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. 2025 Apr 18:17:1083-1101.
doi: 10.2147/IJWH.S476959. eCollection 2025.

Bleeding Through a Pandemic: Women's Lived Experiences with Heavy Menstrual Bleeding During the COVID-19 Pandemic

Martina Anto-Ocrah  1   2 , Nabeeha Jabir Affan  2 , Hemika Vempalli  1 , Michael Chen  3 , Celestin Niyomugabo  4 , J Christopher Glantz  5 , Stefanie Hollenbach  5
Affiliations

Bleeding Through a Pandemic: Women's Lived Experiences with Heavy Menstrual Bleeding During the COVID-19 Pandemic

Martina Anto-Ocrah et al. Int J Womens Health. .

Abstract

Introduction: Heavy menstrual bleeding (menorrhagia) affects 10 million reproductive-age women. Stress is a mechanism for menstrual disorders, and during the COVID-19 pandemic, women reported worsening premenstrual and menstrual symptoms. We hypothesized that there would be a positive association between COVID stress and menorrhagia and a negative association between menorrhagia and mental health. A third objective was to explore women's lived experiences with menorrhagia during the pandemic, including menstrual pain and impact on socialization, sex life, and product use.

Methods: This was a secondary data analyses of a cross-sectional study that recruited adult women between the ages of 18-45 years using Dynata, a survey sampling company that maintains a web panel of survey takers across the United States. Menorrhagia was assessed with the Aberdeen Menorrhagia Severity Scale (AMSS), COVID stress with the COVID-19 Pandemic-related Perceived Stress Scale (PSS-10-C), and mental health with the Mental Health Continuum Scale (MHC-SF). We grouped the participants into mild menorrhagia (AMSS score 0-33)" and moderate/severe menorrhagia (AMSS score 34-100) and compared the outcomes using descriptive statistics, correlations, and linear regression.

Results: The survey was conducted in May 2021. Among 1,037 initial responses, 360 naturally cycling women met the study eligibility criteria. Women with heavy bleeding reported more COVID-stress than those without heavy bleeding (p < 0.01) and heavy bleeding intensified with increasing COVID-related stress (adj. β = 0.37, 95% CI: 0.21, 0.53). Adjusting for baseline depression, mental health worsened as heavy bleeding increased (adj. β = -0.1, 95% CI: -0.24, -0.03). Compared to those without heavy bleeding, women with heavy bleeding were more likely to report severe pain and bed confinement, less socialization, a negative impact on sex life, and greater use of menstrual products.

Conclusion: COVID-related stress affects menstrual physiology and also complex interactions between life-course, social functioning, financial strain, and psychological stress. Our findings support increased awareness of these interactions in gynecologic care during a global pandemic.

Keywords: COVID; COVID risk; COVID stress; heavy bleeding; menorrhagia; menstrual cup; menstruation; pandemic; women’s health.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic of Final Sample Size of Study Participants.
Figure 2
Figure 2
Prevalence of Menorrhagia during the COVID-19 Pandemic in the Study Population (n = 360). Evaluated with the Aberdeen Menorrhagia Severity Scale (AMSS). Mild AMSS score = 0–33; Moderate/Severe AMSS score = 34–100.
Figure 3
Figure 3
Scatter Plot of COVID Stress vs Heavy Menstrual Bleeding, Assessed with the Aberdeen Menorrhagia Severity Scale (AMSS), n = 341*.
Figure 4
Figure 4
Scatter Plot of the Association Between Menorrhagia Measured by the Aberdeen Menorrhagia Severity Scale (AMSS) and Mental Health Measured by the Mental Health Continuum (MHC) Scale (n = 360).
Figure 5
Figure 5
The Cycle of Stress, Menstruation, and Poverty.
See this image and copyright information in PMC

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