COVID-19-related stress may impact menstrual cycles

Women who experienced greater levels of stress during the COVID-19 pandemic were more likely to have variability with menstruation, according to findings presented at the American Society for Reproductive Medicine Scientific Congress & Expo.

“COVID-19 is one of the most stressful collectively experienced disasters modern society has ever seen,” Shannon M. Malloy, BS, research and data associate at Ovia Health, said during her presentation. While stressful in its own right, the pandemic has exacerbated other sources of anxiety like economic stability, financial stress and social isolation. For menstruating people, these stressors may be contributing to natural irregularity.”

Malloy and Danielle E. Bradley, MS, MPH, director of clinical services and evidence at Ovia Health, surveyed individuals in the U.S. from March 2020 to April 2021. The study cohort included 12,302 respondents who used Ovia Health’s Fertility mobile app.

The researchers found that 36% of all respondents reported some changes in their menstrual cycle and/or symptoms. Women most often reported that their cycle started earlier or later than usual (87%), as well as heavier bleeding (27%) and stronger menstruation symptoms (29%) such as low back pain, cramping and discharge changes, according to Malloy and Bradley.

Respondents who experienced changes in menstruation usually scored higher than average on the Perceived Stress Scale than those who reported no changes (8.5 vs 8.3, respectively; P < .05). However, regardless of reported menstruation changes, all respondents had stress scores markedly higher during, compared with prior to, the pandemic, Malloy and Bradley noted.

Menstruation changes due to stress may impact individuals trying to conceive or who are dealing with infertility, according to the researchers. More than half of respondents reported that they thought stress contributed to their menstrual cycle or symptom changes. Moreover, many women believed the COVID-19 vaccine altered their menstrual cycles. However, the survey did not consider whether respondents received a COVID-19 vaccine. Several U.S. universities are currently investigating the potential link between COVID-19 vaccination and changes in menstruation.

Overall, stress levels in women of reproductive age have been noticeably higher during the COVID-19 pandemic than pre-pandemic benchmarks, Malloy noted in her presentation.

“This added layer of stress is another barrier for women trying to build their family,” she said. “As a provider, you may be observing more menstrual irregularity in your patient populations, and you may also be observing more patients coming in believing that they are subfertile or infertile due to menstrual irregularity in those who have experienced difficulty conceiving for over 6 months or over 1 year.”