Effect of COVID-19 on Menstruation and Lower Reproductive Tract Health

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 selfpurchased 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.

Effect of COVID-19 on Menstruation and Lower Reproductive Tract Health [Letter]

“…Overall, we thank Li et al 1 for their insights regarding women’s health and COVID-19, and we hope the suggestions offered aim to build on these foundations of the study to improve it further. Future research can aid in identifying the specific and in-depth effects of COVID-19 on women’s health and how services can be implemented to support patients affected.…”

“…We thank Li et al 1 and the departments of Obstetrics and Gynaecology for their insightful study on the “effect of COVID-19 on menstruation and lower reproductive tract health”. As medical students in the UK, we recognise the importance of research on women’s health and appreciate the future implications of this study.…”

“…Firstly, a limitation discussed in the study was recall bias, 1 as the study consisted of an online survey collecting self-assessment data, requiring women to recall symptoms from several years ago. However, it was mentioned that studies reported the validity of self-assessment is 92.9–100%.…”

“…For example, 37.4% of participants had pre-existing gynaecology conditions, and 64.1% received three doses of the COVID-19 vaccination. 1 We believe that the participants with pre-existing gynaecology conditions should have been excluded, as their symptoms could be from their condition. Current ongoing research has demonstrated the potential impact of the COVID-19 vaccine and changes in menstruation.…”