COVID pandemic stress and menstrual cycle changes

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a period of unprecedented global stress since its inception. At the beginning of the pandemic, educational institutions and businesses shut down, while socializing was strictly prohibited for long periods of time.

For many women, these factors contributed to increased time spent on household chores and childcare, along with professional work responsibilities and increased exposure to domestic strife. These daily activities were often coupled with a lack of emotional support in the form of outings or discussions with friends.

Study: Higher Perceived Stress during the COVID-19 pandemic increased Menstrual Dysregulation and Menopause Symptoms. Image Credit: fizkes / Shutterstock.com

The resulting stress may have impacted both physical and mental health. A new study published on the preprint server medRxiv* explores this effect on women’s reproductive health against a background of poor social and healthcare support in the initial period of the pandemic.

Introduction

There has been a lack of research on the impact of COVID-19 on women. However, since many women have complained of altered menstrual cycles after taking the vaccine, more research has been conducted on how COVID-19 vaccines affect the female reproductive system.

Such abnormalities, as well as menopausal disturbances, indicate the state of female health and, indirectly, female metabolic dysfunction and cardiovascular risk. These factors have been associated with cognitive impairment, such as Alzheimer’s disease (AD).

Stress is known to affect the hypothalamic-pituitary-gonadal (HPG) axes adversely, subsequently causing menstrual alterations. Stress also increases the risk of mental illness.

During the pandemic, depression was reported to affect more females than males. In fact, there is a suggestion that both these areas are interlinked.

Pandemic-related stress may be affecting mental health and menstrual irregularities simultaneously or sequentially.”

The current study explores the links between menstrual symptoms and psychosocial outcomes like anxiety, perceived stress, or depression. The data was acquired from the Rapid Evidence Study of a Provincial Population-Based COhort for GeNder and SEx (RESPPONSE), which is led by the Women’s Health Research Institute in British Columbia, Canada.

Study findings

Premenopausal women

In the sample of premenopausal women, over 25% reported that they had noticed changes in their cycles from March 2020. Of these, 44% complained of heavier or more painful periods, whereas 25% reported a longer duration of bleeding as compared to pre-pandemic periods.

About 20% of women said they had more periods than before during the pandemic, while one in seven had shorter periods. These symptoms were correlated with those younger than 40 as well.

Menopausal women

In this cohort of women, about 7% experienced changes in their postmenopausal status after March 2020. Of these, one in seven began to have menstrual bleeding again, while just over 10% had heightened menstrual symptoms. However, it is likely that over 50% had experienced some changes to their postmenopausal status associated with public health interventions to control the pandemic.

Excluding women who are likely to be in perimenopause, the same proportion of menopausal symptoms related to the pandemic was reported.

Overall, women with higher levels of stress, depression, or anxiety were more likely to experience menstrual and menopausal symptoms. Pandemic stress among those with menstrual disturbances in the premenopausal group was four points higher, while depression and anxiety scores were doubled. This was not related to the number of children.

Among postmenopausal women, these scores were three and about two points higher among those who reported some changes in their symptoms.

Conclusions

Women have been shown to perceive greater stress, anxiety, and depression than men. The self-reported disruption of menstrual cycles in 28% of premenopausal women, as well as altered menopausal symptoms in 7% of the cohort, indicates an association with pandemic-related conditions before vaccines became widely available. The higher the level of anxiety, depression, and stress, the greater the odds of menstrual cycle changes.

Stress has pervasive effects on mental and physical health and our results add to the growing data that female-specific reproductive cycles are also affected.”

Interestingly, having more children did not contribute to stress or changes in the woman’s menstrual cycle, thus ruling out the role of parental duties in inducing stress. However, the proportion of women with greater stress was much higher in the younger cohort of premenopausal women. This may be due to age- or stress-related differences in the effect of the pandemic on the HPG axis.

In fact, older women may be less stressed by the pandemic. This would reflect a lower impact on the endocrine axis as well.

More research is needed to understand how the pandemic has affected female health, given the withdrawal of emotional lifelines and the difficulty of exercising out of the home during this period.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.