Pandemic-related stress linked to increase in ovulatory disturbances among women
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ATLANTA — Stress related to the COVID-19 pandemic was associated with an increase in subclinical ovulatory disturbances among women without a change in menstrual cycle length, according to a speaker at ENDO 2022.
“The effects of subclinical ovulatory disturbances are extremely applicable to individual women,” Jerilynn C. Prior, MD, FRCPC, professor of endocrinology at the University of British Columbia in Vancouver, Canada, said during a press conference. “These are reversible, these are health-protective strategies that are fundamental to the biology of people to prevent pregnancy when there is too much duress, not enough food or threats to physical life.”
Prior and colleagues conducted the Menstruation Ovulation Study 2 (MOS2) during the first 2 years of the COVID-19 pandemic in 2020 and 2021. The study cohort included 125 single women aged 19 to 35 years who were not prescribed hormonal contraceptives and who were menstruating monthly. The study was a follow-up of the first Menstruation Ovulation Study (MOS) conducted in a similar cohort of 301 women from 2006 to 2008. Ovulation in MOS was assessed by threefold increased follicular-to-luteal urinary progesterone, whereas in MOS2, validated quantitative basal temperature was used. Participants kept a menstrual cycle diary to describe daily experiences. A questionnaire was conducted to collect demographics, reproduction information and anthropomorphic variables.
The participants in both study cohorts were similar in age, BMI, living situation and education. There were fewer white women in MOS2 compared with MOS (56% vs. 76%), and fewer women in MOS2 were parous compared with MOS (8% vs. 20%).
The mean menstrual cycle length and flow length were similar between the two cohorts. In MOS2, 63% of women experienced subclinical ovulation disturbances during the study compared with 10% of women in MOS (P < .001).
Principal components analysis was conducted to analyze diary findings. MOS2 participants reported more outside stresses, frustration, anxiety, depression and sleep problems compared with MOS participants (P = .001).
“In previous prospective data over a full year, the highest prevalence of short luteal phase was 25%,” Prior said. “In this study, there were equal proportions of short luteal phase and anovulatory with no egg release at all. It’s a graded response depending on the individual’s personal brain perception of the stress that person is under.”
Prior said the normal menstrual cycle lengths indicate estrogen was likely stable in the MOS2 cohort, but progesterone levels were lower with a short luteal phase or anovulatory cycles. These may have several implications, including unexpected early bleeding in women after receiving a COVID-19 vaccination, increased cramp pain during ovulatory disturbances, and more.
“If these kinds of subclinical ovulatory disturbances continue, women are at an increased risk for osteoporosis, early myocardial infarction, breast and endometrial cancers,” Prior said. “These are data that are indicated by the literature. Therefore, we need to know if the women in this cohort are recovered from ovulatory disturbances following the pandemic.”
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Prior J, et al. OR-15. Presented at: ENDO Annual Meeting; June 11-14, 2022; Atlanta (hybrid meeting).
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