaluate more specific changes in the menstrual cycle that are not affected by survey-based recall bias. Materials and Methods: Using a pretest-post-test quasi-experimental evaluation of menstrual cycle parameters before and after COVID-19 vaccination, we conducted an anonymous online survey of two groups of North American women who prospectively monitor their menstrual cycle parameters daily including bleeding patterns, urinary hormone levels using the ClearBlue Fertility Monitor, or cervical mucus observations. The primary outcome measures were cycle length, length of menses, menstrual volume, estimated day of ovulation (EDO), luteal phase length, and signs of ovulation. Perceived (subjective) menstrual cycle changes and stressors were also evaluated in this study as secondary outcome measures. Results: Of the 279 women who initiated the survey, 76 met the inclusion criteria and provided 588 cycles for analysis (227 pre-vaccine cycles, 145 vaccine cycles, 216 post-vaccine cycles). Although 22% of women subjectively identified changes in their menstrual cycle, there were no significant differences in menstrual cycle parameters (cycle length, length of menses, EOD, and luteal phase length) between the pre-vaccine, vaccine, and post-vaccine cycles. Conclusions: COVID-19 vaccines were not associated with significant changes in menstrual cycle parameters. Perceived changes by an individual woman must be compared with statistical changes to avoid confirmation bias.
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Affiliation(s)
- Thomas P Bouchard
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary Schneider
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Madeline Schmidt
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Michael Manhart
- Couple to Couple League, Fertility Science Institute, Cincinnati, Ohio, USA
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Medina-Perucha L, López-Jiménez T, Holst AS, Jacques-Aviñó C, Munrós-Feliu J, Martínez-Bueno C, Valls-Llobet C, Pinzón-Sanabria D, Vicente-Hernández MM, Berenguera A. Self-Reported Menstrual Alterations During the COVID-19 Syndemic in Spain: A Cross-Sectional Study. Int J Womens Health 2022; 14:529-544. [PMID: 35444473 PMCID: PMC9013667 DOI: 10.2147/ijwh.s354655] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Available evidence suggests that there might be an association between the stressors experienced during the COVID-19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain. Materials and Methods A cross-sectional online survey-based study was conducted (March-July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the "Equity and Menstrual Health in Spain" research project. Results Among participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants self-reporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times <12 months: aOR: 1.68, 95% CI, 1.48-1.90), poorer self-perceived health (eg, poor: aOR: 2.00, 95% CI, 1.31-3.07), and those diagnosed with polycystic ovary syndrome (aOR: 1.13, 95% CI, 1.02-1.26). Among participants with a self-reported COVID-19 diagnosis, factors that significantly increased the odds for menstrual alterations were experiencing financial strains (eg, financial issues always/many times <12 months: aOR: 1.53, 95% CI, 1.09-2.14), poorer self-perceived health (eg, poor: aOR: 3.09, 95% CI, 1.01-9.52). Overall, factors that decreased the odds of reporting menstrual alterations included age >25, being a carer, not having a gynecological condition and using hormonal contraception. Discussion and conclusions Findings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Jordina Munrós-Feliu
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de la Salut, Barcelona, Spain.,Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain.,Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR), Direcció Assistencial d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | | | | | | | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Affiliation(s)
- Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Carp-Veliscu A, Mehedintu C, Frincu F, Bratila E, Rasu S, Iordache I, Bordea A, Braga M. The Effects of SARS-CoV-2 Infection on Female Fertility: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020984. [PMID: 35055804 PMCID: PMC8775865 DOI: 10.3390/ijerph19020984] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023]
Abstract
As the coronavirus pandemic is far from ending, more questions regarding the female reproductive system, particularly fertility issues, arise. The purpose of this paper is to bring light upon the possible link between COVID-19 and women’s reproductive health. This review emphasizes the effect of SARS-CoV-2 on the hormones, endometrium and menstrual cycle, ovarian reserve, follicular fluid, oocytes, and embryos. The results showed that endometrial samples did not express SARS-CoV-2 RNA. Regarding the menstrual cycle, there is a large range of alterations, but they were all reversible within the following months. The ovarian reserve was not significantly affected in patients recovering from both mild and severe infection in most cases, except one, where the levels of AMH were significantly lower and basal follicle-stimulating hormone (FSH) levels were increased. All COVID-19 recovered patients had positive levels of SARS-CoV-2 IgG in the follicular fluid. The amount of retrieved and mature oocytes and the fertilization rate were unharmed in three studies, except for one study, where the quantity of retrieved and mature oocytes was reduced in patients with higher levels of SARS-CoV-2 antibodies. The numbers of blastocysts, top-quality embryos, and euploid embryos were affected in most of the studies reviewed.
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Affiliation(s)
- Andreea Carp-Veliscu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
| | - Claudia Mehedintu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Nicolae Malaxa Clinical Hospital Bucharest, 022441 Bucharest, Romania
- Correspondence:
| | - Francesca Frincu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Nicolae Malaxa Clinical Hospital Bucharest, 022441 Bucharest, Romania
| | - Elvira Bratila
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
| | - Simona Rasu
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
| | - Ioana Iordache
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
| | - Alina Bordea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.-V.); (F.F.); (E.B.); (I.I.); (A.B.)
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
| | - Mihaela Braga
- Panait Sarbu Clinical Hospital of Obstetrics and Gynaecology, 060251 Bucharest, Romania; (S.R.); (M.B.)
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Rodríguez Quejada L, Toro Wills MF, Martínez-Ávila MC, Patiño-Aldana AF. Menstrual cycle disturbances after COVID-19 vaccination. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221109375. [PMID: 35796571 PMCID: PMC9295013 DOI: 10.1177/17455057221109375] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/17/2022] [Accepted: 06/07/2022] [Indexed: 06/02/2023]
Abstract
INTRODUCTION After COVID-19 vaccination, women of reproductive age reported changes in their menstrual cycle. MATERIALS AND METHODS A retrospective study was carried out after a survey on social networks that included women aged 18-41 years with normal cycles according to International Federation of Gynecology and Obstetrics and who were vaccinated (complete schedule for two doses, except J&J/Janssen or incomplete with a single dose). Women with following conditions were excluded: pregnant or lactating women; history of diseases that cause menstrual irregularities or early menopause: anorexia, bulimia, polycystic ovary syndrome, hypothyroidism, obesity, or low weight; hysterectomized or oophorectomized patients; and high performance athletes. RESULTS Overall, 950 women completed the survey between July and September 2021. In total, 408 women met the inclusion criteria, and 184 reported the following characteristics: frequency (normal 43.47%, infrequent 25%, and frequent 31.53%), regularity (regular 51.08%, irregular 42.93%, and absent/amenorrhea 5.97%), duration (normal 65.21%, prolonged 26.08%, absent/amenorrhea 8.69%), and volume (heavy 41.84%, light 20.65%, and absent/amenorrhea 6.52%). CONCLUSIONS SARS-CoV-2 infection and COVID-19 vaccination can influence the menstrual cycle and cause alterations.
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Affiliation(s)
- Luisa Rodríguez Quejada
- Gynecology and Obstetrics, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - María Fernanda Toro Wills
- Gynecology and Obstetrics, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Andrés Felipe Patiño-Aldana
- Epidemiology and Public Health, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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50
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Taşkaldıran I, Vuraloğlu E, Bozkuş Y, Turhan İyidir Ö, Nar A, Başçıl Tütüncü N. Menstrual Changes after COVID-19 Infection and COVID-19 Vaccination. Int J Clin Pract 2022; 2022:3199758. [PMID: 36349056 PMCID: PMC9633189 DOI: 10.1155/2022/3199758] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Several factors such as stress, depression, infection, and vaccination influenced the menstrual cycle in women during the coronavirus disease 2019 (COVID-19) pandemic. We investigated whether there were changes in the menstrual cycle in women after COVID-19 vaccination or infection and, if so, the nature of the change. METHODS This study was designed as a descriptive, cross-sectional study. A face-to-face survey was conducted among menstruating women aged 18-50 years from May 31 to July 31, 2022. Women were inquired about their first three menstrual cycles that occurred after COVID-19 infection or vaccination. RESULTS Of 241 women with COVID-19 infection, 86 (35.7%) mentioned that they experienced various changes in their menstrual patterns in the first three cycles after infection. Of 537 participants who received various COVID-19 vaccines, 82 (15.1%) stated that they experienced changes in their menstrual patterns after vaccination. The incidence of postvaccination menstrual change was higher in women who received Pfizer-BioNTech and Sinovac (CoronaVac) vaccines. Only 10.9% of women who reported a change in their menstrual pattern after vaccination or infection consulted a physician. CONCLUSION COVID-19 infection and vaccination can affect the menstrual cycle in women. It is important to be aware of the menstrual changes after COVID-19 infection and vaccination and to warn and inform women about this issue.
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Affiliation(s)
- Işılay Taşkaldıran
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Emre Vuraloğlu
- Department of Family Medicine, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Yusuf Bozkuş
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Aslı Nar
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Neslihan Başçıl Tütüncü
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
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