Have you noticed a change in your menstrual cycles during the pandemic? From longer or shorter cycles, to more cramps and heavy bleeding to heightened PMS symptoms, a substantial number of women have reported changes in their usual menstrual cycle patterns. Additionally, many women have reported changes in their menstrual cycles after receiving COVID vaccines.
The premise I always take when it comes to women's health is that it's really important to believe women – and when enough women are saying they're experiencing something, we need to sit up and listen. In the case of COVID and menstrual cycles, is there really something going on? If so what is it and how concerned should you be?
Let’s dive into the data – which I think you'll find overall, reassuring.
The Pandemic and Menstrual Cycle Changes
The flurry all started on social media early in the pandemic when individuals began 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.
That story wasn’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 got super curious about what was going on among my patients and online community and decided to do a poll of my Instagram audience. I learned that 38% of over 15,000 of those who responded to the poll had 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.
What might be the cause of this?
Illness and Our Menstrual Cycles
It's well known that illness can alter our menstrual cycles. So it isn't surprising to think 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. The authors of a study from Wuhan 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. And menstrual cycle and other symptoms of hormonal imbalance may be one more in a growing list of “long-hauler” symptoms.
We also know that COVID-19 infection can have 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.
However, many of the women reporting menstrual cycle changes have never had COVID-19. So what explains that?
Stress and Our Menstrual Cycles
I think we can all agree that this has been a stressful two years. 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 causing our adrenal glands to produce the “stress hormone” cortisol, and also ramp up production of adrenaline. High cortisol can suppress ovulation and the production reproductive hormones in the body. 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.
Interestingly, a new study on COVID-19 vaccines and menstrual cycle changes demonstrated that most women – in this study at least – did not experience significant variations in their menstrual cycle over 6 months of actively charting their cycles – suggesting that stress just from the fact of being in a pandemic itself may not be a causative factor. However, this same study did find that COVID-19 vaccination can impact the menstrual cycle, though not in a way that is likely clinically significant. You can read my article on COVID-19 and menstrual cycles here.
Bottom Line: If You've Noticed Changes in Your Menstrual Cycle, Have a Check-Up
Unfortunately, research on health issues 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.
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?
Regardless of what the data shows about possible association — or lack thereof– between any aspect of the pandemic or COVID and menstrual cycles, ‘who feels it knows it.” If you’re feeling that something is awry with your cycle, get a proper medical check-up. You can ask your medical provider to run what I call the Hormone Intelligence Women’s Hormone Panel, which includes:
Reclaim your power. Feel at home in your body. And be the force of nature you really are!
- 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.
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.”
Edelman, A. et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination, Obstetrics & Gynecology: January 5, 2022 – Volume – Issue – 10.1097/AOG.0000000000004695