Since the pandemic, a number of women have reported period disturbances after SARS-CoV-2 infection or the vaccine, but research has often minimised the relevance of such symptoms – and until recently, any association between long Covid and menopause has been scarce.
While a 2022 systematic review of research found that women can experience a range of symptoms after a Covid jab, including temporary increased bleeding and longer and more painful periods, studies specifically on long Covid and menopause have been mostly preliminary.
So far, the evidence collected is primarily anecdotal, but the medical profession is becoming increasingly interested in what could be growing proof of a link between the two.
One example involves a 42-year old US woman who, when she stopped menstruating in March 2022, wasn’t particularly concerned, reports STAT News.
Daryn Schwartz had recently come off birth control, and thought her cycles were still adjusting. When her periods hadn’t returned several months later, she sought gynaecological care, but was told to wait it out. So she did, with no changes.
She was having other symptoms, too, like fatigue, chronic pain and difficulty focusing. She would forget names and even words.
Eventually, a doctor told her she was going through menopause – despite having none of the risk factors for early menopause. She started hormone replacement therapy, but felt worse.
She eventually consulted Traci Kurtzer, a gynaecologist and menopause specialist at Northwestern Medicine Centre for Sexual Medicine and Menopause, who validated Schwartz’s feeling that something was off. “I don’t think this is just a naturally occurring spontaneous menopause,” Kurtzer told her.
Lab results found markers for autoimmune disease, and Epstein-Barr virus. “I think this is long Covid,” said Kurtzer. Schwartz had tested positive for the Covid-19 in December when the Omicron variant was dominant.
Kurtzer is one of the few menopause specialists working on the possible ties between long Covid and menopause. Awareness of the impact of the viral infection on the female reproductive system is gaining more attention, though.
Schwartz was hardly the first of her patients with such symptoms. Since the onset of the pandemic, Kurtzer has noticed a troubling trend among patients who had been diagnosed with Covid-19.
“I’ve seen a change in the number of women with earlier menopausal symptoms, and the severity of symptoms is more intense than it used to be,” she said. “And I’m seeing menopausal women – who have been menopausal for years and stable, whether on hormones or not – starting to have symptoms again.”
Other period disturbances include irregular and heavy bleeding, both after Covid-19 infections and vaccines, though those typically resolve more quickly.
Kurtzer believes most of these issues, which can improve and even resolve themselves in weeks or months, although sometimes linger, are linked to some ovarian abnormality caused by the viral infection.
Earlier this year, Kurtzer was asked to join specialists working at the Northwestern Medicine Comprehensive Covid-19 Centre. “The physicians there who are quote-unquote long Covid physicians started to recognise, first, that most of the patients they were seeing were women or people with ovaries. And two, it was not unusual for them to hear reports of menstrual changes or menopausal-type symptoms,” she said.
Kurtzer, too, experienced long Covid, with symptoms including fibrosis of her heart, damage to her lungs, and extreme fatigue.
Despite her initial hesitation in joining the roster of specialists at Northwestern, mainly due to the toll long Covid has taken on her, she decided to see patients at the clinic.
Even with limited treatment options and no full understanding of the mechanism causing menstrual and fertility disruptions after Covid, Kurtzer said being part of the long Covid clinic gives her a chance to better help her patients.
Since she sees many women who experience menopause-like symptoms, she is able to identify what indeed is menopause, and what may be long Covid, as in Schwartz’s case.
“Certainly peri-menopause and menopause symptoms have a lot of overlap with a lot of the other long Covid symptoms,” she said.
But she has ways to distinguish, such as looking out for post-exertional malaise, which is very different from the fatigue caused by menopause, or noticing significant weight loss – rare in menopause.
Unfortunately, the help she can offer is limited. As she knows from her own experience, a long Covid diagnosis doesn’t come with a treatment. Sometimes symptoms improve marginally with hormone therapy, although for some they don’t.
“All I can do right now is say some of your symptoms may also be related to your ongoing long Covid symptoms. And right now, there are no approved treatments for long Covid. So it means just symptomatic management,” she said.
With that can come help from other specialists at the clinic, as well as important acknowledgement of symptoms that can often be puzzling, as well as debilitating for patients.
“On the one hand, just having some answers was validating and helpful and eased a lot of my fears,” said Schwartz. “But on the other hand, to know there is no quote-unquote cure, there’s no specific treatment for long Covid, that’s frustrating.”
Why does it happen?
“It’s very clear that some people, after SARS-CoV-2 infection … start having menstrual irregularities or some pain and other symptoms. Why is this really happening? We don’t really know,” said Ziyad Al-Aly, a clinical epidemiologist at Washington University who studies long Covid.
Three years ago, he said, he would have been quite uncertain about any link between long Covid and earlier or worsening menopause symptoms. Now he sees this as an important, if still overlooked, area of research.
“There is not a lot of research in this area,” he said. Al-Aly thinks Kurtzer’s working hypothesis that the cause may be damage inflicted to the ovaries by the Covid virus is worth exploring.
He added that the investment in trying to understand the mechanism leading to reproductive health symptoms – in women and, often less visibly, in men – has been insufficient so far.
“I think it’s a more important problem than we’re paying attention to. And … there are pockets where people are paying attention to it – but I emphasise the word pockets. You don’t see … in any way …the amount of research that is needed to help us more deeply understand what’s happening,” he said.
See more from MedicalBrief archives:
Confronting America’s next national health disaster: long-haul COVID-19
Covid vaccines linked to vaginal bleeding – Norwegian analysis
UK reports 30,000 “yellow card” menstrual-related vaccination occurrences
COVID-19 vaccination and menstrual cycle – global cohort study