Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age

Abstract

Research question: Does SARS-CoV-2 infection have an effect on ovarian reserve, sex hormones and menstruation of women of child-bearing age?

Design: This is a retrospective, cross-sectional study in which clinical and laboratory data from 237 women of child-bearing age diagnosed with COVID-19 were retrospectively reviewed. Menstrual data from 177 patients were analysed. Blood samples from the early follicular phase were tested for sex hormones and anti-Müllerian hormone (AMH).

Results: Among 237 patients with confirmed COVID-19, severely ill patients had more comorbidities than mildly ill patients (34% versus 8%), particularly for patients with diabetes, hepatic disease and malignant tumours. Of 177 patients with menstrual records, 45 (25%) patients presented with menstrual volume changes, and 50 (28%) patients had menstrual cycle changes, mainly a decreased volume (20%) and a prolonged cycle (19%). The average sex hormone and AMH concentrations of women of child-bearing age with COVID-19 were not different from those of age-matched controls.

Conclusions: Average sex hormone concentrations and ovarian reserve did not change significantly in COVID-19 women of child-bearing age. Nearly one-fifth of patients exhibited a menstrual volume decrease or cycle prolongation. The menstruation changes of these patients might be the consequence of transient sex hormone changes caused by suppression of ovarian function that quickly resume after recovery.

Keywords: COVID-19; Menstrual change; Ovarian function; SARS-CoV-2.

Figure 1

Menstrual volume changes of women with COVID-19. (A) Overall menstrual volume changes. (B) Menstrual volume changes of mildly ill patients. (C) Menstrual volume changes of severely ill patients. (D) Comparison of total menstrual volume changes in mild and severe patients (chi-squared test, P = 0.784). (E) Comparison of increased and decreased menstrual volume in mild and severe patients (chi-squared test, P = 0.698).

Figure 2

Menstrual cycle of women with COVID-19. (A) Overall menstrual cycle distribution. (B) Menstrual cycle distribution of mildly ill patients. (C) Menstrual cycle distribution of severely ill patients. (D) Comparison of menstrual cycles in mildly and severely ill patients. <28 days P = 0.584, 28–32 days P = 0.384, 33–37 days P = 0.08, >37 days P = 0.001, disordered P = 0.211.

Figure 3

Menstrual cycle changes of women with COVID-19. (A) Overall menstrual cycle changes. (B) Menstrual cycle changes of mildly ill patients. (C) Menstrual cycle changes of severely ill patients. (D) Comparison of menstrual cycle changes in mildly ill and severely ill patients. (E) Comparison of non-prolonged (shortened + disordered) and prolonged menstrual cycles in mildly ill and severely ill patients. (F) Comparison of shortened, prolonged, disordered menstrual cycles in mildly and severely ill patients.

Figure 4

Sex hormone and AMH concentrations of mild and severe COVID-19 patients compared with the controls. (A) FSH of mildly and severely ill COVID-19 patients compared with control. (B) LH of mildly and severely ill COVID-19 patients compared with control. (C) E2 of mildly and severely ill COVID-19 patients compared with the control. (D) P of mildly and severely ill COVID-19 patients compared with the control. (E) T of mildly and severely ill COVID-19 patients compared with the control. (F) AMH of mildly and severely ill COVID-19 patients compared with the control. Data are shown as the mean ± SD. AMH = anti-Müllerian hormone; E2 = oestradiol; P = progesterone; T = testosterone.