1. Home
  2. Vol 28, No 6 (2024)
  3. Chen

The association of the severity of Omicron with menstrual and premenstrual syndrome among reproductive age women in China: a cross-sectional study

Nini Chen(1), Xiuping Zhao(2), Yuyi Wang(3), Pingping Su(4), Juan Wang(5), Yun Sun(6),


(1) Zhejiang Pharmaceutical University, Ningbo, China
(2) Department of Gynecology, The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China
(3) Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
(4) The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
(5) Zhejiang Pharmaceutical University, Ningbo, China
(6) Department of Gynecology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
Corresponding Author

Abstract


This study aimed to investigate changes in menstruation and the association of the severity of Omicron with menstruation after the nationwide outbreak of COVID-19 in China. A cross-sectional study adopted an electronic questionnaire to conduct an anonymous online survey. The survey targeted women of reproductive age who had been infected with SARS-CoV-2, and were menstruating regularly in the six months prior to the infection, and experienced at least one menstrual cycle after the infection. The 737 included participants were divided into mild and severe groups based on the severity of the infection. Deviations in first menstrual cycle postinfection were reported in 46.4% of participants (mild group 40.1% vs. severe group 55.2%, P<0.05). Menstrual changes were predominantly a late menstrual period (mild group 25.3% vs. severe group 30.4%), a shorter duration of menstrual flow (mild group 10.4% vs. severe group 14.7%), and a decrease in menstrual flow volume (mild group 16% vs. severe group 21.6%). Premenstrual syndrome symptoms in a small number of women were worse compared with pre-infection, especially in the severe group. During the second menstrual period after infection, most participants reported their menstrual characteristics had returned to those of preinfection (mild group 88% vs. severe group 80.2%, P<0.05). In this investigation, SARS-CoV-2 infection had a substantial effect on women's menstrual characteristics, and the changes were mostly transient. Women with more severe COVID-19 symptoms experienced more significant changes. The potential long-term effects of SARS-CoV-2 on female reproductive health require further observation and research.

References


Cascella M, Rajnik M, Aleem A, Dulebohn SC and Di Napoli

R. Features, evaluation, and treatment of coronavirus

(COVID-19) [cited 2023 Aug 18]. In: StatPearls

[Internet]. Treasure Island (FL): StatPearls

Publishing.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang

H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X and

Peng Z. Clinical characteristics of 138 hospitalized

patients with 2019 novel coronavirus-infected

pneumonia in Wuhan, China. JAMA,2020;

(11),1061-1069.

World Health Organization (WHO). WHO coronavirus

(COVID-19) dashboard. Available from:

https://covid19.who.int (Accessed 7 Jan, 2024)

Huang S, Gao Z and Wang S. China's COVID-19 reopening

measures—warriors and weapons. Lancet,2023;

(10377),643-644.

Geng Y, Fan Y, Deng X, Wang Y, Zhao J, Ji L, Song Z, Li

G, Zhang X, Sun X, Huang H, Xie W and Zhang Z.

The recent outbreak of COVID-19 in China during

the Omicron variant predominance: clinical features and outcomes in patients with autoimmune

inflammatory rheumatic diseases. Rheumatol

Ther,2023; 10(4),1039-1053.

Grifoni A and Sette A. From Alpha to omicron: The response

of T cells. Curr Res Immunol, 2022; 3,146-150.

Lin M, Cao K, Xu F, Wu X, Shen Y, Lu S, Kuang Z, Ding

H, Yuan S, Shao M, Gu G, Xing L, Gu T, Chen S,

Sun J, Zhu J, Zhang X, Yang Y, Zhao G, Huang L,

Xu J and Song Z. A follow-up study on the recovery

and reinfection of Omicron COVID-19 patients in

Shanghai, China. Emerg Microbes Infect, 2023;

(2),2261559.

American Academy of Pediatrics Committee on

Adolescence, American College of Obstetricians and

Gynecologists Committee on Adolescent Health

Care, Diaz A., Laufer M.R. and Breech L.L.

Menstruation in girls and adolescents:using the

menstrual cycle as a vital sign. Pediatrics, 2006;

(5),2245-2250.

Farage MA, Neill S and MacLean AB. Physiological changes

associated with the menstrual cycle: a review. Obstet

Gynecol Surv, 2009; 64(1),58-72.

Munro MG, Critchley HO, Broder MS, Fraser IS and FIGO

Working Group on Menstrual Disorders. FIGO

classification system (PALM-COEIN) for causes of

abnormal uterine bleeding in nongravid women of

reproductive age. Int J Gynaecol Obstet, 2011;

(1),3-13.

Ozimek N, Velez K, Anvari H, Butler L, Goldman KN and

Woitowich NC. Impact of stress on menstrual

cyclicity during the coronavirus disease 2019

pandemic: a survey study. J Womens Health

(Larchmt), 2022; 31(1),84-90.

Li K, Chen G, Hou H, Liao Q, Chen J, Bai H, Lee S, Wang

C, Li H, Cheng L and Ai J. Analysis of sex hormones

and menstruation in COVID-19 women of childbearing age. Reprod Biomed Online, 2021;

(1),260-267.

Taşkaldıran I, Vuraloğlu E, Bozkuş Y, Turhan İyidir Ö, Nar

A and Başçıl Tütüncü N. Menstrual changes after

COVID-19 infection and COVID-19 vaccination. Int

J Clin Pract,2022,3199758.

Lebar V, Laganà AS, Chiantera V, Kunič T and Lukanović

D. The effect of COVID-19 on the menstrual cycle: a

systematic review. J Clin Med, 2022; 11(13),3800.

Wang SW, Mortazavi J, Hart JE, Hankins JA, Katuska LM,

Farlandet LV, Gaskins AJ, Wang YX, Tamimi RM,

Terry KL, Rich-Edwards JW, Missmer SA and

Chavarro JE. A prospective study of the association

between SARS-CoV-2 infection and COVID-19

vaccination with changes in usual menstrual cycle

characteristics. Am J Obstet Gynecol, 2022;

(5),739.e1-739.e11.

Kurmanova AM, Kurmanova GM and Lokshin VN.

Reproductive dysfunctions in viral hepatitis. Gynecol

Endocrinol, 2016; 32(sup2),37-40.

Giunta I, Zayat N and Muneyyirci-Delale O. Histologic

features, pathogenesis, and long-term effects of viral

oophoritis. F&S Reviews, 2021; 2(4),342–352.

Bukovsky A and Presl J. Ovarian function and the immune

system. Med Hypotheses, 1979; 5(4),415-436.7

Bukovsky A, Presl J and Holub M. The role of the immune

system in ovarian function control. Allergol

Immunopathol (Madr), 1981; 9(5),447-456.

Yoshimura Y and Barua A. Female reproductive system and

immunology. Adv Exp Med Biol, 2017; 1001,33-57.

Prokai D and Berga SL. Neuroprotection via reduction in

stress: altered menstrual patterns as a marker for

stress and implications for long-term neurologic

health in women. Int J Mol Sci,2016; 17(12),2147.

Nishikitani M, Nakao M, Tsurugano S, Inoure M and Yano

E. Relationship between menstruation status and

work conditions in Japan. Biopsychosoc Med,2017;

,26.

Nillni YI, Wesselink AK, Hatch EE, Mikkelsen EM, Gradus

JL, Rothman KJ and Wise LA. Mental health,

psychotropic medication use, and menstrual cycle

characteristics. Clin Epidemiol, 2018; 10,1073-1082.

Kala M and Nivsarkar M. Role of cortisol and superoxide

dismutase in psychological stress induced

anovulation. Gen Comp Endocrinol, 2016; 225,117-

Garg MK, Gopalakrishnan M, Yadav P and Misra S.

Endocrine involvement in COVID-19: mechanisms,

clinical features, and implications for care. Indian J

Endocrinol Metab, 2020; 24(5),381-386.

Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N,

Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu

NH, Nitsche A, Müller MA, Drosten C and Pöhlmann

S. SARS-CoV-2 cell entry depends on ACE2 and

TMPRSS2 and is blocked by a clinically proven

protease inhibitor. Cell, 2020; 181(2),271-280.e8.

Reis FM, Bouissou DR, Pereira VM, Camargos AF, dos

Reis AM and Santos RA. Angiotensin-(1-7), its

receptor Mas, and the angiotensin-converting enzyme

type 2 are expressed in the human ovary. Fertil Steril,

; 95(1),176-181.

Vaz-Silva J, Carneiro MM, Ferreira MC, Pinheiro SV, Silva

DA, Silva-Filho AL, Witz CA, Reis AM, Santos RA

and Reis FM. The vasoactive peptide angiotensin-(1-

, its receptor Mas and the angiotensin-converting

enzyme type 2 are expressed in the human

endometrium. Reprod Sci, 2009; 16(3),247-256.

Valdés G, Neves LA, Anton L, Corthorn J, Chacón C,

Germain AM, Merrill DC, Ferrario CM, Sarao R,

Penninger J and Brosnihan KB. Distribution of

angiotensin-(1-7) and ACE2 in human placentas of

normal and pathological pregnancies. Placenta, 2006;

(2-3),200-207.

Jing Y, Run-Qian L, Hao-Ran W, Hao-Ran C, Ya-Bin L,

Yang G and Fei C. Potential influence of COVID19/ACE2 on the female reproductive system. Mol

Hum Reprod, 2020; 26(6),367-373.

Shan T, Shang W, Zhang L, Zhao C, Chen W, Zhang Y and

Li G. Effect of angiotensin-(1-7) and angiotensin II

on the proliferation and activation of human

endometrial stromal cells in vitro. Int J Clin Exp

Pathol, 2015; 8(8),8948-8957.

Yi Y, Zhang Q, Li J, Xie S, Fu J, Li Y and Zhao J. The

association between SARS-CoV-2 infection with

menstrual characteristics changes in China: a crosssectional study. J Psychosom Obstet Gynaecol, 2023;

(1),2238243.

Phelan N, Behan LA and Owens L. The impact of the COVID-19 pandemic on women’s reproductive

health. Front Endocrinol (Lausanne), 2021;

,642755.

Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM,

Jacobs ET and Farland LV. SARS-CoV-2 infection

and subsequent changes in the menstrual cycle among

participants in the Arizona CoVHORT study. Am J

Obstet Gynecol, 2022; 226(2),270-273.


Full Text: PDF

Article Metrics

Abstract View : 452 times
PDF Download : 260 times

Refbacks

  • There are currently no refbacks.