SARS-CoV-2 infection can affect menstruation

By Bhavana KunkalikarReviewed by Benedette Cuffari, M.Sc.Oct 30 2022

In a recent PLoS ONE journal study, researchers assess the association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and menstrual irregularities.

Study: Infection with SARS-CoV-2 is associated with menstrual irregularities among women of reproductive age. Image Credit: Kmpzzz / Shutterstock.com

Background

Several previous studies have indicated that women may be more susceptible than men to the post-acute consequences of the coronavirus disease 2019 (COVID-19) that affect many organ systems and mental health.

SARS-CoV-2-infected pregnant women, for example, are more likely to experience unfavorable outcomes related to pregnancy and delivery. Women also report more pandemic-related stressors, including loneliness, increased stress, and loss of childcare.

Even though the COVID-19 pandemic affects women more severely than men, insufficient research has been conducted to determine how it has affected women's health.

About the study

In the present study, researchers assess menstrual abnormalities observed during the COVID-19 pandemic using a biopsychosocial perspective to investigate the associations between SARS-CoV-2 illness or COVID-19 immunization, as well as psychological factors with irregular periods.

The current study utilized cross-sectional data gathered as part of a baseline evaluation. Cisgender women of reproductive age were enrolled in a study between January 2019 to September 2021 that assessed behavioral and molecular processes involved in bacterial vaginosis and the risk of human immunodeficiency viruses (HIV).

Eligible study participants were cisgender women between the ages of 18 and 45 years who reported sexual activity within the previous three months, were negative for the human immunodeficiency virus (HIV), not using an intrauterine device, had no history of cervix surgery or cervical intraepithelial neoplasia grade 2 or 3, not used antibiotics within the previous two months, and did not have a metronidazole allergy.

Study participants answered a survey that included questions on their menstrual irregularities over the last three months and sociodemographic factors, including age, median monthly income, level of education, race, ethnicity, and employment status.

Participants began receiving a fast chromatographic immunoassay with an Emergency Use Authorization (EUA) from the United States Food and Drug Administration (FDA) for the qualitative detection of SARS-CoV-2 immunoglobulin G (IgG) antibodies in whole blood in October 2020. The presence of detectable antibodies may indicate prior COVID-19 immunization or SARS-CoV-2 infection.

The three-item University of California, Los Angeles (UCLA) Loneliness Scale, four-item Perceived Stress Scale, and 10-item Centers for Epidemiological Studies Depression Scale (CES-D-10) were validated psychological measures that were employed. These measures were used to determine continuous scores related to perceived stress, the severity of depression symptoms, and loneliness, respectively. In addition, participants were questioned in November 2021 about whether and when they had received a COVID-19 vaccine.

Study findings

Baseline evaluations were completed by 182 participants who provided data related to demographics and menstrual irregularities. Among these, 73 measures were successfully implemented, including tests for SARS-CoV-2 IgG, stress, loneliness, and depression. A total of 36 participants provided feedback on a follow-up survey regarding their COVID-19 vaccination status.

In terms of psychological variables, 31 participants rated a minimum of one item that indicated perceived stress in the form of a feeling that obstacles were insurmountable between "fairly often" to "very often" over the previous month. Conversely, 28 participants passed the threshold for high depression, which was defined as 10 or higher on the CES-D. A total of 33 people scored in the "lonely" range on the UCLA Loneliness Scale, whereas 40 people scored "not lonely."

Seven of the 36 individuals who answered the follow-up question regarding COVID-19 vaccination had already received the COVID-19 vaccine. Thus, a previous SARS-CoV-2 infection occurred in the majority of subjects with detectable antibodies.

Twenty-five people mentioned menstruation abnormalities in the previous three months. Fisher's exact test revealed a significant correlation between the presence of detectable SARS-CoV-2 IgG antibodies and the incidence of menstrual irregularities among unvaccinated women since all the seven women who reported menstrual irregularities had SARS-CoV-2 antibodies.

Women with detectable SARS-CoV-2 antibodies were more likely to experience menstrual irregularities, including those who were vaccinated, unvaccinated, and of unknown vaccination status. Women who reported menstrual irregularities before and during the pandemic did not differ significantly. SARS-CoV-2 IgG antibody levels did not significantly correlate with feelings of stress, loneliness, or depression.

Conclusions

The current study reported an association between menstrual abnormalities and a history of COVID-19 vaccination and/or SARS-CoV-2 IgG infection. Few women in the study cohort had received the COVID-19 vaccine prior to being tested for SARS-CoV-2 IgG, which raised the possibility that SARS-CoV-2 infection itself might be associated with irregular menstruation.