Skip to main content
Download PDF
  • Systematic Review
  • Open access
  • Published:

Prevalence of menstrual alterations following COVID-19 vaccination: systematic review & meta-analysis

BMC Women's Health volume 24, Article number: 523 (2024) Cite this article

Abstract

Background

COVID-19 vaccines can lead to diverse local and systemic side effects, but there is limited evidence concerning their association with menstrual cycle changes. This study aimed to assess the prevalence of menstrual cycle alterations after COVID-19 vaccination among adult women.

Methods

We systematically searched the PubMed, Web of Science and Science Direct databases for observational studies that included adult women and investigated the range of menstrual alterations. The quality of the studies was evaluated via the Newcastle–Ottawa scale. All the data were analyzed via Comprehensive Meta-Analysis Software Version 4.0. Forest plots were created to calculate the individual and pooled prevalence rates of different types of menstrual changes and 95% confidence intervals (CI) via fixed-effects and random-effects models, as appropriate. Heterogeneity was assessed with Q statistics and the I2 test.

Results

Eleven studies, encompassing 26,283 adult women, met our eligibility criteria. Among the selected studies, five were cohort studies, five were cross-sectional studies, and one employed a case‒control design. The menstrual changes included abnormal cycle duration, dysmenorrhea, irregular cycles, and abnormal cycle flow (heavy and light flow), with pooled percentages of 27.3% (CI: 7.2–64.6%), 22% (CI: 5.2–59.4%), 16% (CI: 5.8–37.2%), 11.7% (CI: 5.8–22%), and 5.5% (CI: 2.3–12.5%), respectively.

Conclusions

This review highlights the prevalence of menstrual changes after COVID-19 vaccination and emphasizes the importance of considering menstrual health as an integral part of postvaccination monitoring and health care interventions. However, longitudinal studies are essential for establishing a definitive causal relationship between COVID-19 vaccination and menstrual alterations.

Peer Review reports

Background

The COVID-19 pandemic, which emerged in Wuhan, China, in December 2019, created a global health crisis. In response, researchers and public health officials have made substantial efforts to develop vaccines aimed at mitigating the impact of the virus [1]. By late 2020, several vaccines had been successfully developed and authorized for emergency use, resulting in their widespread distribution in early 2021 [2]. Vaccines have become the most effective method to curb the pandemic, leading to notable reductions in both the incidence of COVID-19 and associated mortality rates [3, 4]. Despite their effectiveness, vaccine uptake has been impeded by concerns regarding their efficacy, potential adverse effects, and safety, and the expedited nature of their development [5, 6].

Many studies have been conducted to assess the safety, efficacy, and potential adverse effects of COVID-19 vaccines [7, 8]. Among the observed adverse effects, menstrual cycle changes have emerged as a significant concern [9, 10]. This issue has been substantiated by reports from numerous women who experienced unexpected alterations in their menstrual cycles through the Vaccine Adverse Event Reporting System (VAERS) and social media [11, 12]. Furthermore, observational studies commonly reported longer or shorter menstrual cycles, increased irregularity, and heavier bleeding after COVID-19 vaccination [13, 14]. However, these changes were typically short-term and resolved spontaneously in approximately half of the cases [15, 16].

The National Institutes of Health (NIH) agreed to fund five institutes to explore a potential link between COVID-19 vaccination and menstrual cycle changes, including the underlying mechanisms [17]. This could have lead to greater interest from researchers in investigating the prevalence of menstrual changes following COVID-19 vaccination, but few studies have investigated the underlying mechanisms [18]. Thus, it is important to consolidate these diverse findings for a more comprehensive understanding of the impact of COVID-19 vaccination on the menstrual cycle [19]. Therefore, we performed this systematic review and meta-analysis to summarize the available qualitative and quantitative data from observational studies that investigated menstrual cycle changes associated with COVID-19 vaccination in adult women.

Objective

This systematic review was carried out to answer the following research question:

In adult women, is the use of the COVID-19 vaccine associated with menstrual cycle changes compared with no vaccination?

Methods

This review adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement [20].

Eligibility criteria

The criteria for considering relevant studies for this review were as follows:

  1. 1.

    Types of studies

We included observational studies on humans that investigated the association of the COVID-19 vaccine with menstrual changes, including cross-sectional, prospective or retrospective case‒control, or cohort studies. We excluded experimental in vitro studies, case reports, review articles, editorials, expert opinions, and preprinted articles. Randomized controlled trials (RCTs) were excluded because our study aimed to determine the pooled prevalence of menstrual changes caused by the COVID-19 vaccine. Additionally, vaccine trials did not prospectively collect data on menstrual health outcomes [21].

  1. 2.

    Types of participants

We included human studies in which participants were adult women aged 18–55 years who were otherwise healthy. We excluded studies with the following participant criteria: aged less than 18 years or more than 55 years; pregnant or lactating participants; participants with hormonal or other pathologies that might cause menstrual changes other than the potential effect of the COVID-19 vaccine.

  1. 3.

    Types of interventions

We sought studies in which participants received at least two doses of COVID-19 vaccines of any type.

  1. 4.

    Outcomes

We included studies examining a range of menstrual abnormalities, which included flow (heavy, light, normal), regularity (regular or irregular), duration of cycle (normal or abnormal), and presence of painful menstruation (dysmenorrhea), regardless of whether these changes were self-reported or clinically measured. We excluded studies that investigated the side effects of the COVID-19 vaccine in general and surveillance reports.

Information sources and search strategy

We systematically searched the PubMed, Science Direct, and Web of Science databases for articles published until July 2023. Moreover, we examined the references of the selected articles to find additional relevant articles. Three authors conducted an independent search via the following search terms: (“COVID-19 vaccine” AND “menstrual cycle” OR, “menstrual irregularities”); we also searched for the most widely used vaccine trade names (“Pfizer” OR “Janssen” OR “AstraZeneca” OR “Moderna”, AND “menstrual cycle” OR, “menstrual irregularities”). We also used the truncation (*) with the same root word (vaccine) to find additional research articles. We used truncation to ensure that all potential variants of the search term were found. No limits were applied to the search results except for studies in humans, publication type, or duration filters (2020–July 2023); however, no language restriction was used.

Selection and data collection process

The citations were retrieved via reference management software (Mendeley). Duplicate citations were removed. All the remaining studies underwent a thorough review process. Two authors independently assessed each study, and a third author reviewed all discrepancies to resolve any disagreements during the initial screening. The initial screening involved scrutinizing titles and abstracts against the predefined eligibility criteria. A structured data collection approach was adopted via a Google Excel spreadsheet (Supplementary Tables 1–4). This sheet included essential study information such as the author’s name, year of publication, country of origin, study design, sample size, participant age, inclusion criteria, exclusion criteria, administered vaccine, reported outcomes and results. This methodical process ensured the systematic compilation of relevant data from the selected studies.

Data items

All outcomes for which data were obtained were self-reported menstrual changes in terms of flow (heavy, normal, light), which was normal between 20 and 90 mL, approximately 1 and 5 tablespoons; regularity (interval variations between cycles, where the average is to have periods every 28 days); duration of menstruation (number of bleeding days, where normal is between 2 and 7 days); and duration of cycle (first day of period to the day before the next one, where normal is from 23 to 35 days). Studies have reported menstrual changes via different measurements, such as frequency and the risk ratio. Therefore, we have entered data on positive events to calculate individual and pooled event rates to ensure consistency.

Study risk of bias assessment

In this review, the methodological quality of various types of studies, including cohort and case‒control studies, was evaluated via the Newcastle–Ottawa scale [22]. For cross-sectional studies, a modified version of the Newcastle–Ottawa scale was used as suggested in a previous systematic review [23]. Two independent reviewers conducted the assessments, and a third reviewer resolved any disagreements through mutual consensus. Notably, the overall quality of the studies was not used as a basis for exclusion in this review. Instead, the primary focus was on conducting a comprehensive assessment of postvaccination menstrual changes across the selected studies.

Synthesis methods

All the data were analyzed via Comprehensive Meta-Analysis Software Version 4.0. Forest plots were created to calculate the individual and pooled prevalence of different types of menstrual disorders, 95% confidence intervals (CIs) were calculated for both fixed effects and random effects, and heterogeneity was assessed with Q statistics and the I2 test. The cutoff values for the I2 statistic were used to classify heterogeneity as very low (0–25%), low (25–50%), moderate (50–75%), or high (> 75%). Publication bias was assessed via funnel plots and Begg’s adjusted rank correlation test. A P value < 0.10 was considered to indicate publication bias.

Results

Study selection

The PubMed search produced 65 articles, the Web of Science search yielded 54 articles, and ScienceDirect provided 330 articles. A manual search for relevant articles resulted in the identification of 14 articles. After excluding articles that did not meet the inclusion criteria and removing duplicate citations, 83 articles were identified for thorough retrieval and examination. At this stage, three articles were excluded because they were preprints [24,25,26]. Among the remaining 80 articles, 69 were excluded for several reasons related to participants, interventions, study design, and scope of the studies. These included studies that involved adolescents, peri/postmenopausal, breastfeeding, and pregnant women; studies with unclear pregnancy and/or lactation status; studies that involved women with known hormonal or pathological conditions that affect menstruation; studies with unspecified menstrual changes; studies with unstated COVID-19 vaccine types; studies that reported COVID-19-related adverse events, including menstrual changes, without specifying the type of change; and other reasons, such as study design (experimental, quasiexperimental, mixed-method) or studies of menstrual changes with different scopes, such as fertility and endometriosis. Thus, 11 studies were included for the final review, synthesis of evidence, and assessment of the risk of bias [27,28,29,30,31,32,33,34,35,36,37]. The process of selection and exclusion is shown in the PRISMA flow chart (Fig. 1).

Fig. 1
figure 1

PRISMA flowchart

Full size image

Study characteristics

The 11 studies that were selected included 26,283 participants. Among the selected studies, diverse research designs were used. Specifically, five studies adopted a cohort design; one study employed a case‒control approach. Additionally, five studies utilized a cross-sectional design. For details of the study design, participant demographics, type of vaccine administered, and specific outcomes, please refer to Table 1 for a comprehensive overview.

Table 1 Study characteristics
Full size table

Risk of bias in studies

Assessment of quality for the five cohort studies revealed one study of good quality (7 points), whereas the remaining studies were of fair quality (3–4 points) owing to a lack of unexposed controls, ascertainment of exposure, and adequate follow-up. On the other hand, one cross-sectional study was of fair quality (5 points), whereas four studies were of poor methodological quality (2–4 points) owing to the lack of information on nonrespondents, ascertainment of exposure to the COVID-19 vaccine, and assessment of outcomes via self-reports. The details are shown in Tables 2, 3, and 4.

Table 2 Quality assessment of studies using the Newcastle‒Ottawa scale for assessing cohort studies
Full size table
Table 3 Quality assessment of studies using the Newcastle‒Ottawa scale for assessing case‒control studies
Full size table
Table 4 Quality assessment of studies using a modified Newcastle‒Ottawa scale for assessing cross-sectional studies
Full size table

Key findings on menstrual cycle changes associated with COVID-19 vaccination

The studies included in our analysis did not provide data on the overall prevalence of menstrual cycle changes. Instead, they provide information specific to various types of menstrual alterations. Therefore, we generated multiple forest plots categorizing menstrual cycle changes into irregular cycles, abnormal cycle duration, abnormal menstrual flow, and dysmenorrhea.

Prevalence of irregular cycles after COVID-19 vaccination

Seven studies were included in the analysis of the incidence of irregular circulation cycles after COVID-19 vaccination. Overall, the pooled prevalence was 16% (95% CI: 5.8–37.2%). There was high heterogeneity among the included studies (I2 = 100%; Q = 2576; P value < 0.001), as shown in the forest plot (Fig. 2). However, no publication bias was found in any of the studies (p = 0.440) according to Begg’s adjusted rank correlation test.

Fig. 2
figure 2

Forest plot of irregular cycles after COVID-19 vaccination

Full size image

Prevalence of abnormal cycle duration after COVID-19 vaccination

Figure 3 shows the forest plot for the pooled prevalence of abnormal cycle duration after COVID-19 vaccination. Four studies were included in the analysis of the prevalence of abnormal cycle duration after COVID-19 vaccination. Overall, the pooled prevalence was 27.3% (95% CI: 7.2–64.6%). There was highly significant heterogeneity among the included studies (I2 = 100%; Q = 2658; P value < 0.001). No publication bias was found in any of the studies (p = 0.248) via Begg’s adjusted rank correlation test.

Fig. 3
figure 3

Forest plot of abnormal cycle duration after COVID-19 vaccination

Full size image

Prevalence of abnormal menstrual flow after COVID-19 vaccination

Figure 4 shows the forest plot for the pooled prevalence of heavy flow after COVID-19 vaccination, in which seven studies were included. Overall, the pooled incidence was 11.7% (95% CI: 5.8–22%), and there was highly significant heterogeneity among the included studies (I2 = 100%; Q = 1116; P value < 0.001). No publication bias was found in any of the studies (p = 0.326) via Begg’s adjusted rank correlation test. Furthermore, five studies were included in the analysis of the prevalence of light menstrual flow after COVID-19 vaccination. Overall, the pooled prevalence was 5.5% (95% CI: 2.3–12.5%). There was highly significant heterogeneity among the included studies (I2 = 99%; Q = 317; P value < 0.001). No publication bias was found in any of the studies (p = 0.312) via Begg’s adjusted rank correlation test.

Fig. 4
figure 4

Forest plot of heavy menstrual flow after COVID-19 vaccination

Full size image

Prevalence of dysmenorrhea after COVID-19 vaccination

Figure 5 shows the forest plot for the pooled prevalence of painful menstruation (dysmenorrhea) after COVID-19 vaccination, in which five studies were included for data analysis. Overall, the pooled prevalence was 22.1% (95% CI: 5.2–59.4%). There was highly significant heterogeneity among the included studies (I2 = 100%; Q = 3764; P value < 0.001). No publication bias was found in any of the studies (p = 0.164) via Begg’s adjusted rank correlation test.

Fig. 5
figure 5

Forest plot of dysmenorrhea after COVID-19 vaccination

Full size image

Discussion

The results of our systematic review and meta-analysis highlight the potential association of COVID-19 vaccination with menstrual cycle changes among adult women. We observed that more than one quarter of women experienced abnormal cycle duration, followed by dysmenorrhea in approximately 22% of women, while abnormal menstrual cycle length and flow were less common. When these findings are compared with the literature on menstrual alterations related to COVID-19 vaccination, our results align with and add context to previous observations [38]. One large prospective study indicated that women who received the COVID-19 vaccine experienced a slight increase in the menstrual cycle length of less than one day after both the first and second doses [21]. Individuals who received the vaccine during the follicular phase of their menstrual cycle were more likely to experience cycle length disturbances than those who received it during the luteal phase [39].

The current review revealed a lower prevalence of heavy menstrual flow than did another meta-analysis, which reported that menorrhagia was the most frequently observed menstrual change, with a pooled prevalence of 24.24% [40]. However, our findings might be explained by novel data suggesting that decreased menstrual volume and a prolonged cycle are consequences of SARS-CoV-2 infection independent of its severity [41], and four of our included studies involved patients with prior COVID-19 disease [27, 31, 34, 35]. In contrast, a recently published systematic review and meta-analysis did not find a significant difference in the risk of adverse menstrual events between women who received the COVID-19 vaccine and those who did not, but the evidence is limited by significant heterogeneity and a high risk of bias in the included studies [42].

Moreover, the reporting in this SR was limited to certain outcomes; for example, the duration of menstrual changes and linked vaccine type were reported in three prospective cohort studies that followed participants for sufficient periods. Overall, menstrual changes are temporary and typically last for one to two menstrual cycles postvaccination [31, 33, 36]. One recent study revealed that participants who received the booster vaccine dose had an average cycle duration of 1.20 days longer (95% CI: 1.00–1.40), which persisted from the second to the fourth cycle after receiving the mRNA vaccine [43]. When the vaccination types were compared, the group that received only CoronaVac reported a higher rate of menstrual irregularities than did the groups that received both CoronaVac and BioNTech, with 32.2% and 19.1%, respectively (p = 0.033) [36]. Sensitivity analyses comparing menstrual cycle changes by vaccine brand did not significantly vary among the vaccinated cohorts that received the Pfizer-BioNTech vaccine (55%), the Moderna vaccine (35%), or the Johnson & Johnson/Janssen vaccine (7%) [33].

Although the current review did not explore potential causal relationships, it is important to note that various pandemic-related factors can lead to temporary changes in the menstrual cycle [44]. Several intrinsic mechanisms have been proposed to clarify the link between significant immune challenges, such as vaccination, and the menstrual cycle [45, 46]. These mechanisms involve immune activation in response to diverse stimuli, including immunological influences on the hormones that regulate the menstrual cycle [47, 48]. Furthermore, immune cells in the uterine lining play crucial roles in the build-up and breakdown of this tissue during each menstrual process [49]. Other extrinsic factors that could contribute to menstrual changes include stress related to the pandemic, lifestyle changes due to the pandemic, and infection with SARS-CoV-2 [18, 50]. Reaching a definitive conclusion regarding the direct link between these changes and a specific type of COVID-19 vaccine presents a significant challenge. This challenge arises from various factors, including differences in study designs, research methods, and subjectivity in reporting these outcomes. Moreover, early assessments of adverse events in COVID-19 vaccine trials were focused primarily on systemic and major adverse events [51, 52].

This review was based on an extensive search, pooling data from studies with different populations, and applying strict eligibility criteria to eliminate studies with potential confounding factors. We calculated both individual event rates and combined event rates via appropriate statistical methods. These qualities can be considered strengths of the analysis. Thus, this study may provide valuable insights into menstrual alterations in adult women after COVID-19 vaccination. Nevertheless, it is essential to interpret the results cautiously due to certain limitations. First, there was a moderate to high risk of bias for some of the included studies, owing to the study design, reliance on self-reported outcomes, short follow-up periods, and lack of control groups. Second, we observed significant heterogeneity in our findings, likely stemming from several factors, including variations in sample size, differences in sampling methods, the diverse nature of the populations studied, and variations in settings and vaccine administration.

Currently, we have sufficient evidence from studies over the past three years indicating the association of the COVID-19 vaccine with temporary menstrual cycle alterations in adult women. However, the exact mechanisms remain unclear; therefore, experimental studies are warranted to determine the temporal link between the COVID-19 vaccine and menstrual cycle changes. The following criteria might optimize the study design and strengthen outcomes: (1) recruitment of unvaccinated controls; (2) inclusion of different age categories, e.g., adolescents and perimenopausal women; (3) the establishment of clinical measures for menstrual characteristics; (4) adequate follow-up of not less than one year after exposure to the COVID-19 vaccine series/booster dose; (4) adjustment for other factors that contribute to menstrual changes.

Finally, it is important to consider the menstrual cycle as a crucial indicator of women’s health and not merely fertility/pregnancy-related health. Thus, efforts should be made to increase the awareness of health care providers regarding the latest evidence of the impact of the COVID-19 pandemic on women’s health. Moreover, women’s concerns about vaccination should be addressed, and proper counseling based on the available evidence should be provided. With respect to public health considerations, although menstrual cycle changes are potential side effects of COVID-19 vaccination, they should not discourage vaccination. Additionally, mechanisms of reporting and monitoring of menstrual health outcomes for future COVID-19 vaccination programs should be strengthened.

Conclusions

This systematic review consolidates the growing body of evidence regarding the potential association of COVID-19 vaccination with menstrual cycle alterations, highlighting abnormal cycle duration and dysmenorrhea as more commonly reported than other menstrual cycle characteristics. However, the evidence is limited by a moderate risk of bias and heterogeneity among the included studies. Thus, further trials are needed to explore causal relationships. While these observed menstrual variations prompt significant considerations for women’s health and health care practices, vaccination continues to be advised for women of reproductive age.

Data availability

No datasets were generated or analysed during the current study.

References

  1. Chi WY, Li YD, Huang HC, et al. COVID-19 vaccine update: vaccine effectiveness, SARS-CoV-2 variants, boosters, adverse effects, and immune correlates of protection. J Biomed Sci. 2022;29(1):82.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rahman MA, Islam MS. Early approval of COVID-19 vaccines: pros and cons. Hum Vaccines Immunotherapeutics. 2021;17(10).

  3. Han X, Xu P, Ye Q. Analysis of COVID-19 vaccines: types, thoughts, and application. J Clin Lab Anal. 2021;35(9).

  4. Patel R, Kaki M, Potluri VS, Kahar P, Khanna D. A comprehensive review of SARS-CoV-2 vaccines: Pfizer, Moderna & Johnson & Johnson. Human Vaccines and Immunotherapeutics. 2022;18(1).

  5. Roy DN, Biswas M, Islam E, Azam MS. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: a systematic review. PLoS ONE. 2022;17(3):e0265496.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Adu P, Poopola T, Medvedev ON, Collings S, Mbinta J, Aspin C, et al. Implications for COVID-19 vaccine uptake: a systematic review. J Infect Public Health. 2023;16(3):441–66.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Toubasi AA, Al-Sayegh TN, Obaid YY, Al-Harasis SM, AlRyalat SAS. Efficacy and safety of COVID-19 vaccines: a network meta-analysis. J Evidence-Based Med. 2022;15(3).

  8. Beladiya J, Kumar A, Vasava Y, Parmar K, Patel D, Patel S, Dholakia S, Sheth D, Boddu SHS, Patel C. Safety and efficacy of COVID-19 vaccines: a systematic review and meta-analysis of controlled and randomized clinical trials. Rev Med Virol. 2024;34(1):e2507.

    Article  CAS  PubMed  Google Scholar 

  9. Zhang B, Yu X, Liu J, Liu J, Liu P. COVID-19 vaccine and menstrual conditions in female: data analysis of the vaccine adverse event reporting system (VAERS). BMC Women’s Health. 2022;22(1):403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chao MJ, Menon C, Elgendi M. Effect of COVID-19 vaccination on the menstrual cycle. Front Med (Lausanne). 2022;9:1065421.

    Article  PubMed  Google Scholar 

  11. Wong KK, Heilig CM, Hause A, Myers TR, Olson CK, Gee J, Marquez P, Strid P, Shay DK. Menstrual irregularities and vaginal bleeding after COVID-19 vaccination reported to v-safe active surveillance, USA in December, 2020-January, 2022: an observational cohort study. Lancet Digit Health. 2022;4(9):e667–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Katz A, Tepper Y, Birk O, Eran A. Web and social media searches highlight menstrual irregularities as a global concern in COVID-19 vaccinations. Sci Rep. 2022;12(1):17657.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wang S, Mortazavi J, Hart JE, Hankins JA, Katuska LM, Farland LV, Gaskins AJ, Wang YX, Tamimi RM, Terry KL, Rich-Edwards JW, Missmer SA, Chavarro JE. A prospective study of the association between SARS-CoV-2 infection and COVID-19 vaccination with changes in usual menstrual cycle characteristics. Am J Obstet Gynecol. 2022;227(5):739.e1-739.e11.

    Article  CAS  PubMed  Google Scholar 

  14. Bisgaard Jensen C, Bech BH, Hansen SN, Rask CU, Fink P, Nielsen H, Meinertz Dantoft T, Thysen SM, Rytter D. Prevalence of and risk factors for self-reported menstrual changes following COVID-19 vaccination: a Danish cohort study. Hum Reprod. 2023;38(9):1825–34.

    Article  CAS  PubMed  Google Scholar 

  15. Laganà AS, Veronesi G, Ghezzi F, Ferrario MM, Cromi A, Bizzarri M, Garzon S, Cosentino M. Evaluation of menstrual irregularities after COVID-19 vaccination: results of the MECOVAC survey. Open Med (Wars). 2022;17(1):475–84.

    Article  PubMed  Google Scholar 

  16. Laganà AS, Lukanovič D, Noventa M, Margioula-Siarkou C, Terzic S, Chiantera V. Menstrual cycle changes after COVID-19 vaccination or infection: not two sides of the same coin. Evid Based Nurs. 2023;26(3):110–1.

    Article  PubMed  Google Scholar 

  17. Shriver EK. (2021). Item of Interest: NIH funds studies to assess potential effects of COVID-19 vaccination on menstruation. https://www.nichd.nih.gov/newsroom/news/083021-COVID-19-vaccination-menstruation. Accessed 8 Aug 2024.

  18. Dellino M, Vimercati A, D’Amato A, Damiani GR, Laganà AS, Cicinelli E, Pinto V, Malvasi A, Scacco S, Ballini A, Resta L, Ingravallo G, Maiorano E, Cazzato G, Cascardi E. GONE WITH THE WIND: the transitory effects of COVID-19 on the Gynecological System. J Pers Med. 2023;13(2):312.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sharp GC, Fraser A, Sawyer G, Kountourides G, Easey KE, Ford G, Olszewska Z, Howe LD, Lawlor DA, Alvergne A, Maybin JA. The COVID-19 pandemic and the menstrual cycle: research gaps and opportunities. Int J Epidemiol. 2022;51(3):691–700.

    Article  PubMed  Google Scholar 

  20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Reviews. 2021;10(1):89.

    Article  Google Scholar 

  21. Edelman A, Boniface ER, Male V, et al. Association between menstrual cycle length and covid-19 vaccination: global, retrospective cohort study of prospectively collected data. BMJ Med. 2022;1:e000297.

    Article  PubMed  PubMed Central  Google Scholar 

  22. The Ottawa Hospital Research Institute (no date) Ottawa Hospital Research Institute. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed: 6 Aug 2023.

  23. Herzog R, et al. Is Healthcare Workers’ intention to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Alvergne A, Kountourides G, Argentieri MA, Agyen L, Rogers N, Knight D, Olszewska Z. COVID-19 vac-cination and menstrual cycle changes: a United Kingdom (UK) retrospective case–control study. MedRXiv, 2021–11.

  25. Zhang B, Yu X, Liu J et al. COVID-19 vaccine and menstrual conditions in female: data analysis of the vaccine adverse event reporting system, 07 April 2022, PREPRINT (Version 2) available at Research Square [https://doi.org/10.21203/rs.3.rs-1388159/v2]

  26. Gibson EA, Li H, Fruh V, Gabra M, Asokan G, Jukic AMZ, Baird DD, Curry CL, Fischer-Colbrie T, Onnela JP, Williams MA, Hauser R, Coull BA, Mahalingaiah S. Covid-19 vaccination and menstrual cycle length in the Apple Women’s Health Study. medRxiv [Preprint]. 2022 Jul 10:2022.07.07.22277371.

  27. Farland LV, Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, et al. COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertil Steril. 2023;119(3):392–400.

    Article  CAS  PubMed  Google Scholar 

  28. Matar SG, Nourelden AZ, Assar A, Bahbah EI, Alfryjat AM, Hasabo EA, et al. Effect of COVID-19 vaccine on menstrual experience among females in six arab countries: a cross-sectional study. Influenza Other Respir Viruses. 2023;17(1):e13088.

    Article  CAS  PubMed  Google Scholar 

  29. Namiki T, Komine-Aizawa S, Takada K, Takano C, Trinh QD, Hayakawa S. The association of three doses of the BNT162b2 mRNA vaccine with abnormal bleeding and an irregular menstrual cycle among premenopausal females: a single institute observation study. J Obstet Gynecol Res. 2022;48(11):2903–10.

    Article  CAS  Google Scholar 

  30. Quejada L, Toro Wills MF, Martínez-Ávila MC, Patiño-Aldana AF. Menstrual cycle disturbances after COVID-19 vac-cination. Womens Health (Lond). 2022.

  31. Edelman A, Boniface ER, Benhar E, Han L, Matteson KA, Favaro C, et al. Association between Menstrual cycle length and coronavirus disease 2019 (COVID-19) vaccination: a U.S. Cohort. Obstet Gynecol. 2022;139(4):481–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Trogstad L, Laake I, Robertson AH, Mjaaland S, Caspersen IH, Juvet LK, et al. Heavy bleeding and other menstrual disturbances in young women after COVID-19 vaccination. Vaccine. 2023;41(36):5271–82.

    Article  PubMed  Google Scholar 

  33. Wesselink AK, Lovett SM, Weinberg J, Geller RJ, Wang TR, Regan AK, et al. COVID-19 vaccination and menstrual cycle characteristics: a prospective cohort study. Vaccine. 2023;41(29):4327–34.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kumar N, Gangane N, Mohapatra I, Rukadikar C, Sharmila V, Pushpalatha K, et al. Effect of COVID-19 vaccination on menstrual cycle patterns of Reproductive age women: a multicentric observational study. Curr Drug Res Re-views. 2023;16(1):101–12.

    Google Scholar 

  35. Alvergne A, Kountourides G, Argentieri MA, Agyen L, Rogers N, Knight D, et al. A retrospective case–control study on menstrual cycle changes following COVID-19 vaccination and disease. iScience. 2023;26(4):106401.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hasdemir PS, Senol Akar S, Goker A, Kosova F, Ucar D, Ozalp Ates FS, et al. The effect of COVID-19 vaccinations on menstrual cycle and serum anti-mullerian hormone levels in reproductive age women. Hum Fertility. 2023;26(1):153–61.

    Article  CAS  Google Scholar 

  37. Kajiwara S, Akiyama N, Baba H, Ohta M. Association between COVID-19 vaccines and the menstrual cycle in young Japanese women. J Infect Chemother. 2023;29(5):513–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nazir M, Asghar S, Rathore MA, Shahzad A, Shahid A, Ashraf Khan A, Malik A, Fakhar T, Kausar H, Malik J. Menstrual abnormalities after COVID-19 vaccines: a systematic review. Vacunas. 2022;23:S77–87.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Payne LA, Wise LA, Wesselink AK, et al. Association between COVID-19 vaccination and menstruation: a state of the science review. BMJ Sex Reproductive Health. 2024;50:212–25.

    Article  Google Scholar 

  40. Al Kadri HM, Al Sudairy AA, Alangari AS, Al Khateeb BF, El-Metwally AA. COVID-19 vaccination and menstrual dis-orders among women: findings from a meta-analysis study. J Infect Public Health. 2023;16(5):697–704.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lebar V, Laganà AS, Chiantera V, Kunič T, Lukanović D. The Effect of COVID-19 on the Menstrual cycle: a systematic review. J Clin Med. 2022;11(13):3800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Peinemann F, Oberle D, Drechsel-Bäuerle U, Keller-Stanislawski B. Adverse menstrual events reported after and before (or without) COVID-19 vaccination: a systematic review and Meta-analysis of comparative observational studies. Pharmacoepidemiol Drug Saf. 2024;33(8):e5877.

    Article  PubMed  Google Scholar 

  43. Hosoya S, Piedvache A, Nakamura A, Nasu R, Hine M, Itoi S, Yokomizo R, Umezawa A, Hiraike O, Koga K, Osuga Y, Narumi S, Morisaki N. Prolongation of the menstrual cycle after receipt of the primary series and booster doses of mRNA coronavirus Disease 2019 (COVID-19) vaccination. Obstet Gynecol. 2024;143(2):284–93.

    Article  CAS  PubMed  Google Scholar 

  44. Tayyaba Rehan S, Imran L, Mansoor H, Sayyeda Q, Hussain HU, Cheema MS, Tahir MJ, Asghar MS, Mahmmoud Fadelallah Eljack M, Islam MS. Effects of SARS-CoV-2 infection and COVID-19 pandemic on menstrual health of women: a systematic review. Health Sci Rep. 2022;5(6):e881.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Minakshi R, Rahman S, Ayaggari A, Dutta D, Shankar A. Understanding the trauma of Menstrual Irregularity after COVID Vaccination: a bird’s-Eye View of Female Immunology. Front Immunol. 2022;13:906091.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Li S, Liu H, Li D, Chen F. Female reproductive health during the COVID-19 pandemic: latest evidence and understanding. Arch Gynecol Obstet. 2023;308(6):1691–6.

    Article  PubMed  Google Scholar 

  47. Skelly DT, Harding AC, Gilbert-Jaramillo J, Knight ML, Longet S, Brown A, et al. Two doses of SARS-CoV-2 vaccination induce robust immune responses to emerging SARS-CoV-2 variants of concern. Nat Commun. 2021;12(1):5061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Hajjo R, Momani E, Sabbah DA, Baker N, Tropsha A. Identifying a causal link between prolactin signaling pathways and COVID-19 vaccine-induced menstrual changes. NPJ Vaccines. 2023;8. 10.1038/s41541-023-00719-6.

  49. Monin L, Whettlock EM, Male V. Immune responses in the human female reproductive tract. Immunology. 2020;160(2):106–15.

    Article  CAS  PubMed  Google Scholar 

  50. Mitra A, Verbakel JY, Kasaven LS, Tzafetas M, Grewal K, Jones B, Bennett PR, Kyrgiou M, Saso S. The menstrual cycle and the COVID-19 pandemic. PLoS ONE. 2023;18(10):e0290413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Beatty AL, Peyser ND, Butcher XE, Cocohoba JM, Lin F, Olgin JE, Pletcher MJ, Marcus GM. Analysis of COVID-19 vaccine type and adverse effects following vaccination. JAMA Netw Open. 2021;4(12):e2140364.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Graña C, Ghosn L, Evrenoglou T, Jarde A, Minozzi S, Bergman H, Buckley BS, Probyn K, Villanueva G, Henschke N, Bonnet H, Assi R, Menon S, Marti M, Devane D, Mallon P, Lelievre JD, Askie LM, Kredo T, Ferrand G, Davidson M, Riveros C, Tovey D, Meerpohl JJ, Grasselli G, Rada G, Hróbjartsson A, Ravaud P, Chaimani A, Boutron I. Efficacy and safety of COVID-19 vaccines. Cochrane Database Syst Rev. 2022;12(12):CD015477.

    PubMed  Google Scholar 

Download references

Funding

This research was funded by Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2024R289), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Author information

Authors and Affiliations

  1. Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh, 11671, Saudi Arabia

    Abeer Al Shahrani

  2. College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

    Norah Alhumaidan, Lama Alzelfawi, Lena AlDosari & Zeena Alhindawi

  3. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Nahlah Alotaibi & Renad Aljohani

Authors
  1. Abeer Al Shahrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norah Alhumaidan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lama Alzelfawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lena AlDosari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zeena Alhindawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nahlah Alotaibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renad Aljohani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

“Conceptualization, A.A.; methodology, N.A2, L.A, and Z.A.; data curation, N.A3, L. A, and R.A.; writing—original draft preparation, A.A, and L.A.; Statistical analysis and synthesis: Dr. Ahmed Hassan (Biostatistician). N.A2 , N.A3 and R.A. prepared all Tables, Z.A prepared Figs. 1, 2, 3, 4 and 5. All authors have read and agreed to the published version of the manuscript.”

Corresponding author

Correspondence to Abeer Al Shahrani.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al Shahrani, A., Alhumaidan, N., Alzelfawi, L. et al. Prevalence of menstrual alterations following COVID-19 vaccination: systematic review & meta-analysis. BMC Women's Health 24, 523 (2024). https://doi.org/10.1186/s12905-024-03349-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-024-03349-9

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us