The effect of COVID-19 vaccination on the menstrual pattern and mental health of the medical students: A mixed-methods study from a low and middle-income country

Consensus recommendations for measuring the impact of contraception on the menstrual cycle in contraceptive clinical trials

OBJECTIVE

We sought to develop consensus recommendations for measurement and analysis of data on contraceptive-induced menstrual changes (CIMCs) in contraceptive clinical trials. We built upon previous standardization efforts over the last 50 years and prioritized input from a variety of global experts and current regulatory authority guidance on patient-reported outcomes.

STUDY DESIGN

We completed a formal consensus-building process with an interdisciplinary group of 57 experts from 30 organizations and 14 countries in five global regions who work across academia, nonprofit research organizations, the pharmaceutical industry, and funding agencies. Smaller topical working groups drafted and revised recommendations.

RESULTS

We developed 44 consensus recommendations, including research approaches to establish the evidence for future improvement in the measurement and analysis of CIMC data and guidance for investigators to implement presently. Priority recommendations call for simplification of terminology to make measurement accessible and patient-centered, accounting for intrinsic and extrinsic factors that may impact outcomes during study design and recruitment, standardized data collection of primary CIMC and acceptability outcomes, and harmonized approaches for analysis of these data, including addressing missing data.

CONCLUSION

By virtually convening a large group of global experts working across disciplines and sectors via a formal methodology, we developed consensus recommendations that will improve the current and future measurement and analysis of CIMC data in contraceptive clinical trials. Using these standardized approaches will permit valid and reliable contraceptive product labeling on CIMC outcomes that matter to users and greater comparability across trials that can inform clinical guidance and contraceptive counseling.

IMPLICATIONS

Consensus recommendations on measuring bleeding changes and related outcomes in contraceptive clinical trials can improve reporting of standardized, patient-centered outcomes in future product labeling. These improvements can enable healthcare providers to offer more relevant guidance on contraceptives and users to make more informed decisions about their choice of method.

Susceptibility to Infection and Impact of COVID-19 Vaccines on Symptoms of Women with Endometriosis: A Systematic Review and Meta-Analysis of Available Evidence

Women with endometriosis were deemed more prone to COVID-19 infection in some reports. Considering that endometriosis-related aberrant immune response, understanding how COVID-19 vaccination influences its clinical status is crucial. The aim of this meta-analysis was the evaluate the susceptibility to COVID-19 infection and modifications of symptoms following COVID-19 vaccination in women with endometriosis. Electronic searches on EMBASE, MEDLINE, Scopus, Cochrane at CENTRAL, Scielo.br, LILACS and other databases were searched from inception to March 2024. Studies were eligible if they analyzed the incidence of infection in endometriosis women or the changes in symptoms after two doses of COVID-19 vaccine and had a control group. Four studies (2249 women) were included. No increased susceptibility to COVID-19 infection due to presence or absence of endometriosis was retrievable (risk ratio (RR) 1.42 [95% CI 0.88 to 2.27]; I2 = 33%). Patients with endometriosis did not experience an overall worsening of symptomatology relative to controls (RR 1.58 [95% CI 0.67 to 3.75]; I2 = 94%). An increase in the risk of dysmenorrhea worsening was noted (RR 1.88 [95% CI 1.11 to 3.17]; I2 = 63%). No other differences regarding menstrual flow (RR 1.25 [95% CI 0.70 to 2.23]; I2 = 78%), intermenstrual bleeding (RR 1.14 [95% CI 0.83 to 1.56]; I2 = 39%) and pelvic pain (RR 2.55 [95% CI 0.65 to 10.05]; I2 = 80%) compared to controls was retrievable. Therefore, mRNA vaccines do not seem to lead to worsening of symptomatology in endometriotic women. However, a slight temporary increase in dysmenorrhea may be present. Moreover, endometriosis does not seem to increase the risk of contracting COVID-19.

Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials

Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.

Hospital Español de Pachuca Research Group, Licona-Meníndez RD, Peón AN. Anti-COVID-19 Vaccination Alters the Menstrual Cycle and Dose Accumulation Enhances the Effect

Background and Objectives: New investigations have detected an enhanced probability for women to develop menstrual cycle alterations after anti-COVID-19 vaccination. Moreover, given that the protective immunity provided by anti-COVID-19 vaccination appears to wane quickly, booster vaccination has been recommended. Nonetheless, whether adverse events arise from such repeated immunization has not been studied. Materials and Methods: We studied the incidence of menstrual cycle alterations, the quantity of menstrual cycle alterations per subject, and of altered menstrual cycles in nonpregnant women of fertile age after anti-COVID-19 vaccination in a cohort of vaccinated female subjects by the means of a standardized questionary that was applied via telephone calls each month. Subjects that received up to four doses were studied for 6 months after each dose. We calculated the odds ratio for enhanced incidence, as well as quadratic functions for the tendencies. A sensitivity analysis excluding subjects taking hormonal birth control and those with polycystic ovary syndrome was performed. Results: Anti-COVID-19 vaccination enhanced the probability to develop menstrual cycle alterations (OR 1.52, CI at 95% 1.2-1.8, p < 0.0001) and, interestingly, such a tendency was enhanced when subjects received more doses (R2 = 0.91). Furthermore, the same trends repeated for the quantity of alterations per subject, and of altered cycles. Such an effect was further demonstrated to be independent upon the vaccine brand being applied, the birth control status, and the diagnosis of polycystic ovary syndrome. Conclusions: Vaccination is the most cost-effective measure for primary prevention and is considered to be safe. Nonetheless, in this article, we show data that suggest that repeated vaccination of adult female subjects may lead to an enhanced incidence of menstrual cycle-related adverse events, quantity of alterations per subject, and altered cycles. We therefore think that the development of new vaccine formulations that produce longer-lasting immunity is of paramount importance to reduce the potential for dose accumulation-dependent enhanced risk.

The Evaluation of Menstrual Alterations in Mexican Women After Vaccination Against COVID-19

Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the vaccine. The evaluation of these alterations in women with the same and multiple vaccination schedules will provide valuable information. Methods An observational, cross-sectional study was carried out; data were collected through a survey of 164 vaccinated women at the American British Cowdray (ABC) Santa Fe Medical Center Hospital in Mexico City. The survey was validated by the Delphi method. Results The survey was applied from March 2023 to February 2024. Post-vaccination menstrual alterations occurred in 48.1%; the most frequent alteration was menorrhagia in 20.7% and pain accompanied by menstruation in 27.4%. Fifty-seven percent had a history of previous COVID-19 infection. There were no significant associations between changes in menstrual bleeding after vaccination, history of COVID-19 infection, and age group (p>0.9). However, women who received multiple doses of vaccines had a higher risk of suffering abnormalities in bleeding by 36.6%. Conclusion The incidence of menstrual disorders in this study post COVID-19 vaccination was 49%. Menstrual alterations in patients who received multiple doses and a single regimen were similar at 47% and 48%, where there is no statistical significance. The greatest number of menstrual alterations was seen in the first dose at 36%, probably due to the immunity they acquired after the different types of vaccination. Vaccination is a very effective way to prevent the severity of COVID-19 infection; it has an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving the first dose of the vaccine had changes in the amount of bleeding specifically the amount.

COVID-19 vaccine side effects on menstrual disturbances among Iranian women

Background

Many studies reported of menstrual disturbances as possible side effects of COVID-19 vaccination. Our objective was to evaluate the association between vaccination and the occurrence of menstrual disturbances among Iranian women.

Methods

We used to google form questionnaires to collect reports of menstrual disturbances from 455 women aged 15-55 years in Iran. We estimated the relative risk of menstrual disturbances according to vaccination in a self-controlled case-series design after vaccination. We examined the occurrence of such disorders after the first, second and third doses of vaccine.

Results

Findings The prevalence of menstrual disturbance was more in latency and heavy bleeding than others disorder after vaccination, although ֮ %50 of women doesn't have any disturbance. We observed increased risks after vaccination also for other menstrual disturbances, in menopausal women too (>10%).

Discussion

Menstrual disturbances were generally common regardless of vaccination. We found a significant increase in menstrual disturbances after vaccination, particularly for latency and heavier bleeding than usual, longer duration and for short interval between menstruations. Mechanisms underlying these findings may involve bleeding disturbances in general, as well as endocrine alterations of immune system stimulation and relation to hormonal secretion.

Effects of Different Types of COVID-19 Vaccines on Menstrual Cycles of Females of Reproductive Age Group (15-49): A Multinational Cross-Sectional Study

Background Globally, there are more than 474 million cases and around 6 million deaths due to COVID-19. The case fatality rate was 0.5-2.8% while for 80-89 years old, it was 3.7-14.8%. Given the seriousness of this infection, prevention becomes critical. Hence, the introduction of vaccines led to a significant reduction (> 75% protection) in COVID-19 cases. On the other hand, patients seeking help for serious pulmonary, cardiovascular, neurological, and gynecological complaints have also been recorded. Clinical studies on the effects of vaccination focused mostly on life-or-death results rather than reproductive outcomes such as menstruation, fertility, or even pregnancy outcomes. This survey was conducted to get more evidence on the association between menstrual cycle irregularities and some globally most prevalent COVID-19 vaccines. Methods An online cross-sectional survey was conducted by a team from Taif University, Kingdom of Saudi Arabia, from January to June 2022 on females within the reproductive age group (15-49 years) using a semi-structured questionnaire. Data were analyzed using SPSS Statistics version 22.0 and presented as frequency and percentage. The chi-square test was applied for the association and a p-value of <0.05 was considered significant. Results A total of 2381 responses were included. The mean age of respondents was 25±7.7 years. Around 1604 (67%) participants observed post-vaccination menstrual changes, and the findings were significant (p< 0.001). A strong association (p=.008) was found between the type of vaccine and changes in the menstrual cycle in participants (AstraZeneca 11 (36%)) after one dose. A strong association (p=.004) was also seen between the type of vaccine (Pfizer 543 (83%)) and menstrual changes after the booster dose. Cycles became irregular 180 (36%) or prolonged 144 (29%) in females inoculated with Pfizer after two doses of vaccination (p=0.012). Conclusion Post-vaccination menstrual irregularities were reported by females of reproductive age, especially the new vaccines. Prospective studies for similar insights are needed. Finding the co-occurring impacts of vaccination and COVID-19 infections in the wake of the emerging new long-haul COVID-19 phenomena is crucial for reproductive health.