COVID-19 vaccination and menstrual cycle changes: A United Kingdom (UK) retrospective case-control study

There has been increasing public concern that COVID-19 vaccines cause menstrual cycle disturbances, yet there is currently limited data to evaluate the impact of vaccination on menstrual health. Our objectives were (1) to evaluate the prevalence of menstrual changes following vaccination against COVID-19, (2) to test potential risk factors for any such changes, and (3) to identify patterns of symptoms in participants’ written accounts.

Methods We performed a secondary analysis of a retrospective online survey titled “The Covid-19 Pandemic and Women’s Reproductive Health”, conducted in March 2021 in the UK before widespread media attention regarding potential impacts of SARS-CoV-2 vaccination on menstruation. Participants were recruited via a Facebook ad campaign in the UK and eligibility criteria for survey completion were age greater than 18 years, having ever menstruated and currently living in the UK. In total, 26,710 people gave consent and completed the survey. For this analysis we selected 4,989 participants who were pre-menopausal and vaccinated. These participants were aged 28 to 43, predominantly from England (81%), of white background (95%) and not using hormonal contraception (58%).

Findings Among pre-menopausal vaccinated individuals (n=4,989), 80% did not report any menstrual cycle changes up to 4 months after their first COVID-19 vaccine injection. Current use of combined oral contraceptives was associated with lower odds of reporting any changes by 48% (OR = 0.52, 95CI = [0.34 to 0.78], P<0.001). Odds of reporting any menstrual changes were increased by 44% for current smokers (OR = 1.16, 95CI = [1.06 to 1.26], P<0.01) and by more than 50% for individuals with a positive COVID status [Long Covid (OR = 1.61, 95CI = [1.28 to 2.02], P<0.001), acute COVID (OR = 1.54, 95CI = [1.27 to 1.86], P<0.001)]. The effects remain after adjusting for self-reported magnitude of menstrual cycle changes over the year preceding the survey. Written accounts report diverse symptoms; the most common words include “cramps”, “late”, “early”, “spotting”, “heavy” and “irregular”, with a low level of clustering among them.

Conclusions Following vaccination for COVID-19, menstrual disturbance occurred in 20% of individuals in a UK sample. Out of 33 variables investigated, smoking and a previous history of SARS-CoV-2 infection were found to be risk factors while using oestradiol-containing contraceptives was found to be a protective factor. Diverse experiences were reported, from menstrual bleeding cessation to heavy menstrual bleeding.

Competing Interest Statement
The authors have declared no competing interest.

Funding Statement
The British Academy