Pandemic Stress Altered Many Women’s Menstrual Cycles

From the fear of getting sick to lockdown isolation, the COVID-19 pandemic dramatically increased stress levels, and for many women, the uptick led to changes in their monthly periods.

More than half of respondents to an online survey reported changes in their menstrual cycles during the pandemic, including differences in premenstrual symptoms and in the time between cycles and the duration of their bleeding.

“It is well-known that stress can cause changes in menstrual cycles, and these changes range from shorter or longer periods to heavier or lighter bleeding, and may cause women and people who menstruate to skip or miss a period altogether,” said study author Nicole Woitowich. She’s a research assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine, in Chicago.

“Stress-related menstrual cycle changes or irregularities … can be worrisome or cause added stress or uncertainty for the affected individuals, particularly for those who may monitor their menstrual cycle as a means of birth control or for those who are actively trying to conceive,” she said.

For the study, more than 200 menstruating women in the United States took part in an online survey between July and August 2020. They answered questions about stress levels during the pandemic and their menstrual cycles.

The more stress women felt when U.S. pandemic lockdowns began, the more pronounced their menstrual irregularities were, the study found. Women who reported high levels of stress were more likely to experience heavier bleeding and longer periods than women who were only moderately stressed out during the early part of the pandemic.

The study was recently published online in the Journal of Women’s Health.

The researchers described it as the first study in the United States to evaluate the impact of stress of menstrual periods. Prior studies have linked menstrual irregularities to mood disorders such as anxiety and depression, as well as acute stressors such as natural disasters, displacement or famine.

The findings mirror what Dr. Susan Khalil hears from many of her patients. She’s an assistant professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City, who reviewed the findings.

“When stress affects your menstrual cycle, it is harder to predict when you are fertile or are pregnant,” Khalil said. “It also makes it harder to resume trying to conceive as it’s difficult to predict ovulation, and this can add to the stress of trying to conceive.”

Many of Khalil’s patients are concerned that the COVID-19 vaccine will cause menstrual changes. “The vaccine is safe and has not been linked directly to changes in the endometrial lining, but this is a new area of exploration,” she said. Menstruation occurs when the lining of the uterus (endometrium) sheds.

“If you have more bleeding or concerns that your menstrual cycle has changed, see your physician as this opens up the conversation,” Khalil advised.

More information

The American Psychological Association offers healthy ways to cope with stress.

SOURCES: Nicole Woitowich, PhD, research assistant professor, medical social sciences, Northwestern University Feinberg School of Medicine, Chicago; Susan Khalil, MD, assistant professor, obstetrics, gynecology, and reproductive science, Icahn School of Medicine at Mount Sinai, New York City; Journal of Women’s Health, Sept. 28, 2021, online