Effect of COVID-19 on Menstruation and Lower Reproductive Tract Health

Figures & data

Figure 1 Schematic of study methods. COVID-19, coronavirus disease 2019.

Table 1 Demographic Characteristics of Child-Bearing Age Women with COVID-19

Characteristics	n	%
Age (years)
17–18	5	0.8
19–27	176	28.9
28–37	293	48.0
38–47	112	18.4
48–55	24	3.9
BMI (kg/m^2)
<18.5	102	16.7
18.5–23.9	397	65.1
24–26.9	65	10.7
27–29.9	27	4.4
≥30	19	3.1
Marital status
Single	236	38.7
Married	357	58.5
Divorced	17	2.8
Number of children
0	325	53.3
1	172	28.2
2	103	16.9
≥3	10	1.6
Smoking
Yes, currently smoke	24	3.9
No, have quit smoking	22	3.6
No, never smoked	564	92.5
COVID-19 Vaccine (dose)
0	44	7.2
1	17	2.8
2	138	22.6
3	391	64.1
4	20	3.3
Systemic underlying disease
Respiratory disease, such as COPD	4	0.7
Diabetes	5	0.8
Hypertension	11	1.8
Cardiovascular disease	3	0.5
Hepatopathy	5	0.8
Nephropathy	1	0.2
Thyroid gland disease	44	7.2
Malignant tumor	3	0.5
Other	12	2.0
None of the above, healthy	531	87
Gynecologic disease
Vaginitis	103	16.9
HPV infection	38	6.2
SIL (LSIL/HSIL)	7	1.1
Endometrial polyps	10	1.6
Uterine myoma	48	7.9
Submucosal myoma	1	0.2
Adenomyosis of uterus	9	1.5
Polycystic ovary syndrome	28	4.6
Ovarian cyst	26	4.3
Ovarian endometriosis	16	2.6
Pelvic inflammation disease	26	4.3
None of the above, healthy	382	62.6

Abbreviations: COPD, chronic obstructive pulmonary disease; SIL, Cervical squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion.

Table 2 Cross Tabulation of COVID-19 Infection Symptoms, Duration of Symptoms, Treatment, Mood Changes Following COVID-19 Infection and Time of Menstruation When COVID-19 Symptoms First Appeared

Characteristics	n (%)	p
COVID-19 symptoms		<0.001
Fever	543 (89)
Cough	466 (76.4)
Sore throat	353 (57.9)
Soreness all over	386 (63.3)
Fatigue	390 (63.9)
Reduced sense of smell and taste	236 (38.7)
Abdominal pain and diarrhea	75 (12.3)
Vomit	54 (8.9)
Chills	246 (40.3)
Light-headedness and headaches	305 (50)
Runny nose	283 (46.4)
Chest tightness	109 (17.9)
Shortness of breath or dyspnea	103 (16.9)
Lack of sleep	159 (26.1)
None of above	13 (2.1)
Body temperature		<0.001
Normal	45 (7.4)
37.3°C–38°C	121 (29.8)
38.1°C–39°C	282 (46.2)
39.1°C–41°C	130 (21.3)
No measurement	32 (5.2)
Treatment
No treatment	64 (10.5)	<0.001
Self-purchased medications (such as ibuprofen, cough suppressant and so on)	504 (82.6)
Hospitalization	4(0.7)
Other	38 (6.2)
Duration of symptoms
1–5 days	241 (39.5)	<0.001
6–10 days	257 (42.1)
11–15 days	88 (14.4)
16–30 days	18 (3.0)
≥31 days	6 (1.0)
Mental health symptoms
Significant stress	68 (11.1)	<0.001
Worry	70 (11.5)
Anxiety	133 (21.8)
Fear	30 (4.9)
Depression	38 (6.2)
Low mood	125 (20.5)
Irritability	90 (14.8)
Mood swing	57 (9.3)
Insomnia	137 (22.5)
Lighter sleep	142 (23.3)
Relax	11 (1.9)
No significant change	284 (46.6)
Menstrual time when COVID-19 symptoms first appeared
The first 2 days of menstruation/early menstruation	92 (15.1)	<0.001
Day 3–5 of menstruation/mid-Menstruation	26 (4.3)
Day 6–8 of menstruation/Late menstruation	22 (3.6)
Within 7 days after the end of menstruation/Ovulation	62 (10.2)
8–11 days after the end of menstruation	119 (19.5)
Within 7 days before the start of the next period	99 (16.2)
More than 1 month after last menstruation	31 (5.1)
Not paying attention or forgetting	161 (5.1)

Figure 2 The proportion of changes in menstruation during COVID-19 infection.

Figure 3 (A) Menstrual changes during COVID-19 Infection (menstrual cycle length, period duration and menstrual flow). (B) No significant changes in dysmenorrhea and non-menstrual bleeding during COVID-19. (C) Risk factors influencing menstrual changes during COVID-19 infection.

Table 3 Comparison of Participant’s Responses About the Effect of COVID-19 on Menstruation During COVID-19 Infection and After Recovery from COVID-19

	During COVID-19 Infection	After Recovery from COVID-19	p
Changes in menstruation (n/%)
Changes	91 (66.4%)	43 (31.4%)	<0.001
No changes	46 (33.6%)	94 (68.6%)
Menstrual cycle length (n/%)
Earlier menstrual cycle	43 (31.4%)	19 (13.9%)	<0.001
Prolonged <7 days	14 (10.2%)	7 (5.1%)
Prolonged 7–10 days	2 (1.5%)	5 (3.6%)
Prolonged >10 days	2 (1.5%)	2 (1.5%)
Unchanged	69 (50.4%)	100 (73.0%)
Did not notice or forgot	7 (5.1%)	4 (2.9%)
Period duration (n/%)
Shorter period	20 (4.6%)	10 (7.3%)	<0.001
Longer period	33 (24.1%)	13 (9.5%)
Unchanged	76 (55.5%)	109 (79.6%)
Did not notice or forgot	8 (5.8%)	5 (3.6%)
Menstrual flow (n/%)
Lighter flow	29 (21.2%)	16 (11.7%)	<0.001
Heavier flow	31 (22.6%)	12 (8.8%)
Unchanged	66 (48.2%)	103 (75.2%)
Did not notice or forgot	11 (8%)	6 (4.4%)
Non menstrual bleeding (n/%)
Mild bleeding	19 (13.9%)	10 (7.3%)	<0.001
Moderate bleeding	17 (12.4%)	4 (2.9%)
Heavy bleeding	6 (4.4%)	2 (1.5%)
Unchanged	91 (66.4%)	117(85.4%)
Did not notice or forgot	4 (2.9%)	4 (2.9%)
Dysmenorrhea (n/%)
Relieved	12 (8.8%)	2 (1.5%)	<0.001
Worsened	15 (10.9%)	7 (5.1%)
Unchanged	106 (77.4%)	123 (89.8%)
Did not notice or forgot	4 (2.9%)	5 (3.6%)

Figure 4 Trends in menstrual changes during COVID-19 infection and after recovery from COVID-19.

Figure 5 (A) Abnormality observed in lower genital tract during COVID-19 infection. (B) The risk factors contributing to the predominant abnormal observation of the lower genital tract during COVID-19 infection, estimated from the binary logistic regression.

Table 4 Time Required for Lower Reproductive Tract to Return to Pre-Infection in Women with Abnormal Lower Reproductive Tract Observations After COVID-19 Negativity (n=34)

Categories	n	%
Less than half month	1	2.9
Half month	7	20.6
1 month	9	26.5
2 months	8	23.5
Less than 1 month, not yet recovered	3	8.8
1 month, not yet recovered	3	8.8
2 months, not yet recovered	3	8.8