Impact of COVID-19 Vaccination on Menstrual Cycle, Quality of Life and Perception on Fertility: A Mixed Methods Study of Women in Delhi-NCR

A prospective study of the association between SARS-CoV-2 infection and COVID-19 vaccination with changes in usual menstrual cycle characteristics

Some women experienced alterations in their menstrual cycles during the Coronavirus disease 2019 (COVID-19) pandemic. This study aimed to evaluate the changes in menstrual cycles among Iranian women during the COVID-19 pandemic. This cross-sectional study included 1500 women of childbearing age referred to healthcare centers in Tehran, Iran from April-November 2022. Participants were selected using the stratified sampling method. Data were collected via a questionnaire covering information on menstrual cycle, COVID-19 infection, and COVID-19 vaccination status. The study's outcomes focused on menstrual changes by evaluating cycle regularity, duration, and symptoms based on participant-reported observations. The findings revealed that the pattern of menstrual change during the pandemic occurred in the form of a shorter interval in 8.6%, and longer interval in 8.9%, shorter duration in 10.4%, longer duration in 9.4%, heavier bleeding in 12.3%, lighter bleeding in 14.7%. The chance of menstrual changes in women who were infected with COVID-19 was 54% higher than that of women who were not infected, and the chance of menstrual changes in women who received 3 doses of COVID-19 vaccine was 1.5 times higher than women who had not been vaccinated. Our research revealed a high incidence of menstrual changes among Iranian women of childbearing age during the COVID-19 pandemic. Healthcare providers should be knowledgeable about the menstrual changes associated with COVID-19 infection and vaccination to provide information and support to affected women.

Objective: Various side effects of the COVID-19 vaccine, such as fatigue, have been reported. However, there has been a recent increase in reports of menstrual cycle changes among women. This study assessed the effect of the COVID-19 vaccine on the menstrual cycle of Saudi women. Methods: In this cross-sectional study, data were collected between November and December 2021 from 500 healthy Saudi females between 20 and 40 years. We included all women who reported having a normal menstrual cycle before being vaccinated against COVID-19. Results: A total of 65.6% of participants reported having significant changes in their cycle in terms of period timing, blood flow, and pain following the first and 65.6.% following the second COVID-19 vaccination doses. Both the mRNA and adenovirus vectored COVID-19 vaccines affected the cycle similarly. The induced COVID-19 vaccine menstrual cycle abnormality is a short-term effect lasting <3 months after the first and second doses. Conclusion: There are reported side effects of the COVID-19 vaccine; however, changes in the menstrual cycle have not been reported. Our study assumes that the menstrual cycle changes observed in the study’s participants were unlikely to be caused by reasons other than the COVID-19 vaccines, since we excluded all participants with medical interventions, medical conditions, and the age range that might affect the menstrual cycle. Although this effect is a short-term effect, the exact mechanism behind this phenomenon must be investigated.

The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists

SARS-CoV-2 infection and subsequent changes in the menstrual cycle among participants in the Arizona CoVHORT study

Background: During the last two years, the world witnessed an urgent need for vaccines to tackle the coronavirus disease 2019 (COVID-19) pandemic. Several side effects, mainly non-life-threatening, were reported following COVID-19 vaccination. There are increasing concerns about the potential effects of COVID-19 vaccines on menstrual cycle (MC) changes amid a paucity of scientific studies on this crucial issue. The present study aimed to assess the changes in menstrual cycle (MC) among Jordanian women after receiving a COVID-19 vaccine. Method: An online-based cross-sectional study was conducted from 10 to 24 August 2021. The main menstruation-related complaints were identified and included in the survey tool that targeted Jordanian women who received at least one dose of a COVID-19 vaccine. Results: A total of 633 married and unmarried women were recruited, 222 (35.1%) and 411 (64.9%), respectively. Unmarried women showed a significantly higher occurrence of menstruation dysfunctions after getting a COVID-19 vaccine compared to married women (p = 0.001). During MC, around 34.3% of participants were suffered from increasing back and abdominal pains. The most common dysfunction was a prolonged MC (24.8%), while only 16.1% experienced pre-menstruation bleeding. Additionally, 19.4% of participants stated that the MC dysfunctions last for one month, 8.7 % for two months, and 35.4% for more than two months. Conclusion: This study showed that COVID-19 vaccines negatively affected the MC in terms of the occurrence of dysfunctions and accompanying symptoms. However, further studies are required to investigate the characteristics of women who are more likely to be affected and the potential mechanisms underlying these effects.

Structured abstractO_ST_ABSObjectivesC_ST_ABSOur objectives were (1) to evaluate the prevalence of menstrual changes following vaccination against COVID-19, (2) to test potential risk factors for any such changes, and (3) to identify patterns of symptoms in participants written accounts. DesignA secondary analysis of a retrospective online survey titled Covid-19 Pandemic and Womens Reproductive Health, conducted in March 2021 in the UK before widespread media attention regarding potential impacts of SARS-CoV-2 vaccination on menstruation. SettingParticipants were recruited via a Facebook ad campaign in the UK. ParticipantsEligibility criteria for survey completion were age greater than 18 years, having ever menstruated and currently living in the UK. In total, 26,710 people gave consent and completed the survey. For this analysis we selected 4,989 participants who were pre-menopausal and vaccinated. These participants were aged 28 to 43, predominantly from England (81%), of white background (95%) and not using hormonal contraception (58%). Main outcome measureReports of any menstrual changes (yes/no) following COVID-19 vaccination and words used to describe menstrual changes. ResultsAmong pre-menopausal vaccinated individuals (n=4,989), 80% did not report any menstrual cycle changes up to 4 months after their first COVID-19 vaccine injection. Current use of combined oral contraceptives was associated with lower odds of reporting any changes by 48% (OR = 0.52, 95CI = [0.34 to 0.78], P<0.001). Odds of reporting any menstrual changes were increased by 44% for current smokers (OR = 1.16, 95CI = [1.06 to 1.26], P<0.01) and by more than 50% for individuals with a positive COVID status [Long Covid (OR = 1.61, 95CI = [1.28 to 2.02], P<0.001), acute COVID (OR = 1.54, 95CI = [1.27 to 1.86], P<0.001)]. The effects remain after adjusting for self-reported magnitude of menstrual cycle changes over the year preceding the survey. Written accounts report diverse symptoms; the most common words include cramps, late, early, spotting, and irregular, with a low level of clustering among them. ConclusionsFollowing vaccination for COVID-19, menstrual disturbance occurred in 20% of individuals in a UK sample. Out of 33 variables investigated, smoking and a previous history of SARS-CoV-2 infection are found to be risk factors while using oestradiol-containing contraceptives was found to be a protective factor. Diverse experiences were reported, from menstrual bleeding cessation to heavy menstrual bleeding. Summary boxO_ST_ABSWhat is already known on this topic?C_ST_ABSO_LIMenstrual disturbances including changes in frequency and/or dysmenorrhoea following vaccination have been reported as early as 1913 for the typhoid vaccine (1). Since then there have only been a few studies investigating this topic, using small sample sizes (hepatitis vaccine (2)) or reporting mixed results (HPV vaccine (3,4)). C_LIO_LIThe UKs Medicine and Healthcare products Regulatory Agency (MHRA) is closely monitoring reports of menstrual disorders, with more than 30,000 reports made to its yellow card surveillance scheme by 2 September 2021 following vaccination with both mRNA and adenovirus-vectored COVID-19 vaccines (5). C_LIO_LIIn a recent preprint of a retrospective case-control study of 21,380 pre-menopausal participants living in the US, 45.8% of 9,579 people with regular menstrual cycles experienced heavier bleeding after COVID-19 vaccination. In addition, 70.5% of 1,545 non-menstruating people using long-acting reversible contraceptives (LARC) experienced breakthrough bleeding after COVID-19 vaccination (6). This informative study may be affected by selection bias and may not be generalisable. C_LI What this study addsO_LIIn a large sample of participants vaccinated against COVID-19 surveyed in the UK before widespread media attention to related menstrual changes, the prevalence of menstrual changes was 1 in 5. C_LIO_LIOut of 33 socio-demographic, health, vaccine, COVID- and pandemic-related and reproductive variables, the odds of reporting any menstrual changes following COVID-19 vaccination were associated with a history of SARS-CoV-2 infection, smoking behaviour and the type of contraceptives used. C_LIO_LIMenstrual changes that were reported were diverse, ranging from increased bleeding to the cessation of bleeding. C_LIO_LIThe study highlights the need for greater consideration of the menstrual cycle in health interventions. C_LI

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.

Observations of women and clinicians indicated that the prevalence of menstrual cycle problems has escalated during the COVID-19 pandemic. However, it was not clear whether the observed menstrual cycle changes were related to vaccination, the disease itself or the COVID-19 pandemic-induced psychological alterations. To systematically analyze this question, we conducted a human online survey in women aged between 18 and 65 in Hungary. The menstrual cycle of 1563 individuals were analyzed in our study in relation to the COVID-19 vaccination, the COVID-19 infection, the pandemic itself and the mental health. We found no association between the COVID-19 vaccination, the vaccine types or the COVID-19 infection and the menstrual cycle changes. We also evaluated the menstrual cycle alterations focusing on three parameters of the menstrual cycle including the cycle length, the menses length and the cycle regularity in three pandemic phases: the pre-peak, the peak and the post-peak period in Hungary. Our finding was that the length of the menstrual cycle did not change in any of the periods. However, the menses length increased, while the regularity of the menstrual cycle decreased significantly during the peak of the COVID-19 pandemic when comparing to the pre- and post-peak periods. In addition, we exhibited that the length and the regularity of the menstrual cycle both correlated with the severity of depression during the post-peak period, therefore we concluded that the reported menstrual cycle abnormalities during the peak of COVID-19 in Hungary might be the result of elevated depressive symptoms.

Effect of COVID-19 pandemic and COVID-19 vaccine on menstrual cycle Menstrual cycle irregularities include changes in menstrual cycle frequency, regularity, duration or intensity, as well as breakthrough bleeding. The global prevalence of irregular menstrual cycle ranges from 5% to 34% during reproductive years, and related problems constitute one of the most common reasons for referral to a gynecologist. It has been stated that during the Covid-19 pandemic and after the covid-19 vaccines, menstrual irregularities increased and the number of pads decreased in women. If these changes are related to the vaccine, it is thought that it may be a result of the immune response to the vaccine rather than a specific vaccine component. While reported changes in menstrual cycle after vaccination are short-lived, robust research on this potential adverse reaction remains critical to the overall success of the vaccination program. While Covid-19 affects social life, women cause hormonal imbalances, especially during the sexually active period. As a result, menstrual cycle irregularities may result in a decrease in the number of pads used and result in a decrease in the number of population that will threaten future generations. The aim of this study was to investigate the effects of mRNA vaccine and adenovirus vectored vaccines developed as Covid-19 pandemic and Covid-19 vaccine between December 2019–2022, the beginning of the pandemic process, on hormonal disorders and menstrual cycle irregularities. Resources were accessed from the literatures PUBmed, Web of Science, Google Academic using the keywords “Covid-19 pandemic, Covid-19 vaccine, menstruation, menstrual cycle irregularity” and 14400 references were identified. The number of retrospective studies and case reports were excluded, and the number decreased to 30, and 20 of the appropriate scientific publications were included in the study by scanning the rest. Keywords: Covid-19 pandemic, Covid-19 vaccine, menstruation, menstrüel cycle irregularity

This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) vaccination on menstrual cycle changes among Korean women of reproductive age. This exploratory correlational study used data from an online, self-administered questionnaire obtained from the Korea Social Science Data Center database. The survey assessed menstrual cycle changes following COVID-19 vaccination among Korean women of reproductive age (15-49 years) who were menstruating regularly and had a history of COVID-19 vaccination. Data were collected between February and March 2023. A total of 227 participants who completed the online questionnaire were included in the analysis. The risk of menstrual cycle changes was higher among older women (reference group: 40-49 years; 15-19 years: odds ratio [OR], 0.25 [p=.006]; 30-39 years: OR, 0.03 [p=.030]), women with obesity (reference group: body mass index [BMI] >23 kg/m2; BMI <18.5 kg/m2: OR, 0.03 [p=.030]; BMI 18.5-22.9: OR, 0.002 [p=.002]), and unmarried women (OR, 3.02). Increased risk was also observed among participants with a history of COVID-19 infection (OR, 3.46; p=.015), those who received the second or lower dose of the vaccine, and those reporting excessive menstrual flow (OR, 2.07; p=.015), intermenstrual symptoms (OR, 2.72; p=.037), or irregular menstruation (OR; 5.37, p<.001). Menstrual cycle changes following COVID-19 vaccination appear to be influenced by multiple factors, particularly the interaction between a history of irregular menstruation and environmental conditions. Further longitudinal studies and tailored management strategies for specific subgroups, including unmarried and obese women, are needed to support women's health and quality of life.

Pharmacovigilance agencies did not collect data regarding menstrual changes after COVID-19 vaccination even if many women experienced it. Our aim was to evaluate whether COVID-19 vaccination is associated with secondary changes in menstrual cycle and to assess both quality of life (QoL) and sexual function (SF). This study is a retrospective analysis referred to our Department from January 2021 to December 2021. The study cohort responded to same questionnaires before the second dose of vaccination (referring to previous 3 months) and 3 months after that (referring to three menstrual cycles after full-dose vaccination). The surveys administered were FSFI, FSDS, SF-36, MEDI-Q and the VAS-scale for dysmenorrhea. Four-hundred-nineteen vaccinated women were included in the study. The survey did not show a significant change in menstrual cycle length before and after COVID-19 vaccine (5.88±3.67 vs. 4.97±2.89, P=0.21); the interval between periods was significantly higher after a full-cycle vaccination (28.32±7.34 vs. 32.38±7.45, P<0.02); 32 patients (7.6%) developed amenorrhea after the second dose; VAS Scale did not change significantly (median range 3 (3-5) vs. 4 (3-6), P=0.20). MEDI-Q did not show significant variations before and after the vaccination (43.21±11.65 vs. 40.28±9.88, P=0.35). QoL and SF did not change significantly (FSFI median 27 [24-29] vs. 28 [25-30], P=0.12, FSDS median 9 [5-11] vs. 8 [4-12], P=0.22), SF-36 median 81 [70-85] vs. 82 [72-86], P=0.43). COVID-19 vaccination is associated with a significant change in intervals between menstrual cycles without other alterations in menstrual characteristics, in QoL or SF.

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.

SummaryThere has been increasing public concern that COVID-19 vaccination causes menstrual disturbance regarding the relative effect of vaccination compared to SARS-CoV-2 infection. Our objectives were to test potential risk factors for reporting menstrual cycle changes following COVID-19 vaccination and to compare menstrual parameters following COVID-19 vaccination and COVID-19 disease. We performed a secondary analysis of a retrospective online survey conducted in the UK in March 2021. In pre-menopausal vaccinated participants (n = 4,989), 18% reported menstrual cycle changes after their first COVID-19 vaccine injection. The prevalence of reporting any menstrual changes was higher for women who smoke, have a history of COVID-19 disease, or are not using estradiol-containing contraceptives. In a second sample including both vaccinated and unvaccinated participants (n = 12,579), COVID-19 vaccination alone was not associated with abnormal menstrual cycle parameters, while a history of COVID-19 disease was associated with an increased risk of reporting heavier bleeding, “missed” periods, and inter-menstrual bleeding.

Background: According to recent reports, many women who received COVID-19 vaccine reported symptoms of menstrual irregularity. However, this finding is still unclear. Therefore, this study aimed to determine the prevalence of women with menstrual cycle changes following receiving COVID-19 vaccines and identify the risk factors associated with menstrual cycle changes during the pandemic. Material and methods: A cross-sectional descriptive study was conducted among women aged 20-40 years attending the outpatient clinics, general gynecology and reproductive and endocrine and infertility medicine department (REIMD) at King Fahad Medical City (KFMC) hospital in Riyadh, Saudi Arabia. Demographic data, medical and COVID-19 vaccination history, detailed menstrual cycle duration and frequency were obtained. Results: A total of 1117 women participated in this study. The age of 35.2% of them ranged between 24 and 29 years. Most (72.6%) of regular cycles before uptaking of COVID-19 vaccine became irregular. On the other hand, 17% of irregular cycles before uptaking the vaccine became regular, p&lt;0.001. Vast majority of the participants (98.6%) had received COVID-19 vaccine. More than half of them (51.4%) had taken three doses. The most frequently reported vaccine was Pfizer-BioNTech (70.4% -83.5%). Frequency of menstrual cycles have increased from 29.64±16.29 days before uptaking of COVID-19 vaccine to 62.11±173.12 after uptaking it, p&lt;0.001. In addition, rate of heavy bleeding increased from 12.4% before uptaking of the vaccine to 24.9%, p&lt;0.001. Conclusion: Frequency and amount of menstrual bleeding were affected after intake of COVID-19 vaccine. However, number of doses and vaccine type were not associated with menstrual changes.