Long Covid affects menstrual cycle, study shows

Women with long-term COVID experience significantly more heavy or irregular periods than women without long-term COVID-19 symptoms. This is according to new research published this week in the scientific journal Nature Communications .

The researchers show that long Covid not only causes fatigue, shortness of breath and concentration problems, but also affects the menstrual cycle and the uterine lining.

"Long Covid is much more than just a respiratory disease," says researcher Victoria Male of Imperial College London. "The disease also affects women's reproductive systems, and that deserves more attention."

Long Covid can disrupt the menstrual cycle, but the phase of that cycle also appears to influence the severity of Long Covid symptoms.

In a large survey of more than 12,000 women, participants with long-term COVID were almost twice as likely to report heavy or prolonged bleeding than women who had not been ill. About one in six reported bleeding between cycles.

A smaller diary study of 54 women showed that fatigue, headaches, and dizziness increased more frequently around menstruation. A third, biological study found inflammatory responses in the uterine lining and subtle hormonal shifts—while ovarian function itself remained intact.

The researchers suspect that chronic inflammation plays a significant role in the impact on the cycle. After a COVID-19 infection, immune cells in the uterine lining can remain overactive. This disrupts the balance between hormones and blood vessels.

"The uterine lining is very sensitive to immune and hormonal changes," Male explains. "Our findings suggest that long-term COVID can disrupt that delicate balance."

During the pandemic, many women reported changes in their menstrual cycles after infection, but such symptoms were often dismissed as stress-related. This new study provides the first biological evidence that long COVID is indeed linked to menstrual disruptions.

Although the symptoms are not life-threatening, they can significantly impact daily life. Heavy or prolonged bleeding increases the risk of iron deficiency and fatigue, problems that often already occur with long COVID.

The researchers advocate for greater awareness of this issue within the medical community. Doctors should routinely discuss menstrual changes with women experiencing long-term COVID symptoms. Many studies on long-term COVID haven't yet included this data, even though it's crucial for a proper understanding of the disease. "We can't treat long-term COVID effectively if we ignore half the population."

Women experiencing persistent symptoms after a COVID-19 infection are advised to monitor their menstrual pattern. Heavier bleeding, a longer menstrual period, or bleeding between cycles are signs worth discussing with a doctor. GPs are advised to be alert to these symptoms and, if necessary, to check women for iron deficiency or hormonal imbalances.

Although the link has now been firmly established, it remains unclear whether long Covid is the direct cause of the menstrual changes or whether underlying immunological factors play a role. The researchers want to investigate in follow-up studies whether anti-inflammatory drugs or hormonal therapies can help to restore the cycle.