What We Know (So Far) About COVID-19 and Your Menstrual Cycle

After several months of sheltering-in-place and quarantine self-care, it’s clear that the coronavirus (COVID-19) is here for the long haul. Yet, as a relatively novel virus, there’s still a lot unknown about how it affects our monthly periods.

To better understand the link between the two, we spoke to Dr. Kimberly Langdon, M.D., an OB/GYN based in Ohio and a medical advisor for Medzino Health. Here’s the lowdown:

COVID-19 can cause period changes.

While it’s true that COVID-19 could disrupt your period, it’s important to note the same can be said for any sickness. The reason? Illness can affect your body’s ability to normally ovulate, according to Langdon.

As you might already know, the menstrual cycle is split into four phases: the menstrual phase, the follicular phase, ovulation, and the luteal phase. Every phase is governed by a series of specific hormonal changes.

Ovulation typically occurs about halfway (14ish days) through your cycle. This phase is marked by a rise in luteinizing hormone (LH), which triggers the release of an egg. But if the egg remains unfertilized, it doesn’t implant itself into the uterus lining—causing the uterus to shed the egg and lining via muscular contractions (cramps). The result is your period.

However, during a bout of illness (like COVID-19), your body becomes physically stressed. This messes with the hormonal changes necessary for normal ovulation, causing a delay in ovulation (or none at all). In turn, your period is late or even MIA.

A mild COVID-19 infection likely won’t damage your reproductive system.

According to Langdon, COVID-19 can allegedly affect any organ. That’s because it can cause a cytokine storm, “an overzealous immune response [that can lead to] vessel wall damage,” she explains. However, with mild infections, it’s unlikely to cause “any damage to the blood flow to the ovaries, uterus, pituitary gland, or hypothalamus—the last two [of which] are in the brain and are responsible for initiating egg recruitment for ovulation,” she shares.

Abnormal periods and pandemic stress are totally a thing.

Make no doubt about it: Living through this pandemic has been one heck of a stressful experience. The rapid outbreak of the virus—coupled with the country’s economic downturn—has paved the way for anxiety, worry, and loads of stress.

<<READ MORE: How Stress Affects Your Period>>

This can lead to period changes, just like physical illness. Again, “the basic underlying problem with stress [and menstruation] is due to the impact it has on ovulation,” explains Langdon. “It can easily disrupt the normal cycle” by interrupting the hormonal changes needed for normal ovulation function.

To top things off, high levels of stress (*cough*pandemic*cough*) can increase the risk of dysmenorrhea, a.k.a. super painful periods. Ugh.
Pandemic Stress
And if you’re trying to conceive (TTC)? Take note: According to a 2016 article in Journal of Biomedical Science, higher levels of stress hormones (like cortisol) can reduce estradiol, a type of estrogen. This can decrease the quality of the oocyte, or immature egg, potentially causing reproductive issues like difficulty conceiving. 

If you’re TTC and feeling uber stressed, consider chatting with a mental health professional during these difficult times. It may also help to hone in on relaxation techniques, like yoga and meditation

COVID-19 symptoms might be worse during your period.

Around the web, folks with COVID-19 have reported experiencing worse symptoms when Aunt Flo shows up. And while it’s still unknown how menstruation specifically affects the severity of COVID-19 symptoms, there’s some scientific merit behind this relationship.

According to an article in the American Journal of Obstetrics & Gynecology, it’s common for medical conditions to become exacerbated during menstruation. This typically occurs during the luteal phase (just before your period) and menstrual phase (your actual period), when estrogen is an at all-time low. Coincidentally, “estrogen has been [found] to influence immunity by affecting the development of white blood cells,” says Langdon. In other words, it can regulate the immune system and how your body handles disease.

In theory, the plummet of estrogen during the luteal and menstrual phases may explain why COVID-19 symptoms flare up during people’s periods. Nevertheless, more specific research is necessary to confirm the link.
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You might be more likely to get infections before or during your period.

The changes in estrogen throughout your cycle—along with its relationship with immunity—may also affect your risk of infections.

Before ovulation, during the follicular phase, “you’re less susceptible to infections due to higher estrogen levels,” says Langdon. From an evolutionary standpoint, this makes a lot of sense; it’s your body’s way of making sure you’re in tip-top shape to release an egg and have sex (and therefore, fertilize the egg).

It’s a different story after ovulation, during the luteal phase. As mentioned earlier, estrogen decreases in the luteal phase and is at “the lowest level on the first day of menstruation,” says Langdon. In turn, you may be more vulnerable to infections during this time.

Again, there isn’t any research on menstruation and COVID-19 risk. It’s also still important to stay safe and follow CDC guidelines for protecting yourself—no matter what phase you’re in.

There’s still a lot to learn about how COVID-19 affects the menstrual cycle. In the meantime, (please) pay attention to any period changes, even in the middle of pandemic. Many health care providers, including gynecologists, are currently offering virtual appointments for their patients.

About the Expert: Dr Kimberly Langdon M.D. is a retired obstetrician/gynecologist with 19 years of clinical experience. Beside obstetrics, she specialized in gynecologic diseases such as menstrual disorders, vaginitis, infertility, menopause, contraception, pelvic pain, sexually transmitted infections, and minimally-invasive surgeries. She is currently a medical advisor at Medzino Health, a digital health company based in Austin, TX.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107848/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194613/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315337/

https://academic.oup.com/epirev/article/36/1/104/566554/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812655/

ABOUT THE AUTHOR
Kirsten Nunez
Learn more about Kirsten at k-nunez.com.

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