Infection with SARS-CoV-2 is associated with menstrual irregularities among women of reproductive age

Abstract

Background: Biological and psychological mechanisms may be responsible for menstrual irregularities occurring among women during the COVID-19 pandemic.

Study design: From January 2019 to September 2021, women (18- to 45-years-old and not using hormonal contraception) were recruited in Miami-Dade County, Florida. Cross-sectional, self-report surveys collected data on menstrual irregularities, COVID-19 vaccination, stress, depression, and loneliness. A EUA approved rapid test assay using whole blood measured SARS-CoV-2 IgG antibodies. Chi-square and Fisher's exact tests described menstrual irregularities among women recruited before versus after the start of the COVID-19 pandemic and with detectable versus undetectable SARS-CoV-2 IgG antibodies. A logistic regression examined the relationship between the presence of SARS-CoV-2 IgG antibodies and menstrual irregularities controlling for age, stress, depression, and loneliness.

Results: Among 182 women enrolled, 73 were enrolled after pandemic onset, and 36 provided vaccination data. Having detectable SARS-CoV-2 IgG antibodies was associated with a higher percentage of menstrual irregularities among unvaccinated women (0% vs. 39%, p = .026) and among all women regardless of vaccination status (31% vs. 5%; p = .005). Adjusting for age and psychological variables, the odds of menstrual irregularities were 7.03 times (95% CI [1.39, 35.60]; p = .019) higher among women with detectable antibodies compared to women without detectable antibodies. Neither enrollment date, age, nor psychological factors were associated to menstrual irregularities.

Conclusions: Biological mechanisms related to SARS-CoV-2 infection may be responsible for irregular menstruation and should be further examined to mitigate the impact of the COVID-19 pandemic on women's health.

Fig 1. Study timeline.

This research was conducted in Miami-Dade County in South Florida. In March 2020, COVID-19 was declared a public health emergency in Florida. From April 2020 to September 2020, stay-at-home orders were issued for the state. In April 2021, vaccines against COVID-19 were authorized for all residents over 18.

Fig 2. SARS-CoV-2 IgG antibodies, menstrual irregularities, and psychological factors over time.

Data collected after the start of the COVID-19 pandemic on the percent of participants with detectable IgG antibodies, percent of participants with menstrual irregularities, and mean scores on perceived stress as measured by the Perceived Stress Scale, depression as measured by the Center for Epidemiological Studies Depression Scale, and loneliness as measured by the UCLA Loneliness Scale were calculated separately for each month of recruitment. Dotted lines are used for variables calculated as mean scores (continuous scale shown in left vertical axis). Solid lines are used for dichotomous variables presented as a percentage of the sample with the characteristic (percentage shown in right vertical axis).

Fig 3. Adjusted odds ratio for menstrual irregularities.

Predictors of menstrual irregularities in a multivariable logistic regression model containing detectable IgG antibodies, age, perceived stress score, depression score, and loneliness score. Adjusted Odd Ratios of menstrual irregularities were calculated and presented using a log base 2 scale in a Forest Plot. Null line is indicated for no predictor effects and bolded lines represent adjusted odds ratio with 95% confidence intervals. Bolded lines above and below the null line indicate increased or decreased odds of menstrual irregularities, respectively. Note. Detectable IgG Ab were operationalized into Detectable/Undetectable SARS-COV-2 IgG Antibodies.