COVID-19 pandemic continues to disrupt women’s reproductive health
The COVID-19 pandemic has disrupted the reproductive health of many women, and these women may need additional medical and psychological support, according to a presentation at Society for Endocrinology BES 2021.
“Our findings highlight a real need to provide appropriate medical care and mental health support to women affected by menstrual disturbance, given the unprecedented psychological burden associated with the pandemic,” study author Michelle Maher, MB, BCh, BAO, a senior house officer in the department of endocrinology at St. James’s Hospital in Dublin and the School of Medicine at Trinity College Dublin, said in a Society for Endocrinology press release.
The researchers said their study was the first to demonstrate that women continue to experience reproductive disturbances a year into the pandemic.
Stress can disturb sleep, which is associated with infertility, the researchers said. Also, stress can affect hormone levels that, in turn, disturb menstrual cycles. Stress can disturb body weight too, with increased belly fat associated with menstrual dysfunction.
In April 2021, the researchers distributed an online survey to women of reproductive age via social media, and 1,335 women (median age, 34 years; age range, 29-38 years) responded. The survey included measures of depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7) and sleep quality (Pittsburgh Sleep Quality Index).
According to the survey, 966 (77%) of these women recorded their menstrual cycles, and 581 (56%) saw an overall change in their menstrual cycle since the pandemic began. There was no change in the cycle length (median length, 28 days; range, 28-30 days) or length of menses (median length, 5 days; range, 4-5 days), but they did report wider variability in the minimum (P < .0001) and maximum (P < .0001) cycle length.
Compared to the time before the pandemic, these women additionally experienced a significant increase in menorrhagia (P < .0001), dysmenorrhea (P < .0001) and missed periods (P < .0001). Also, 64% reported worsening premenstrual symptoms, and 54% experienced reductions in libido.
The survey further showed that rates of severe depression, anxiety and poor sleep were more than double those found in large-scale representative community samples, the researchers said.
The researchers said poor sleep quality was an independent predictor of overall change in menstrual cycle (OR = 1.11; 95% CI, 1.05-1.18) and missed periods (OR = 1.11; 95% CI, 1.03-1.19) during the pandemic.
Additionally, they said that increased anxiety was an independent risk factor for change from nonpainful to painful periods (OR = 1.06; 95% CI, 1.01-1.11) and worsening of premenstrual symptoms (OR = 1.06; 95% CI, 1.01-1.07) during the pandemic.
With increased levels of psychological distress and poor sleep associated with menstrual cycle disruption, the researchers concluded, the pandemic continues to significantly impact female reproductive health.
“This study was conducted at a relatively early stage of the COVID-19 vaccination program, so the length of the pandemic and effectiveness of the vaccine may influence future findings,” Maher said. “Further investigation with objective, measurable data is needed.”
More research, the researchers said, will contribute to a greater understanding of how reproductive health can be disrupted and guide future practice and health policy. Next, they will conduct these surveys every 6 months to see how things have changed and identify longer-term effects on female reproductive and mental health. More objective measurements including blood pressure, weight, sex hormone levels and ovulation will be collected in addition to the survey data.
“We would encourage women experiencing any reproductive disturbances such as irregular, missed periods, painful or heavy periods, PMS or reduced sex drive as well as mental health disturbances including symptoms of low mood, anxiety, stress and poor sleep to see their [general practitioner] for advice,” Maher said. “We are planning to provide support for women affected by menstrual cycle abnormalities by developing psychological support workshops at our center.”