Impact of SARS-CoV-2 infection on menstrual cycle

By Tarun Sai LomteReviewed by Aimee MolineuxJul 4 2022

In a recent study published in the Journal of Clinical Medicine, researchers systematically reviewed the impact of coronavirus disease 2019 (COVID-19) on the menstrual cycle.

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

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

About the study

In the present study, researchers performed a systematic review to analyze the impact of COVID-19 on the menstrual cycle. Medline, Cochrane library, and Scopus databases were systematically searched. The terms ‘menstrual cycle’ and ‘virus diseases’ were used to search across medical subject headings in Medline.

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

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

Findings

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

About 237 adult women aged 18 to 45 who were not lactating/pregnant without menstrual irregularities in the six months before infection were included. Ninety patients were severe COVID-19 cases, and the remaining had mild disease. It observed that nearly 20% of the participants had a significant decrease in menstrual volume with no significant differences between mild and severe cases.

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

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

Approximately 22% of cases were severely ill, 48% reported recent mental disorder (depression/anxiety), 36% underwent gynecological surgery, and 12% had a history of benign gynecological disease. Severe COVID-19 patients exhibited higher amenorrhea, irregular periods, menstrual volume, and pain than non-severe cases, albeit the differences were insignificant.  

The cohort study was a part of an ongoing Arizona CoVHORT study. Investigators administered surveys on COVID-19 symptomology every six weeks. It included 127 COVID-19 patients aged 18-45 who were not pregnant at the time of inclusion nor had been recently pregnant. Among these, 20 patients reported menstrual cycle changes. The median number duration between the positive test and the last reported menstrual change was 57.5 days.

The common changes include irregular menstruation, infrequent menstruation, and increased premenstrual syndrome symptoms. Patients with menstrual cycle changes were more likely to experience more COVID-19 symptoms such as fatigue, shortness of breath, headache, and body aches/pains. Notably, the researchers could not adjust for potential confounders, and the study did not provide information about the duration of menstrual changes.

Conclusions

The present (systematic) review identified prolonged menstrual cycle and decreased menstrual volume resulting from COVID-19. It noted that disease severity did not significantly affect menstrual cycle changes. Nonetheless, the insufficient amount of data limits the ability to draw firm conclusions and highlights the need for further research.