Long COVID and periods: The unspoken impact on female well-being
Many people with long COVID — who keep experiencing COVID-19 symptoms months after the disease should have subsided — have been pointing out that it has also affected their menstrual cycles. Medical News Today wanted to find out more.
Over the past few months, an increasing number of people worldwide say that after developing COVID-19, they are experiencing a prolonged state of ill health that people now refer to as long COVID.
People with long COVID often experience symptoms, such as fever, fatigue, or headaches, on and off for months after the initial disease should have subsided.
Existing evidence indicates that COVID-19 symptoms should disappear around 2 weeks after the onset of symptoms.
Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.
The reasons why so many people continue to experience disruptive symptoms remains unclear. However, researchers and medical doctors are now starting to look into possible mechanisms and the best ways to support individuals with long COVID.
Most recently, on social media and dedicated support groups, many people with long COVID have spoken about how this prolonged state of illness has affected their menstrual cycles, further impacting their quality of life.
Medical News Today spoke to six people with long COVID who have been experiencing disruptive changes to their menstrual cycles to find out more.*
MNT have also sought the opinions of two medical experts. One is Dr. Linda Fan, assistant professor of Obstetrics, Gynecology and Reproductive Sciences and the section chief of Gynecology and the Director of Gynecologic Quality and Safety at Yale School of Medicine in New Haven, CT.
The other is Dr. Valinda Nwadike, a board-certified obstetrician-gynecologist based in the United States.
However, while everyone we spoke to had experienced some changes to their menstrual cycle, the form of these disruptions varied.
One contributor, Rose, reported getting irregular periods since she developed COVID-19, months previously.
“I noticed that my menstrual cycles changed immediately when I became ill [with COVID-19],” Rose told MNT.
“Two weeks into my COVID-19 battle, I was supposed to get my period, and nothing came. I figured to myself, ‘I must be really sick. It will come next month.’ But nothing came the next month, either. Eight months later, and I’ve only had five periods.”
Julia, who is in her mid-40s, developed COVID-19 symptoms in March but had no access to a test. She believes she had long COVID, which has interfered with her menstrual cycle.
“In May, I skipped a whole month’s cycle of having a period. In June and then July, it returned, but [it was] very erratic, lasting a lot longer and stopping and starting,” she explained.
Several people told us that they were worried about an unusual amount of clots in their menstrual discharge or about unusually large clots in the blood.
Bianca, a woman in her late 40s, told us that she only started to experience these changes to her menstrual cycle some time after the initial illness.
“I didn’t notice anything different during the initial onslaught of COVID. It wasn’t until 3 months later […] when some symptoms came back that I noticed a change. I noticed an increase in clots — but quite a bit.”
Louise had a similar experience. “My cycles,” she told us, “have been more irregular — [going from] 24 to 28 days. The first 3 months, I had big clots that were very alarming for me, and I had to take a photo, and I sent it to the [family doctor] who said [that] this is normal.”
Yet, she added, “I know for sure it isn’t normal [for me].” Louise also noticed an increase in the severity of her long COVID symptoms around the time that she would get her period: “A week before my period I would relapse and [also become] more breathless.”
Edith also reported irregular periods and increases in the severity of long COVID symptoms around the time her period is due.
“[My periods] have changed in frequency, duration, flow, intensity, and pain level. I also experience COVID symptom flare-ups before my period starts, which is rather confusing because my periods are unpredictable,” she told MNT.
“I will experience extreme, debilitating fatigue, horrible muscle aches that completely lock my body down — and only when I get my period do I realize that that’s why my body felt that way.”
Edith also specified that her doctors diagnosed perimenopause in her case. However, she remains unconvinced by this assessment because of the peculiar timing of these changes to her menstrual cycle.
“[M]y perimenopause status has been attributed to the issues I’ve had with my periods post-COVID, which I don’t feel is at all accurate,” she explained.
Finally, Jean, who has been taking birth control pills for many years, worries because her periods are returning — even though she continues to take contraceptive medication.
She told us that she associates this change with the fact that she is experiencing long COVID. Like Bianca and Louise, she also started noticing unusual clots in her menstrual discharge.
“I have been taking birth control pills for 10 years. During this period, I [did] not get my periods. At ‘worst,’ I [used to have] spotting once a year. Since getting ill, I have been consistently getting my monthly periods, getting shorter periods, getting a ton of clots (more than I’ve gotten in my life combined).”
Most of the contributors told MNT that, alongside other symptoms of long COVID, the changes to their menstrual cycles have affected how they can live their lives.
For instance, Jean explained that: “The reason I started birth control was due to incredibly painful periods and other debilitating PMS symptoms. Now, these are back, though not as bad as prior to taking the birth control. I am already housebound due to other symptoms.”
“One other thing is [that] my major issues, [and] emergency [hospital] visits, seem to all coincide with my cycle,” she added.
Louise reported that the changes to her period have “affected me mentally because I worried about clots and complications, but I have been OK.” However, “[t]he [long COVID] relapses have been mentally draining,” she said.
Edith told us about the significant emotional impact of these changes: “I feel like I have PMS all the time. COVID has [also] made me more sensitive emotionally, and I am aware of emotional ups and downs that I’m having now that I didn’t have before.”
Rose experienced a debilitating array of symptoms just before getting her period:
“[In] the days leading up to my period, my eczema would worsen, my breathing would start to get more difficult, my POTS [postural orthostatic tachycardia syndrome] would act up, I would get a migraine with aura, my fingertips would have sharp pains, my joints would start hurting, and my right leg would start tingling.”
Julia believes that the blood loss that she associates with her much heavier and unpredictable periods likely contributed to the development of anemia.
“[These changes were] an additional worry at the time, with all the other post-COVID symptoms, as it felt my body was shutting down,” she told MNT.
For Bianca, the changes she noticed in her menstrual cycle triggered worries about reported links between COVID-19 and cardiovascular complications.
“It made me pay attention to the advice related to the increased risk of heart attack and stroke for people suffering from post-COVID symptoms,” she said. “I started taking a daily low dose aspirin,” low doses of which can reportedly help prevent stroke in females.
All of the contributors who responded to MNT‘s queries said they had received little to no support from doctors when they sought help for long COVID symptoms, including disrupted periods.
Jean said that she received few explanations and even less support when she expressed her worries regarding her menstrual cycle.
“With regard to my period, my [gynecologist] just says it’s due to the stress that my body is going through due to this illness, while all other healthcare professionals do not care, since having periods is normal (they don’t put it into a context that I haven’t had periods for the past 10 years).”
Bianca said she was much less successful in receiving expert care. “I have seen my doctor, but not just [about] the period change, but for overall post-COVID help, and [they were] unable to help me. [Her doctor] immediately dismissed any COVID relationship [regarding the impact on menstruation],” she told us.
This dismissal led Bianca to worry about other possible reasons for the changes, such as breast cancer. She underwent a costly mammogram, which revealed she was cancer-free.
According to Bianca, her doctor rejected her worries about COVID-19 because she had been unable to take a test to confirm infection with SARS-CoV-2, the virus that causes this disease.
“I had COVID-19 in April, and [my doctor’s] own hospital said I did not qualify for COVID testing then because I had not been out of the country or near anyone who had been. And then they said I had symptoms consistent with COVID-19 and had [to isolate] for 2 weeks,” she recounted.
Because of the resistance she encountered from healthcare practitioners, Bianca told MNT that she is doing her own research into long COVID and self-medicating, which, she admits, can be dangerous.
“It was frustrating, and then my doctor is questioning if I even had [COVID-19]. Walking her through to helping me with post-COVID symptoms seemed impossible, so I literally gave up and feel alone in trying to read everything I can to help myself. It’s dangerous because I have hypertension, and I have no idea how much [of] whatever I take is going to conflict with my meds or pressure.”
“I understand that doctors and everyone are just learning about [COVID], but when you are dealing with it for months and months, and you experience what I did, you feel as if they are gaslighting you — as if they want to put you in a box that they are more comfortable dealing with because they don’t want to admit they don’t know,” she told MNT.
Her symptoms, as well as the process of seeking and not receiving appropriate health support, have taken their toll on Bianca: “There is trauma related to this, and I would rather get a referral to a doctor who is willing to admit what they don’t know [how to help].”
Like Louise, others confessed that they do not have enough confidence in the health system even to attempt to seek support for their disrupted periods or other symptoms of long COVID.
“I didn’t dare to discuss more [of] my issues with [my family doctor] as they always dismiss [them],” she told us.
A few have been luckier in their pursuit of specialist care. Rose told MNT that she was “able to receive some care after a fair amount of trial and error.”
Rose also explained that because she had not tested positive for COVID-19, she came across a lot of resistance from doctors, which, like Bianca, she described as gaslighting.
“I have finally found a team of doctors who believe me,” she told us, “but we’re still all learning about how long COVID affects the body. For my menstrual cycles, I recently found an endocrinologist I like who is monitoring my progress and contemplating testing my estrogen levels as a next step.”
Almost none of the contributors who were in touch with MNT had access to any specialized resources through their healthcare providers.
They confessed to navigating long COVID on their own, with informal support from dedicated online groups set up by people in similar situations, such as the Body Politic support group.
Some of them have been researching treatments and coping strategies online, turning to Reddit forums and YouTube videos discussing potentially helpful medication for people with long COVID.
Jean told MNT that she wishes there was more interest from researchers and medical professionals concerning long COVID, in general, but also specifically concerning menstrual cycles:
“In general, medical […] advice is lacking for the entire COVID illness, [and more so] with regard to periods. I’ve been told [that it is due to] ‘stress and anxiety’ by the majority of doctors for every symptom. I’ve worked in the medical device field in women’s health, so I’m very aware of these issues — the gender bias is ingrained in medicine, and add [COVID] to that… I’ve been through lots of stress in certain periods of my life and have never had any of these symptoms.”
Rose wished that there were more ways of finding out whether a person has had COVID-19 besides antibody tests — blood tests that show if a person has recently had a SARS-CoV-2 infection by screening for the presence of antibodies generated in reaction to this virus.
“[N]ot everyone who tests positive for the nasal swab ends up testing positive for antibodies. If I had a way to show doctors I definitely fought [COVID-19], I wouldn’t be dismissed, told I have anxiety, etc., as much as I am now,” she told us.
“I regret not going to the hospital when I became ill and getting a PCR test [a test that detects the presence of a virus in the system] because currently, I’m lost in the system with nobody fighting for me but myself,” she added.
A common thread for most of the people who spoke to MNT about their experiences was that they wished they had access to more specialized resources and expert care.
“I wish I had access to doctors who specialize in post-SARS and long-term illness. I wish my doctor got it and was a source of understanding and was willing to learn about this with me instead of trying to gaslight me into her comfort zone. I wish there was more research and understanding for those of us the health system wouldn’t let test for COVID but who are holding the lack of a positive test as a barrier. I wish they would remember us when the COVID vaccine is available.”
Bianca, Edith, and Julia all expressed a wish that their doctors would believe them and that they could access expert knowledge about the long-term impact of COVID-19.
For instance, Edith told us that “[a]ccess to doctors and or women’s health experts about their research or insights about menstruation and COVID-19” would have been most helpful for her.
It remains unclear why menstrual cycles might be affected during and after COVID-19.
However, based on their experiences of how viral infections can unexpectedly impact periods, our medical experts have offered some possible explanations.
Dr. Fan emphasized that: “Stress itself is well-known to cause menstrual irregularities by disrupting the hypothalamic-pituitary-ovarian axis (essentially the hormonal system that the brain uses to speak to the ovaries).”
“We see this in [people who] experience other chronic diseases, life-stressors, anxiety and or PTSD [post-traumatic stress disorder],” she added.
Dr. Fan hypothesized that the new coronavirus could affect female reproductive organs.
“The published information on the effects of SARS-CoV-2 is fairly sparse. However, there is some biologic plausibility that the virus could attack ovarian function directly based on some of the effects of the virus on other organs,” she told MNT.
“[S]mall studies out of China this year have revealed that 25% of people with COVID have menstrual changes. These appear to return to baseline after the person recovers, and there is nothing to indicate changes in fertility,” Dr. Fan went on to say.
According to one study published in Reproductive BioMedicine Online in September, of 177 individuals with COVID-19 with menstrual records, 45 (25%) reported changes in the volume of menstrual blood, and 50 (28%) saw various changes to their menstrual cycles, such as lighter bleeding or longer-lasting periods.
The study participants were part of a cohort of people with COVID-19 who had received care at Tongji Hospital in Shanghai, China.
Dr. Nwadike told MNT that, based on anecdotal evidence, changes to the menstrual cycle might depend “on the length and severity of illness” in people who have had COVID-19.
“Some patients experience heavier cycles, and others have lighter volume. Comorbidities [coexisting conditions] affect the cycle volume as well. But what has been consistent is a return to normal cycles as their COVID symptoms improve. This is probably related to ovarian hormone suppression.”
– Dr. Valinda Nwadike
Dr. Fan wanted to reassure us that “[w]hile it can be disconcerting, one or two delayed or changed periods should not cause too much anxiety in the setting of COVID-19 infection.”
Nevertheless, she encouraged those who may be experiencing period changes due to COVID-19 to speak with their doctors and receive additional tests if necessary.
“It’s appropriate to let your [doctor] know that you’ve had some menstrual irregularity. They may wish to perform other tests, such as a blood count to check for anemia, possible pregnancy, or thyroid function,” Dr. Fan said.
If the bleeding is heavier than usual or lasts longer than you feel comfortable with, hormonal treatment options may be available. But knowledge is power, in this case. I think just knowing that it is an expected side effect is reassuring,” she added.
When MNT asked how a person with menstrual changes related to COVID-19 might best advocate for their health needs, Dr. Fan advised persistence and keeping a detailed record of these changes.
“If it is worsening, asking for a telehealth visit with your [obstetrician-gynecologist] or family [doctor] is a good place to start. Having your menstrual history on hand through a tracking app is a great idea,” she suggested.
Those who are navigating the effects of long COVID and its impact on periods without help from medical experts are calling for more insights into the possible consequences of this disease on the body and better overall care and specialist support.
“We need recognition, we need medical help, we need research, we need financial assistance in paying for our medical needs, and we need to feel as if the medical community remembers us and is there for us. We need to be acknowledged. There are thousands of us all over the world. We are exhausted, and we cannot do this alone forever.”
* We have changed the names of the contributors to protect their identities.
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