Meena’s* period has been delayed by more than two months now. “I am feeling worse by the day. I keep getting cramps and headaches, which normally happens when I am PMSing or menstruating. But I still haven’t got my period. I have to take a painkiller almost everyday due to the head and body aches,” the 47-year-old based in Bengaluru tells TNM. She points out that this change isn’t regular for her menstrual cycle.
Miles away in Mumbai, 34-year-old filmmaker Sofia has a similar trial to share. When she got her period in January, she was completely thrown off by the debilitating pain she experienced. The period was also of a longer duration. “It usually lasts for six to seven days. The last two days will mostly just be spotting. But this time, I was bleeding heavily for seven days. I was on a shoot on my first period post COVID and had to step away because I was doubling over with pain. On the second day of my period, I bolted from a friend’s birthday party within an hour due to the pain. This isn’t normal for me,” the director says.
In Chennai, 24-year-old Arushi narrates how something ‘abnormal’ was happening to her cycle. “I used to get menstrual cramps for two days, but now I am cramping for three. The changes in my periods have been anxiety-inducing. As I don’t know how to track them anymore, I can no longer prepare my body the way I used to earlier, by modifying my diet, etc.”
While it may not be extraordinary for people’s menstrual cycles to change based on lifestyle, circumstances, travel, health and other such factors, Meena, Sofia, Arushi, and many other women who reported these changes had one thing in common – they had contracted COVID-19 and experienced these disruptions only after it. While no direct link has been established between COVID-19 and menstruation or sexual and reproductive health, there have been several anecdotes over the past two years of menstruators noting changes in their cycles post COVID, and even after COVID-19 vaccination.
Shweta, a journalist based in Delhi, noticed that her first period after contracting COVID-19 around two months ago was 10 days late. “Besides, it was over in two days instead of the usual three. This was quite similar to what had happened to my cycle after vaccination. But there was also a lot of pain and heavy bleeding at the time, which didn’t happen when I got my period after contracting the infection. Many of my friends have also noticed such changes,” she says.
Dr Sowmya Sangmesh, consultant obstetrics and gynaecologist, laparoscopic surgeon, and infertility specialist from BGS Gleneagles Global Hospital, confirms that she is seeing people report menstrual irregularities after contracting COVID or getting vaccinated. “Menstrual cycles are linked to hormones. The illness is not triggering changes in the ovarian function per se, but it does induce stress and hormonal changes. Any short-term illness can cause menstrual disruption. Besides, there is some evidence that the blood clotting mechanism may get aggravated due to COVID-19. Usually, we tell women not to worry if they experience changes for three to six cycles post COVID. If it goes beyond that, we can carry out investigations,” she says.
Dr Vinutha Arunachalam, senior consultant obstetrician and gynaecologist at Apollo Women’s Hospital, concurs that stress hormones can cause menstrual irregularities. “It could be that the hormonal imbalances due to sedentary lifestyle, or added workload due to work-from-home and domestic chores for women, have reached a threshold. Many women have experienced such episodes, but it is limited to just one or two abnormal cycles post COVID,” she says.
While both doctors assert that there is no established link between COVID-19 and menstrual disruptions, Dr Hema Divakar, who chairs the International Federation of Gynaecology and Obstetrics (FIGO) Committee on Well Woman Health and Care, asserts that a lack of academic evidence does not automatically mean there is no connection between the two. “In most cases, we do see that things go back to normal after two or three period cycles,” Dr Hema says.
However, there are some people who have been experiencing long-term disruptions too. Riya*, a law student, who also has polycystic ovaries, had to get several medical examinations done due to her irregular menstrual episodes after she contracted COVID-19 in April last year. Once, she even required medication to stop the blood flow which had gone on for more than five days. “Earlier, my cycles used to be fairly on time or just slightly delayed. But all that has changed now. The flow starts randomly, and I am not able to predict or track it anymore because it is that irregular,” the 26-year-old says. She adds that while she has not received a diagnosis directly connecting these changes in her cycle to COVID-19, she suspects there is a link – even if these issues were in the making and only started to act up now. “The fact that I can't really track my period any longer has made a lot of things difficult. For instance, the last flow left me feeling so weak that I could barely go about my day. It ended just about two days back, after I took prescribed medicines to stop bleeding,” Riya says.
Both the doctors and people with lived experiences say there is a lack of medical literature to document how COVID-19 could affect sexual and reproductive health. There are some studies that document minor changes to the menstrual cycle post vaccination. According to an article in BMJ, “Menstrual changes have been reported after both mRNA and adenovirus vectored COVID-19 vaccines, suggesting that, if there is a connection, it is likely to be a result of the immune response to vaccination rather than a specific vaccine component.” Some others acknowledge discussions and anecdotes on social media and blogs about changes in periods since the pandemic started. However, menstruation has been largely left out of most large-scale COVID-19 studies, including vaccine trials.
Some doctors and studies point to the changes being a result of not just the stress the body goes through due to the COVID-19 infection, but also the psychological stress of the pandemic, isolation, effects of critical illness, and the immune response. Further, long COVID – defined by the World Health Organisation as “usually three months from the onset of COVID-19 with symptoms that last for at least two months and cannot be explained by an alternative diagnosis” – could cause aspects of menstrual disruptions as well, such as increased menstrual bleeding, blood clotting and worsening PMS.
Dr Sowmya agrees that there needs to be more research and data on the topic, but points out that there could be challenges. “What makes data collection challenging here is that menstrual irregularities are subjective. Hormonal patterns may change every month, causing cycles to vary. So regular observation to ascertain what is normal and not for an individual would be important in a study,” she says.
According to Dr Hema, gynaecologists and doctors need to ask a person reporting menstrual disruptions if they had contracted COVID-19 or were vaccinated recently. They also have to document the same, even if they cannot prove a connection yet, she says. She adds that doctors must not brush off women’s concerns as stress- or hormone-related, even though those could be major factors. “If you don’t collect post-COVID data, you will never know if there is a potential connection,” Dr Hema says.
Shweta agrees, adding that data around women’s health should not be neglected. “Two years have passed since the virus changed the world. Given that a fairly large section of the population is of menstruating age, it was upsetting that there is nothing concrete to make ourselves aware of the way the virus can affect menstrual health. What a lot of women have been hearing from medical doctors is that these changes are related to stress. Even if that is the case, data needs to be made available if so many of us are experiencing these disruptions,” she asserts.
When asked if she will get medical attention for her menstrual health now, Meena is hesitant. “My previous experiences with gynaecologists have been that they will make you take all sorts of tests and then ask you to do yoga. Things were fine until COVID-19 hit. Now it is crazy. I have cramps, migraine, bloating, weight gain, and no periods. I find that the doctors have very little to offer to women like us, unless we have a serious illness or want to have our uterus or fibroids removed. They don’t really want to listen,” Meena says.
Medical gaslighting is not a new experience for women, and has been documented across geographies and demographics. Women are often disbelieved, accused of being dramatic, and told their pain is ‘normal’. In fact, many people whom TNM spoke to expressed hesitation in approaching doctors about the changes in their menstrual health after COVID-19.
Shruti Sunderraman, a Bengaluru-based journalist with polycystic ovarian syndrome (PCOS), has been tracking the menstrual irregularities she experienced after COVID-19 vaccination. “But no doctor has listened to me or paid any heed to my anecdotal evidence. I don't expect doctors to be welcoming in the face of vaccine hesitancy, but to see them entirely dismiss a patient’s experience is a new level of frustration,” she says. Last month, Shruti had to be hospitalised with menorrhagia (abnormally heavy bleeding at menstruation) that lasted 15 days. When she sought a follow up after the initial medical intervention to stop the bleeding, the doctor “only treated her symptomatically and dismissed everything I had to say about my post-vaccine and post-COVID menstrual and mental health history”. The 30-year-old adds that this “hormonal imbalance” cost her a lot, including her mental health, and compelled her to quit her job. “I am not expecting anyone to take my words as data points. But please believe your patients,” she says.
Acknowledging this trend, Dr Hema points out that when patients in their 40s approach gynaecologists, the initial assumption is usually that their concerns of menstrual disruptions are related to perimenopause or other age-related changes. “Be that as it may, when we ask them if they got vaccinated recently or had COVID-19, they say yes,” she observes. “In many cases, the reasons we cite such as the sedentary lifestyle, financial difficulties and other problems may have existed throughout. It is possible they may have peaked to cause the current issue. However, there could still be a larger connection between menstrual cycles and COVID-19 that we just don't know yet. If a woman is saying she is suddenly experiencing irregularities, listen to her, believe her. This is real and not in their heads.”
*Names changed