Endocrine Abstracts

Background: The combined effect of the COVID-19 pandemic and associated restrictions have adversely affected population mental health. Periods of psychological distress can induce menstrual dysfunction. We previously demonstrated a significant disruption in women’s reproductive health during the first 6 months of the pandemic. The present study investigates longer term reproductive and mental health disturbances.

Materials and Methods: An online survey was distributed through social media in April 2021. The survey included measures of depression (PHQ-9), anxiety (GAD-7) and sleep quality (Pittsburgh Sleep Quality Index). All women of reproductive age were invited to participate.

Results: 1335 women responded to the survey. Median age was 34 years (range 29-38). 966 (77%) recorded their menstrual cycles. 581(56%) reported an overall change in their menstrual cycle since the beginning of the pandemic. There was no change in the median cycle length (28 days (28-30)) or days of menses (5 (4-5)), but there was a wider variability in the minimum (P < 0.0001) and maximum (P < 0.0001) cycle length. There was a significant increase in menorrhagia (P < 0.0001), dysmenorrhoea (P < 0.0001) and missed periods (P < 0.0001) compared to pre-pandemic. 64% of women reported worsening pre-menstrual symptoms. 54% had a reduction in their libido. Rates of severe depression, anxiety and poor sleep were more than double those from large scale representative community samples. Poor sleep quality was an independent predictor of overall change in menstrual cycle (OR=1.11, 95%CI 1.05-1.18), and missed periods (OR=1.11, 95%CI 1.03-1.19) during the pandemic. Increased anxiety was an independent risk factor for change from non-painful to painful periods (OR=1.06, 95%CI 1.01-1.11) and worsening of pre-menstrual symptoms (OR=1.06, 95%CI 1.01-1.07) during the pandemic.

Conclusion: The COVID-19 pandemic continues to bear a significant impact on female reproductive health. Increased levels of psychological distress and poor sleep are associated with menstrual cycle disruption.