Effect of SARS-CoV-2 infection on the menstrual cycle

In a recent study published in Clinical Medical JournalResearchers systematically reviewed the effects of coronavirus disease 2019 (COVID-19) on the menstrual cycle.

The pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has a major impact on human life. Extensive research has been conducted on COVID-19 and its effects on the respiratory, nervous and circulatory systems. However, its effects on the reproductive system are relatively unknown. Previous studies have observed a correlation between viral infections and changes in the female reproductive system.

For example, one study found that the early stages of hepatitis B (HBV) or hepatitis C virus (HCV) infection were characterized by progressively shorter and rarer long and heavy menstrual periods. I did. There are quite a few anecdotal reports of the effects of SARS-CoV-2 infection on the female reproductive system and changes in menstruation, but these data are inadequate to draw definitive conclusions.

About research

In this study, researchers conducted a systematic review to analyze the effects of COVID-19 on the menstrual cycle. The Medline, Cochrane library, and Scopus databases were systematically searched. The terms “menstrual cycle” and “viral disease” were used to search the entire heading of Medline’s medical subject.

In other databases, the search terms for all fields were “menstrual cycle” and “COVID-19 / COVID”. They reviewed articles written in English, published between 2020 and 22. Two reviewers individually screened titles / summaries for relevant studies. After full-text screening, data on study characteristics and results were extracted. Studies were included that described at least one menstrual feature among participants with a history of COVID-19.

Menstrual cycle characteristics include the length of the menstrual cycle, the length and amount of menstruation, regularity, abnormal bleeding / spots during the normal menstrual period, and the frequency and symptoms of PMS. Articles describing the effects of treatment, vaccination, lifestyle changes, or pandemic-related stress were excluded. Only research studies were included, regardless of study design.

Survey results

Initially, 444 articles were identified, duplicates were removed, and then 424 were screened at the title / summary level. After various stages of the review, three papers were included in the systematic review. Two were cross-sectional studies and one was a cohort study. One cross-sectional study examined the effects of SARS-CoV-2 infection on sex hormone changes and the menstrual cycle in infected women of childbearing age.

Approximately 237 adult women aged 18-45 years were included who had no menstrual irregularities and were not breastfeeding / pregnant during the 6 months prior to infection. 90 patients had severe COVID-19 cases and the rest had mild illness. Almost 20% of the participants showed a significant decrease in menstrual flow, with no significant difference between mild and severe cases.

One-fifth reported an extension of the menstrual cycle compared to the duration of the pre-infection cycle. Statistically, there were no significant changes in menstrual irregularities between patients with severe COVID-19 and patients with mild COVID-19. In contrast, the duration and amount of menstrual cycle was significantly different between infected women and controls. This study suggested that changes in the menstrual cycle were transient.

Another cross-sectional study was conducted in China from January to March 2020. We evaluated the association between ovarian function and COVID-19. The study included 78 women under the age of 50 with COVID-19. Participants were asked about their menstrual cycle information for the last three months.

Approximately 22% of cases are severely ill, 48% report recent mental illness (depression / anxiety), 36% undergo gynecological surgery, and 12% have a history of benign gynecological disease. I did. Patients with severe COVID-19 showed higher amenorrhea, irregular duration, menstrual flow, and pain than non-severe cases, although there was no significant difference.

The cohort study was part of an ongoing Arizona CoVHORT study. Investigators conducted a survey of COVID-19 symptoms every 6 weeks. This included 127 COVID-19 patients aged 18-45 years who were not pregnant at the time of enrollment and had never been pregnant recently. Of these, 20 patients reported changes in their menstrual cycle. The median time from a positive test to the last reported menstrual change was 57.5 days.

Common changes include irregular menstruation, rare menstruation, and increased symptoms of PMS.Patients with altered menstrual cycles were more likely to experience more COVID-19 Symptoms Fatigue, shortness of breath, headache, body pain / pain, etc. In particular, researchers were unable to adjust for potential confounders and the study did not provide information on the duration of menstrual changes.

Conclusion

Current (systematic) reviews have confirmed an extension of the menstrual cycle and a decrease in menstrual flow due to COVID-19. It was pointed out that the severity of the disease did not significantly affect the changes in the menstrual cycle. Nevertheless, an inadequate amount of data limits the ability to draw firm conclusions and highlights the need for further investigation.