Summary
Coronavirus disease 2019 (COVID-19): related stress and menstrual changes
Aim:
To assess how stress related to the coronavirus disease 2019 (COVID-19) pandemic has affected women’s menstrual cycles. We hypothesized that women with high levels of COVID-19-related stress would have more menstrual changes compared to those with lower levels of stress.
Methods:
Using a cross-sectional study design, we recruited a representative sample of American adult women of reproductive age (18–45 years) using non-hormonal contraception to participate in an online REDCap (Research Electronic Data Capture, Vanderbilt University) survey. COVID-19-related stress was assessed with the PSS-10-C (Perceived Stress Scale Related to the COVID-19 Pandemic) and dichotomized as low stress (scores less than 25) and high stress (scores of 25 or further).
Self-reported menstrual outcomes were identified as changes in cycle length, duration or flow and increased frequency of spotting between cycles. We used Fisher’s exact and χ2 tests to compare differences in outcomes between the two stress groups and logistic regression models for effect estimates.
Results:
A total of 354 women of reproductive age in the United States completed the menstrual and COVID-19-related stress components of our survey. More than half of these women reported at least one change in their menstrual cycles since the start of the pandemic (n=191), and 10.5% reported a high level of stress related to COVID-19 (n=37 ).
Compared with those with low COVID-19-related stress, a greater proportion of women with high COVID-19-related stress reported changes in cycle length (shorter or longer; P = 0.008), changes in cycle length period (shorter or longer; P < 0.001), greater menstrual flow (P = 0.035), and greater frequency of spotting between cycles (P = 0.006) compared to the pre-pandemic era.
After adjusting for age, smoking history, obesity, education, and mental health history, elevated COVID-19-related stress was associated with increased odds of changes in menstrual cycle length (adjusted odds ratio [aOR] 2. 32, 95% CI 1.12–4.85), duration (aOR 2.38, 95% CI 1.14–4.98), and spotting (aOR 2.32, 95% CI 1.03–5 ,22).
Our data also demonstrated a non-significant trend for heavier menstrual flow among women with high COVID-19-related stress (aOR 1.61, 95% CI: 0.77–3.34).
Conclusion: High level of stress related to COVID-19 is associated with significant changes in menstrual cycle length, alterations in period length, and increased intermenstrual spotting compared to before the pandemic. Since menstrual health is often an indicator of women’s overall well-being, doctors, researchers, and public health officials should consider the association between COVID-19-related stress and menstrual disorders. |
Comments
Women with high stress related to the COVID-19 pandemic were twice as likely to experience changes in their menstrual cycle compared to those with low stress related to the pandemic, according to new research from the University of Pittsburgh published in Obstetrics & Gynecology .
Overall, more than half of study participants reported changes in menstrual cycle length, period length, menstrual flow or increased spotting, irregularities that could have health and economic consequences for women, they say. the researchers.
“At the beginning of the pandemic, it was coming up anecdotally in conversations with girlfriends and other women that ’things have been a little weird with my period since the pandemic,’” said lead author Martina Anto-Ocrah, Ph.D., MPH, MOUNTAIN. (ASCP), assistant professor in the Division of General Internal Medicine at Pitt School of Medicine. “Stress can manifest in women’s bodies as changes in menstrual function, and we know that the pandemic has been an incredibly stressful time for many people.”
Anto-Ocrah and her team developed a two-part survey that included a validated COVID-19 stress scale and self-reported menstrual cycle changes between March 2020 and May 2021. To reach a diverse population that was representative of the US In the US, the researchers worked with a market research company to recruit a geographically and racially representative group of participants to complete the online survey. They restricted the sample to people ages 18 to 45 who identified as female and were not taking hormonal contraceptives.
Of the 354 women who completed both parts of the survey, 10.5% reported a lot of stress.
After accounting for age, obesity and other characteristics, researchers found that women with high COVID-19 stress were more likely to report changes in menstrual cycle length, period length and spotting than their peers. with little stress. There was also a trend toward heavier menstrual flow in the high-stress group, although this result was not statistically significant.
“During the pandemic, women’s roles were redefined and, as a society, we went backwards in terms of gender equality,” Anto-Ocrah said. “Women often shouldered the brunt of childcare and household chores, and found changes in daily activities and risk of COVID-19 infection more stressful than men.”
About 12% of participants reported changes in all four features of the menstrual cycle, a finding the researchers called alarming.
“The menstrual cycle is an indicator of a woman’s overall well-being,” Anto-Ocrah said. “Disruption of the menstrual cycle and fluctuating hormones can affect fertility, mental health, cardiovascular disease and other outcomes. Ultimately, these factors can also influence relationship dynamics, which could exacerbate relationship strain.”
Longer, more frequent, or heavier periods can also take a toll on women’s wallets due to the additional costs of feminine hygiene products.
“We know that the pandemic has had negative economic impacts for many people,” Anto-Ocrah said. "If changes in your flow during a time of economic hardship increase period-related costs, or the ’tampon tax,’ economically, it’s a double whammy."
She hopes the study will inspire more research into COVID-19 stress and women’s health on a global scale, including possible long-term effects on fertility, the menopause transition and mental health.
Other contributing authors to this study were Tori Valachovic, BS, Kimberly Tiffany, BA, Lindsey DeSplinter, Kimberly Kaukeinen, BS, J. Christopher Glantz, MD, MPH, and Stefanie Hollenbach, MD, MS, all of the University of Rochester; and Michael Chen, Ph.D., of Nazareth College.
This research was supported by the National Institutes of Health (5T32NS007338-30 and 7K01NS121199-02).
