The height of the COVID-19 pandemic was stressful, as infection rates and death tolls increased and uncertainty filled the air. While the pandemic has certainly impacted many, studies are indicating that there may have been a greater impact on women. Female employment fell at a faster rate than male employment in various world economies within the first half of 2020 and women were also shown to have shouldered more of the weight of childcare than men during the pandemic, even whilst working. A study also reported that women found the changes to daily activities, resource insecurity and the risk of COVID-19 infection significantly more stressful than men. Now, a new study suggests that this 'pandemic-related stress' experienced during the COVID-19 pandemic may have also affected the menstrual cycles of women.
The study by Dr Martina Anto-Ocrah et al, published in Obstetrics & Gynecology, aimed to investigate how pandemic-related stress affected women’s menstrual cycle length (i.e. the number of days between periods), period duration, flow or the incidence of spotting between cycles. They asked 354 women across the United States, between the ages of 18 and 45, to complete a survey outlining their pandemic-related stress and to report any changes to their menstrual cycle between March 2020 and May 2021.
Over 50% of the women reported a change in either their cycle length, period duration, flow or spotting, and 12% of the women reported changes in all four variables. The authors found a significant relationship between high pandemic-related stress and changes to the cycle length and period duration. This may be attributed to the release of stress hormones affecting the release of hormones that regulate the menstrual cycle, such as oestrogen and progesterone. However, the authors state that ‘the role of pandemic-related stress in relation to menstrual cycle changes has yet to be fully elucidated.’
In an article by The Washington Post, Dr Anto-Ocrah, the lead author of the research article, commented that the results were “alarming” due to the impact of irregular cycles on both physical and mental health. She went on to state that:
“This really extends beyond menstruation, it’s about women’s well-being”.
Do others agree?
While this study has contributed to the growing pool of evidence proposing that menstrual cycles were impacted during the pandemic, there are also studies that oppose this notion. Dr Brian Nguyen et al conducted a retrospective cohort study investigating changes in the menstrual cycle of women using the Natural Cycles mobile tracking app. They did not find a significant association between pandemic-related stress and menstrual changes. Conversely, they reported that more menstrual cycle abnormalities were actually recorded in the app before the pandemic, than during the pandemic.
However, Anto-Ocrah et al noted in their article that a possible reason for this discrepancy may be due to Nguyen et al not using a validated questionnaire to accurately assess the impact of pandemic-related stress. Other studies, such as that of Ozimek et al have also found menstrual cycle irregularities during the early months of the pandemic, thereby suggesting that the pandemic may have impacted the menstrual well-being of women over a long period of time, as the studies were conducted a year apart. Dr Nicole Woitowich, a Biomedical scientist at Northwestern University and an author in the Ozimek et al study, made the following comment to The Washington Post:
“Women have really borne the brunt of the pandemic, from multiple facets. From being the primary caregiver, from dealing with remote learning, and oftentimes working while navigating that as well.”
Dr Linda Fan, an assistant professor of obstetrics, gynaecology and reproductive sciences at Yale School of Medicine, also commented in The Washington Post that she has discovered an increase in the number of patients coming in to discuss irregular menstrual cycles (as of November 2022 when the article by The Washington Post was released). She encourages women to visit their doctors and track their periods to be aware of any abnormal patterns. This is because, aside from stress, prolonged irregularities in a menstrual cycle could also be indicative of pregnancy, thyroid disease, cancer and various other concerning disorders.
While Anto-Ocrah’s research suggests that the pandemic may have affected women’s menstrual cycles, they also noted that their study has some limitations, such as the possibility of recall bias in the survey responses, whereby the women may have over/under-reported the changes in their menstrual cycle. This may have affected the validity of such self-reports and their overall findings. Although the authors noted that the validity of self-reports on women’s reproductive history has been found to be high, they acknowledged the need for further studies with ‘objective assessments of menstrual functioning’.
According to a report led by Dr Gemma Sharp, an associate professor at the University of Exeter, questions on menstruation have not been included in many large-scale COVID-19 studies. She states that more research is also necessary to know if any pandemic-related menstrual cycle changes could have lasting effects. In the article by The Washington Post, she states:
“From what we know about how the menstrual cycle is regulated, we think these changes are likely to be short-term and unrelated to long-term health and fertility, but it is absolutely crucial that scientists can produce evidence on this to give women the reassurance they deserve.”
By Success Fabusoro (Blog writer)