Women’s reproductive health has suffered as a consequence of the pressures brought about by the COVID-19 pandemic, with changes in menstrual cycles and aggravation of premenstrual symptoms, shown in Irish survey data.

The study’s co-author, Dr. Michelle Maher, of the Department of Endocrinology at St James’ Hospital in Dublin, said in a news release that the findings “Our findings highlight a real need to provide appropriate medical care and mental health support to women affected by menstrual disturbance, given the unprecedented psychological burden associated with the pandemic,” given the unprecedented psychological burden associated with the pandemic.

More than 1300 women participated in the poll, which was performed in April 2021. Of those who responded, 56 percent reported changes in their menstrual cycle, 64 percent indicated worsening of premenstrual symptoms, and 54 percent reported decreased sex drive, among other findings. 

“There is a pressing need to educate and inform women,” said Dr. Lisa Owens, the study’s lead author and also a researcher at St James’s Hospital, in a statement to Medscape News UK. “Many women are unaware of the impact their lifestyle choices and mental health have on their reproductive health.”

Additionally, she believes that general practitioners have a role to play in providing advice to women who are experiencing mental health difficulties, and she has stated that cognitive-behavioral therapy, as well as dietary and exercise modifications, can be beneficial for women suffering from hypothalamic amenorrhoea. 

To see if there are any long-term effects on female reproductive and mental health, the team aims to conduct the questionnaires at 6-month intervals. They will also monitor blood pressure, weight, sex hormones (including testosterone), and ovulation.

The researchers, according to Dr. Owens, requested participants in the current study to record their menstrual cycle data on a smartphone app and to consent to be contacted again.

“We have just sent out a follow-up survey to these women so it will be very interesting to see the results,” she said.

Additionally, according to Dr. Maher’s statement, the researchers are “planning to provide support for women affected by menstrual cycle abnormalities by developing psychological support workshops at our center,”

Cynthia Graham, professor of Sexual and Reproductive Health, University of Southampton, told Medscape News UK that it is “plausible” that stress during the pandemic might cause disruption to women’s reproductive health, especially to menstrual cycles. 

According to the researchers, “there’s strong evidence from decades ago that stress can influence the menstrual cycle…so the premise of this [study] makes sense,” while it is unclear how “strongly this can be related to the pandemic.” 

Furthermore, she stated that she has “concerns” about the study, specifically about how it was circulated through social media and how the women were recruited. 

As she pointed out, the current study is cross-sectional and retrospective; “a better design would be a prospective study” while she acknowledged that this would be “harder to do” and result in fewer women participating. 

Prof. Graham further remarked that the self-reports spanned the duration of the pandemic, which is “more than a year”, and it is not apparent whether characteristics such as sex drive were addressed in the survey by a one-time inquiry, despite the availability of “standardized measures”.

The use of historical data samples to derive comparisons for rates of anxiety, depression, and sleep quality was also questioned by her, as it was not obvious whether they were drawn from comparable cohorts. 

Nevertheless, Professor Graham added that, overall, studies that have looked at the impact of the COVID-19 pandemic on sexuality have also revealed: “reduced sexual interest” that has been “attributed to lockdown”.

One study found that individuals reported more “sexual experimentation or diversity in their relationships,” though the exact findings depended on the population sample studied. Another study found that single people experienced a greater “negative impact,” with a study finding that single people experienced a greater “negative impact.”

Numerous studies, especially in the UK, have attested to the impact of the COVID-19 pandemic and its attendant public health restrictions on mental health, with women, young people, and those living with preschool-aged children particularly affected.

The authors underline that psychosocial distress can induce menstrual dysfunction via activation of the hypothalamic-pituitary-adrenal axis, and they hypothesized that menstrual function would therefore have been impaired during the pandemic.

Six months into the pandemic, in September 2020, they conducted an online poll of 1031 women of reproductive age, finding major disturbances to reproductive health. 

This included alterations in the menstrual cycle since the onset of the pandemic, increasing premenstrual symptoms, new menorrhagia, and new dysmenorrhea, which were connected with mental health problems.

Anxiety, as measured by a GAD-7 score of 15, was reported by 8 percent of women, compared to 2 percent in previous samples, and poor sleep quality, as measured by a PSQI global score of 5, was reported by 96 percent of women, compared to 42 percent in previous studies. 

According to the results of a logistic regression study, PSQI scores were an independent predictor of overall change in menstrual cycles, with each unit decline in sleep quality linked with an 11 percent increase in the odds of menstrual cycle change.

Sleep quality was also found to be a predictor of missed periods, with each unit decrease in sleep quality being associated with an 11 percent increase in the chance of missing periods.

Change in GAD-7 scores was also an independent predictor of switching from non-painful to painful periods during the pandemic, with each unit increase in anxiety linked with a 6 percent increase in the odds of worsening period pain.

A 6 percent increase in the likelihood of worsening premenstrual symptoms was shown to be connected with each unit’s rise in anxiety level. 

In contrast, each unit rise in scores on the SF-12’s mental health component scale was associated with a 3 percent reduction in the likelihood of experiencing increasing premenstrual symptoms during the course of the study.

After more than a year since the breakout of the COVID-19 pandemic, “Women continue to suffer reproductive and mental health disturbances, over a year following the outbreak of the COVID-19 pandemic,” according to the researchers. 

“Further longitudinal studies are needed to elucidate the longer-term reproductive and psychological consequence of the pandemic, which are likely to depend on its duration and vaccine efficacy.”