Effect of COVID-19 on Menstruation and Lower Reproductive Tract Health

Abstract

Background: To evaluate the dynamically impact of the coronavirus disease 2019 (COVID-19) on the female reproductive system. Methods: An online survey was shared to women of reproductive age who had been infected with COVID-19 and recovered in China between January and March 2023. Results: In total, 610 women of childbearing age completed the menstrual component of the survey and 82.6% (n=504) women self-purchased medications without hospitalization. 254 women were menstruating during COVID-19 infection. 66.9% of them reported changes in menstruation, including cycle length (64.7%), menstrual flow (72.4%), and duration (53%), compared to pre–COVID-19. COVID-19–related chest tightness (OR: 9.5; 95% CI: 1.9–46.3), COVID-19–related stress (OR: 18.4; 95% CI: 1.4–249.7), and COVID-19–related low mood (OR: 6.2; 95% CI: 1.4–28.2) were associated with these menstrual changes. However, over 73% of women who menstruated during and after COVID-19 regained their pre-infection menstrual cycle (73%), duration (79.6%), and flow (75.2%) during their first menstruation after COVID-19 recovery. Compared to pre-infection, 19.7% (n=124) women reported changes in lower reproductive tract during COVID-19, including volume and color of vaginal discharge, vulvar pruritus, and vaginitis. These changes were significantly increased in those with a history of pelvic inflammatory disease (OR: 12.1; 95% CI: 3.1–48.2), ovarian cysts (OR: 4.9; 95% CI: 1.2–19.4), and vaginitis (OR: 5.5; 95% CI: 2.1–14.4) prior to COVID-19. However, 52.4% reported that their lower reproductive tract health had returned to its pre-infection within the first month after recovery from COVID-19, while 73.5% reported a return to the pre-infection within 2 months. Conclusion: Changes in menstruation and lower reproductive tract associated with COVID-19 are transient. Menstruation and lower reproductive tract health will gradually return to pre-COVID-19 status within 2 months of recovery, which can help alleviate excessive concerns about the effects of COVID-19 on the reproductive system.