Evaluation of menstrual symptoms after Coronavirus disease 2019 vaccination in women with endometriosis

Abstract

Background: Vaccination can have an impact on menstruation, and this impact may be more notable in women with inflammatory gynecological pathologies such as endometriosis. Objectives: We aimed to investigate the impact of mRNA-based SARS-CoV-2 vaccines on menstrual cycle–related symptoms in women with endometriosis and assess the effect of hormonal therapy on potential SARS-CoV-2 vaccination-induced menstrual changes. Design: A total of 848 women who received at least two doses of mRNA-based COVID-19 vaccines were prospectively recruited: 407 with endometriosis (endometriosis group) and 441 healthy controls (non-endometriosis group). Methods: Data regarding demographics, clinical characteristics, hormonal treatment, and menstrual-associated symptoms in the first and second cycle after vaccination were collected through an online survey. Results: A similar percentage of patients in both the endometriosis and the non-endometriosis group self-reported menstrual-associated changes the first (52.6% versus 48.8%, respectively) and second cycle after vaccination (29.0% versus 28.1%, respectively). Although the total symptoms recorded were not different between the two groups, several specific symptoms were statistically more frequent in the endometriosis group. These were pain disorders and fatigue in the first cycle after vaccination and pain disorders, menstrual headache and fatigue in the second cycle after vaccination. Bleeding frequency/regularity disorders were found to be more frequent in the non-endometriosis group in the first cycle after vaccination. Patients under hormonal treatment reported fewer changes in menstrual symptoms in the first and second cycle after vaccination compared with those not receiving this treatment. Similarly, patients in the endometriosis group receiving hormonal treatment reported fewer changes in menstrual-associated symptoms compared with those not following any hormonal treatment in the first and second menstrual cycle after the last vaccination. Conclusion: Women with endometriosis immunized with mRNA-based SARS-CoV-2 vaccines did not perceive greater worsening or new menstrual-associated symptoms after complete COVID-19 vaccination compared with healthy controls. Hormonal treatment may have a protective effect against worsened or new menstrual symptoms induced by COVID-19 vaccination.

Changes in Endometriosis-Associated Symptoms Following Immunization against SARS-CoV-2: A Cross-Sectional Study

“…In contrast, there are also studies reporting reduced occurrence or improvement in their symptoms following COVID-19 vaccination, similar to our results [ 11 , 18 ]. However, the studies focusing on dysmenorrhea or back pain described above are very heterogenous regarding their methods; a few evaluated the intensity of the symptoms [ 16 , 17 ], others compared endometriosis patients vs. health controls [ 16 , 19 ], and only two of these studies followed the same approach that we used here and compared the occurrence of the symptoms before and after immunization [ 11 , 18 ]. The majority of our participants reported dysmenorrhea and back pain less frequently after immunization, but rarely, we also observed the reverse pattern, i.e., dysmenorrhea and back pain after but not prior to immunization, similar to our results regarding changes in menstrual bleeding reported elsewhere [ 5 ].…”

“…Comparable data regarding risk factors for emerging back pain after immunization against COVID-19 are rare. One study excluded patients with thyroid disease, others do not report on BMI or thyroid dysfunctions [ 16 , 17 , 18 , 19 ], and one study found no impact of BMI and thyroid disease on changes regarding dysmenorrhea and back pain following immunization against COVID-19 [ 11 ].…”

“…Taken together, the currently available published studies provide very heterogeneous results regarding changes in menstrual symptoms following immunization against COVID-19, partly due to different methodology and the use of surrogate parameters [ 17 , 19 , 23 , 24 , 25 ]. Several studies evaluated symptoms only in patients with endometriosis, but not in the general population [ 9 , 16 , 19 ].…”

“…Taken together, the currently available published studies provide very heterogeneous results regarding changes in menstrual symptoms following immunization against COVID-19, partly due to different methodology and the use of surrogate parameters [ 17 , 19 , 23 , 24 , 25 ]. Several studies evaluated symptoms only in patients with endometriosis, but not in the general population [ 9 , 16 , 19 ]. Other studies evaluated only the worsening of the symptoms, the overall effect of pandemics, or just only vaccines, but reports about the incidence of menstrual symptoms in the general population after different immunization methods are not available [ 6 , 16 , 17 , 23 , 24 ].…”

“…Since the beginning of the pandemic of coronavirus disease 2019 (COVID- 19), there have been emerging reports about disturbances in different medical conditions [1][2][3][4]. The menstrual cycle is one of the most observed parameters regarding women's health, and therefore, there is a robust amount of data about its alteration after immunization against COVID-19 [3][4][5][6].…”