Largest study yet shows how Covid vaccines affect periods

Almost half of participants in a recent study who menstruated regularly at the time of the survey reported heavier bleeding during their periods after receiving the Covid-19 vaccine. Others who usually didn’t menstruate – including transgender men, people on long-acting contraceptives and postmenopausal women – also experienced unusual bleeding.

The new study – the largest to date – expands on research that has highlighted the temporary effects of Covid-19 vaccines on menstrual cycles, but so far focused primarily on menstruating cisgender women.

Although vaccines have largely prevented deaths and serious illnesses with few reported side effects, many medical experts initially dismissed concerns when women and people of various genders began to report erratic menstrual cycles after received the injections.

To get a better idea of ​​these post-vaccination experiences, researchers from the University of Illinois at Urbana-Champaign and Washington University School of Medicine in St. Louis distributed an online survey in April 2021 to thousands of people around the world. After three months, the researchers collected and analyzed more than 39,000 responses from people between the ages of 18 and 80 about their menstrual cycles. All of the survey respondents had been fully immunized — with Pfizer-BioNTech, Moderna, Johnson & Johnson, or another that had been approved outside the United States. And to their knowledge, the participants had not contracted Covid-19 before being vaccinated.

The research, published Friday in the journal Science Advances, shows that 42% of people with regular menstrual cycles experienced heavier bleeding after vaccination, while 44% reported no change and 14% reported heavier periods. light. Additionally, 39% of respondents on gender-affirming hormone therapy, 71% of people on long-acting contraceptives, and 66% of postmenopausal women experienced breakthrough bleeding after one or both injections.

“I think it’s important for people to know this can happen, so they don’t get scared and shocked and caught without supplies,” Katharine Lee said. , a biological anthropologist at Washington University School of Medicine in St. Louis, and the first author of the study.

Dr Lee cautioned, however, that the study did not compare the results with a control group of people who were not vaccinated. And it’s possible that people who observed changes in their cycles after vaccination were more likely to participate in the survey. Still, the results match smaller studies that reported menstrual changes after vaccination with more robust controls.

Importantly, the new study also found that certain demographics may be more likely to experience menstrual changes, and the study may help them be better prepared, Dr. Lee said. A heavier menstrual flow was more likely for those who were older, for example. Survey respondents who used hormonal contraception, had been pregnant in the past, or had been diagnosed with a reproductive condition such as endometriosis, fibroids, or polycystic ovary syndrome were also more likely to have heavier bleeding. during their period. People who identified as Hispanic or Latino also tended to report heavier bleeding. And people who experienced other vaccine side effects, such as fever or fatigue, were also more likely to have irregular periods.

Postmenopausal women who were slightly younger, around an average age of 60, were more likely to have breakthrough bleeding after the vaccine than those who were older. But the type of vaccine postmenopausal women received, whether they had other side effects like fever or had a previous pregnancy, didn’t seem to have an effect on their bleeding.

Some level of variation in your period – the number of days you bleed, how heavy your flow is, and the length of your cycle – is normal.

“Our menstrual cycles are not perfect clocks,” said Dr. Alison Edelman, professor of obstetrics and gynecology at Oregon Health & Science University, who has also studied the impact of Covid-19 vaccines on menstruation. .

Hormones secreted by the hypothalamus, pituitary and ovaries regulate the monthly cycle and can be affected by internal and external factors. Stress and illness, weight loss or gain, calorie restriction, and strenuous exercise can all alter typical menstrual patterns.

The endometrium, which lines the uterus and sheds during menstruation, has also been linked to the immune system. Because of the role it plays in remodeling uterine tissue and providing protection against pathogens, it’s possible that when vaccines activate the immune system, which they should, they also somehow trigger another effects downstream in the endometrium, causing a disruption in your menstrual cycle, Dr. Edelman said. And some people may be more sensitive to immune or hormonal changes in their body.

In his research, Dr. Edelman found that some women’s periods came a day or two later than usual after being vaccinated against the coronavirus. But the changes were temporary – periods tended to return to normal after one or two cycles.

If you experience any new or unusual bleeding, write it down. The menstrual cycle can be considered another vital sign, along with your body temperature or blood pressure, that provides clues to your health, said Dr. Jennifer Kawwass, a reproductive endocrinologist at Emory University, who doesn’t did not participate in the study.

“A significant change in menstrual cycle interval or bleeding pattern warrants further investigation to ensure there is no underlying endocrinological, hematological or anatomical cause,” Dr. Kawwass said. . Breakthrough bleeding in people who no longer have their periods normally, for example, can also be a warning sign of cancer of the cervix, ovary, uterus or vagina.

That being said, a subtle variation in your menstrual cycle, if you have regular periods, shouldn’t be a cause for concern and doesn’t require you to change anything you normally would, says Dr. Kawwass.

Clinical trials and other studies have already established that Covid-19 vaccines are safe and effective and are unlikely to impact long-term fertility.

Experts agree that the mayhem Covid-19 can wreak throughout your body, including potential lingering effects, is far worse than any side effects caused by vaccination against the disease.

People who have had a fever after an injection can schedule their next dose on a day when they won’t have to go to work, Dr. Edelman said. But you shouldn’t let temporary menstrual changes keep you from getting fully vaccinated or boosted. Since cases are on the rise again, delaying vaccination for two weeks or more can significantly increase your risk of contracting Covid-19, she said.

Still, it’s important to track your body’s response to vaccination, and public health officials should acknowledge concerns about variations in the menstrual cycle in addition to warning people about the risk of contracting Covid-19, said Keisha Ray, a bioethics expert at McGovern Medical School at UTHealth Houston.

Increased transparency around menstrual changes or other vaccine side effects could also have another benefit: reducing vaccine hesitancy.

“We try to be honest. We’re trying to validate people’s lived experiences,” Dr. Lee said. In turn, she hopes the new research will help improve people’s health conversations and lead to more inclusive clinical trials in the future.

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