Have you noticed a change in your menstrual cycles this past year or lately and wondered if it’s just you? In short, it’s not. From longer or shorter cycles, to more cramps and heavy bleeding to heightened PMS symptoms, a substantial number of women are reporting changes in their usual menstrual cycle patterns. And many are wondering what’s causing their cycles to take a turn for the irregular or more uncomfortable. .
Let’s dive into this unexpected side effect of pandemic life, what it means, and what we can do to keep – or to get – our menstrual cycles on track. And let's dispel some bad science and dangerous misinformation.
The Pandemic and Menstrual Cycle Changes
It seems like we learn something new about how the COVID-19 virus can affect us every day, but one area that’s just now coming into focus is how both the pandemic – and COVID infection itself – is affecting women's menstrual cycles. It all started on social media, with individuals reporting menstrual cycle irregularities and changes after having COVID-19. As just one example, Salon profiled Alexandra Plazas-Herrera, a woman who got COVID-19 in March of 2020 and soon after began experiencing unexpected menstrual cycle irregularities. During the infection itself, she had two periods in just one month, the second of which lasted two full weeks. Testing revealed hormone imbalances that were not there just a few months before.
This story isn’t an isolated incident, either. According to a small study of 177 hospitalized patients from researchers in Wuhan, China, about 25 percent of COVID-19 patients had menstrual volume changes, and 28 percent had menstrual cycle changes, the most common being decreased amount of menstrual flow or cycle prolongation. An informal survey by researcher Dr. Natalie Lambert found that out of 3,292 women who had COVID-19, 9.1 percent reported having menstrual cycles that were heavier, lighter, or just different, and an estimated 10.1 percent reported having irregular or skipped menstrual cycles.
I decided to do a poll of my Instagram audience and learned that 38% of over 15,000 of those who viewed my Instagram poll have experienced menstrual cycle changes during the pandemic. Of these, 56% have experienced heavier periods, 44% lighter periods, 58% have had skipped periods, and 42% have had more frequent periods.
So what explains these symptoms? The authors of the Wuhan study suggest that it’s the consequences of sex hormone changes caused by “suppression of ovarian function that quickly resumes after recovery.” In other words, either the infection – or perhaps the stress of being sick – causes temporary changes in estrogen, progesterone, FSH, and other sex hormones that regulate the menstrual cycle. But the extent of hormonal changes remains unclear and of the few studies that have been done – most have not found hormone changes.
From a clinical perspective, this menstrual cycle changes during a time of high stress, illness, or major changes in one's daily rhythms isn’t all that surprising. We’ve long known that even the common cold or flu can cause your period to be late or may exacerbate PMS symptoms. It’s only logical that fighting off a novel virus could lead to changes in the menstrual cycle, too. Perhaps having COVID-19 stresses our bodies by simply being a scary experience, or perhaps having the SARS-CoV-2 virus does impact women's cycles in ways we are just beginning to assess. And menstrual cycle and other symptoms of hormonal imbalance may be one more in a growing list of “long-hauler” symptoms. However, many of the women reporting menstrual cycle changes have never had COVID-19.
What explains that? One answer clearly stands out: stress.
Stress and Our Menstrual Cycles
I think we can all agree that this has been a stressful year. Thanks to nearly relentless pressures including sheltering at home, new work models, money issues, balancing work and kids and sometimes homeschooling, and our typically bottomless “to-do” lists – plus the more insidious stressor of trying not to get exposed to a potentially lethal virus – women’s stress levels have gotten worse. We’ve been worried about the safety of our parents and grandparents, our kids, and our own physical and mental health. Many of us have also been working full-time and trying to learn algebra so we can help our kids get through school. Add all this together and in my mind, it’s like the perfect recipe for hormone and menstrual cycle disruption, even if there has been the small bright light for some (but not all!) women of not having to rush out to work the same way or getting to enjoy wearing sweatpants a little more often.
We already know that stress can make PMS and painful periods worse, making both the pain itself and our perception of the pain worse. For example, one study on more than 250 women showed that women who experience high levels of stress have more than a seven-times greater risk of reporting “moderate” PMS symptoms compared to those with lower stress levels. The odds were about 2.5 greater for high-stress levels and “severe” symptoms. That study was done in 2009 – imagine not only how many more women would report “high” stress levels right now but how much more severe that stress likely is.
The constant stress we’ve experienced this year can leave us in fight-or-flight mode and overload the hypothalamic-pituitary-adrenal axis, which is the pathway in our body that links our brain to our adrenal glands, the glands that produce the “stress hormone” cortisol, and that also ramps up production of adrenaline. When our bodies are constantly pumping out cortisol through the HPA axis, it can lead to decreased levels of reproductive hormones in the body and suppress ovulation. Research has shown that chronically elevated cortisol can cause irregular or skipped periods, lack of ovulation, and hypothalamic amenorrhea. In a study of 166 female college students, stress was found to dramatically increase menstrual cycle length to 43 days or longer, while women who report high levels of perceived stress due to common factors such as starting a new job, getting married, or having major family responsibilities are twice as likely to experience long menstrual cycles. Add a pandemic to that and it’s no surprise at all that so many women are struggling through their menstrual cycles. In my new book, Hormone Intelligence, I have an entire chapter on Stress and Hormones, including a quiz to help you determine if stress really is affecting your hormones. But hint: it’s part of it for most women!
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We also know that COVID-19 infection has had some impact on thyroid function, and there’s a relationship between your thyroid and your menstrual cycles. The authors of one study found that abnormal thyroid function – especially low TSH – is common in patients with COVID-19. (In fact, about 15-30% of hospitalized COVID-19 patients will have detectable new-onset thyroid dysfunction.) They concluded that although more research is needed, it’s possible that COVID triggers systemic immune activation that can cause inflammation in the thyroid, subacute hyperthyroidism, or acute hypothyroidism. Thyroid conditions like these are known contributors to menstrual cycle issues. The thyroid not only affects metabolism and weight, but it also interferes with the production of other hormones, including estrogen and progesterone, and can cause infertility, miscarriage, irregular cycles, skipped periods, heavy periods, cognitive problems, and much more. You’ll find thyroid testing is included in my Hormone Intelligence Panel, which I tell you about in a minute.
Can COVID-19 Vaccines Affect your Menstrual Cycle?
COVID vaccination can be followed by clearly defined side effects including fever, chills, headaches, and digestive distress, which may be particularly strong in those under 55, and are more common in women – meaning young women in their reproductive years – aka menstruating – may be the most likely to have COVID vaccine reactions. This is an expected part of the immune system stimulation that helps to create immunity – more robust immunity in healthy young women leads to a more robust immune system response and this is not considered to be a problem.
But since we know the vaccine affects immunity, and immune responses are also related to our menstrual cycles, it’s not too far of a leap to think that the vaccine could cause slight and temporary changes to the menstrual cycle as your body makes antibodies to the COVID-19 virus. In fact, some women have reported menstrual cycle changes after receiving the vaccine, mainly heavy menstrual bleeding. After a Twitter post on this subject from Kate Clancy, Ph.D. Associate Professor at the University of Illinois, women quickly chimed in on social media to report similar side effects including mid-cycle bleeding, early periods, painful cramps, or late periods, and the post went viral.
We still don't know what might explain this, or even if there's a significant link beyond anecdotal reports, but as more people get vaccinated we'll hopefully learn more – assuming this phenomenon is acknowledged and taken seriously by researchers. What is clear, however, is that reports, which are now abounding, about women having menstrual cycle and gynecologic problems just from standing near people who have been vaccinated are completely fake science – and dangerous, ridiculous misinformation. In other words, if you hear it from a wellness ‘influencer' or anyone else – run.
Getting Your Menstrual Cycle Back On Track
If you’re experiencing pandemic-related menstrual cycle disruptions, these steps may help you get your cycle back in sync with your more natural cycle rhythms:
- Get in touch with your cycle
If you’ve not already tracking your cycle – either using a pen and paper charting system or an app – now is a great time to start. This can help you be more aware of how your body changes throughout your cycle and pin down exactly how much your cycle has changed this year. You can also learn much more about ways to get in touch with your menstrual cycle, here.
- Bring some steady rhythms to your life
Pandemic life has been described by many as feeling like being in the movie “Groundhog’s Day” – sort of a monotonous run of one day bleeding into the next without much spice. But in reality, many of us are way off of our normal rhythms, working irregular hours, spending a lot more time on our screens, including hitting up Netflix or Hulu late into the evening just to have some chill downtime. Unfortunately, this can disrupt our central internal clock that helps regulate so many of our body’s functions, including our menstrual cycles. Both our internal clocks and our menstrual cycles work best when we have a consistent rhythm in our lives – which means eating, sleeping, and waking up at roughly the same time every day. If we aren’t, it can feel like we’re living in a perpetual state of jet lag; we’re tired at the wrong time, hungry all the time, we have a painfully difficult time concentrating. One great way to bring steadier rhythms into your life is to avoid technology and blue light in the evening hours. This can help you get to bed earlier and maintain a consistent sleep-wake cycle. For tips on getting your circadian rhythm and sleep back , head over here.
- Give yourself permission to pause
It’s an amazing moment when you realize that the world will not stop spinning on its axis if you put down a few of the balls you’re spinning in the air and replenish yourself. You can pause in any way that feels right to you. It could be a walk in nature without your phone, a long Epsom salt bath, hopping on the phone with a friend, or cooking your favorite meal while listening to a RadioLab Podcast. The goal of this pause is to reduce chronically high cortisol and help your body exit “fight or flight” mode. Meditation and yoga are two other great ways to reduce stress. In fact, both have been shown to improve PMS symptoms. One study showed that yoga interventions improved physical function, bodily pain, abdominal swelling, breast tenderness, abdominal cramps, and cold sweats; another concluded that mindfulness-based stress reduction is a promising therapy for PMDD. For more on permission to pause, head over here.
- Eat for optimal hormone health
Eating for optimal hormone health can help correct the underlying causes of menstrual cycle irregularities. To eat for hormone health, focus on consuming:
- Whole fresh foods
- Plenty of vegetables and fruits (up to 8 servings daily)
- Good quality protein, especially fish eggs, and vegan sources like legumes
- Healthy oils and fats, especially olive oil and avocados
- Nuts, and ample seeds
- Slow-burning carbs in moderation – throughout your cycle and especially in the week before your period when they support healthy serotonin levels (which means less PMS).
You can also try to cut back on common hormone disruptors like alcohol, caffeine, and sugar. This will take additional stress off your body and give it more space to recover and realign. Instead, if you’re looking for a treat try eating small amounts of dark chocolate throughout the day. One study showed that eating 1.4 ounces (40 grams) of dark chocolate every day, half in the morning, half in the afternoon, for two weeks reduced levels of stress hormones in people feeling highly stressed, and eating dark chocolate daily reduced stress hormone levels in those who had high anxiety levels. Dark chocolate is a sweet treat and also contains a small amount of caffeine, making it the perfect, satisfying treat!
- Lean into adaptogens
Adaptogens are a group of herbs famous for their ability to regulate stress response. One of my favorite adaptogens is ashwagandha, which has been used for over 4,000 years in India for healing stress and related symptoms including deep exhaustion, sleep, anxiety, and memory issues. After using ashwagandha, cortisol levels can be reduced by as much as 30% in otherwise healthy but stressed people, which is significantly larger than with many other supplements. I recommend starting with 3 to 6 grams of dried herb in a capsule each day, or 1 to 4 mL (20 to 80 drops) of tincture in water three times a day. (You can learn more about my favorite adaptogens here.)
If You've Noticed Big or Persistent Changes, Have a Proper Medical Check-Up
At least per one early study, COVID-19 infection doesn’t seem to be associated with appreciable changes in female hormone levels. However, if you’re pretty sure that something’s awry with your cycle and you’re not so sure it’s “just” the pandemic, lab work may help you identify if there’s an actual hormonal imbalance or a thyroid problem. Ask your medical provider to run what I call the Hormone Intelligence Women’s Hormone Panel, which includes:
- FSH and LH (best tested on day 3 of your menstrual cycle)
- Progesterone (best tested on day 19 to 22 of your menstrual cycle)
- Sex-hormone-binding globulin
- Free testosterone
- Thyroid panel: TSH, free T4, free T3, reverse T3, anti-TPO, and antithyroglobulin antibodies
- 24-hour salivary cortisol
Together these tests should give you a good picture of your overall hormone health and where you might want to channel your attention.
A Final Thought on Pandemic Menstrual Cycle Changes
Looking forward, my biggest concern is not that all the women struggling with irregular or absent periods, heightened PMS, or heavy bleeding won’t get their menstrual cycles back on track; it’s that this important side effect of the COVID-19 pandemic won’t get the attention it deserves. We’ve already learned that some COVID-19 symptoms are more common in women than men. For example, a survey showed that 36.4 percent of women reported hair loss, while only 8.3 percent of men reported hair loss. Will we invest the time, money, and energy to figure out how women are uniquely impacted by this virus?
Unfortunately, research on struggles that are unique to women is typically underfunded or pushed to the side altogether. At the same time, women are taught to be stoic, told to ignore our suffering, and taught to put everyone else’s health above our own. And if we don’t, we risk being labeled as whiny, hysterical, or high-maintenance.
If you’re struggling with menstrual cycle issues – whether you’ve had COVID-19 or not – make sure that you’re advocating for yourself in your doctor’s office. You might not get the attention you deserve otherwise. Here are a few things we can remember:
- Stop being so polite when you experience “doctor-splaining.”
- Trust our bodies, perceptions, and instincts.
- Use our power and rights to advocate for ourselves, ask questions, and get another opinion.
- Get loud – do what it takes to get heard and get proper testing, treatment, and care.
As we move through and soon hopefully out of this stressful time, remember to give your body some time and space to recover. We’ve all been through a lot of changes in the past year. Any changes are your body’s way of signaling that things have been hard and it’s going to need a little extra care and attention to sink back into “normal.”