COVID-19 Pandemic Stress Affected Ovulation, Not Menstruation

Disorders in ovulation that did not cause any real changes in the menstrual cycle of women were extremely common during the first year of the COVID-19 pandemic and were linked to emotional stress, according to the findings of a “nature experiment” that made it possible made. for comparison with women a decade earlier.

Findings from two studies of women of childbearing age, one conducted in 2006-2008 and the other in 2020-2021, were presented by Jerilynn C. Prior, MD, at ENDO 2022: The Endocrine Society Annual Meeting.

The comparison of the two periods yielded several new findings. “I was taught in medical school that when women do not eat enough, they lose their period. But what we now understand is that there is a graded response to various stressors, acting through the hypothalamus in a common path. There is a rating of disorders, some of which are subclinical or not obvious, ”said Prior, Professor of Endocrinology and Metabolism at the University of British Columbia, Vancouver, Canada.

In addition, women’s menstrual cycle lengths did not differ over the two periods, despite a dramatic 63% decrease in normal ovulatory function associated with increased depression, anxiety, and stress from outside that the women reported in diaries.

“Accepting that regular cycles require normal ovulation is something we just have to get out of our minds. It changes our concept of what is normal if we only know about the cycle length,” she observed.

It will be critical in the future to see if the ovulatory disorders resolve as the pandemic shifts “because there is strong evidence that ovulatory disorders, even with normal cycle length, are associated with bone loss and some evidence that they are related to early heart attacks, breast and endometrial cancers, “Prior told a news conference.

Asked to comment, session moderator Genevieve Neal-Perry, MD, PhD, said Medscape Medical News: “I think what we can take away is that stress itself is a modifier of the way the brain and the gonads communicate with each other, and that then has an impact on ovulatory function.”

Neal-Perry noted that the association of stress and ovulatory disruption has been previously reported in several ways, but “it clearly does not affect everyone. What we do not know is who is most susceptible. There are some studies that a genetic predisposition and a genetic disorder that actually makes them more susceptible to the impact of stress on the reproductive system. “

But the lack of data on weight change in the study cohorts is a limitation. “For me, one of the more important questions going on with weight was. Just looking at a static number does not tell you if there have been any changes. We know that weight gain or weight loss can emphasize the reproductive axis,” Neal noted. -Parry from the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, Chapel Hill.

Experiment of nature Reveals invisible effect of pandemic stress

The women in both cohorts of the Menstrual Ovulation Study (MOS) were healthy volunteers between the ages of 19-35 who were recruited from the Vancouver metropolitan area. All menstruated monthly and none took hormonal birth control. Recruitment for the second cohort began just before the March 2020 COVID-19 pandemic closure.

Interviewer-administered questionnaires (CaMos) covering demographics, socioeconomic status, and reproductive history, and daily diaries kept by the women (menstrual cycle diary) were identical for both cohorts.

Assessments of ovulation differed for the two studies, but were cross-validated. For the earlier period, ovulation was assessed by a threefold increase in follicular-to-luteal urinary progesterone (PdG). For the pandemic-era study, the validated quantitative basal temperature (QBT) method was used.

There were 301 women in the earlier cohort and 125 during the pandemic. Both had an average age of about 29 years and had a body mass index of about 24.3 kg / m2 (within the normal range). The pandemic cohort was more racially / ethnically diverse than the previous one and more in line with recent census data.

More of the women were nulliparous during pandemic than before (92.7% vs 80.4%; P = .002).

The distribution of menstrual cycle lengths did not differ, with both cohorts averaging about 30 days (P = .893). Although 90% of the women in the earlier cohort ovulated normally, only 37% during the pandemic, a highly significant difference (P <.0001).

Thus, during the pandemic, 63% of women had “silent ovulatory disorders”, either with short luteal phases after ovulation or no ovulation, compared to only 10% in the earlier group, “which is remarkable, actually unbelievable,” Prior noted. .

The difference was also not explained by any of the demographic information collected, including socioeconomic status, lifestyle, or reproductive history variables.

And this was not due to COVID-19 vaccination, as the vaccine was not available when most of the women were recruited, and of the 79 recruited during vaccine availability, only two had a COVID vaccine. 19 vaccine received during the study (and both had normal ovulation).

Employment changes, caring responsibilities and worries probable causes

The information from the diaries was more revealing. Several diary components were much more common during the pandemic, including negative mood (feeling depressed or anxious, sleep problems and stress from outside), self-esteem, interest in sex, energy level and appetite. All were significantly different between the two cohorts (P <.001) and between those with and without ovulatory disorders.

“So menstrual cycle lengths and long cycles did not differ, but there was a much higher incidence of silent or subclinical ovulatory disorders, and this was related to the increased stress that women recorded in their diaries. This means that the estrogen levels were reasonable close to normal, but the progesterone levels have dropped remarkably, ”Prior said.

Interestingly, reported menstrual cramps were also significantly more common during the pandemic and associated with ovulatory disruption.

“This is a new observation, because before, we always thought you needed to ovulate to even have cramps,” she said.

Asked whether COVID-19 itself may have played a role, Prior said no woman in the study tested positive for the virus or had COVID for a long time.

“As far as I’m aware, it was the changes in employment … and caring for the elderly and worrying about illness in someone you loved related,” she said.

Asked what she thought would be the result if the study were done now, she said: “I do not know. We are still in a stressful time with inflation and not fully recovered, so most likely the issue is still very much present. . “

Prior and Neal-Perry reported no relevant financial ratios.

ENDO 2022. Presented June 12, 2022.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog and Diabetes Forecast magazine. She’s on Twitter: @MiriamETucker.

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