Real World Data Insights - How Long COVID is impacting female menstrual health

Community Insights - How Long COVID is impacting female menstrual health

In the aftermath of the COVID-19 pandemic, the ongoing challenges presented by prolonged COVID-19 infections and the long-term health implications continues to deliver a world-wide health crisis. While Long COVID (LC) risk factors such as a severe COVID-19 infection, underlying health conditions, age and female sex have been at the forefront of recent research, much less light has been shed on the correlation between? LC and female menstrual health.?

Since the early days of the pandemic, mama health has been working closely with a growing community of Italian patients to help improve our understanding of Long COVID using the patient’s own perspective. Here we are using novel data modeling techniques such as process mining to trace patient journeys and gather unique insights.

Women are considered to be more prone to LC (particularly around the age of 40),? outnumbering men with LC by as much as four to one. Among our own LC patient community at mama health, women account for the? dominant majority (80.5%). The role LC plays on female reproductive health, in particular on women who are menstruating or entering menopause, however, remains largely overlooked.?

Given that more than half of our community are aged between 30-50 years old, the majority therefore yet to reach menopause, we wanted to investigate whether LC could? be disproportionately affecting menstruating (premenopausal) women. This is a question of increasing interest among our LC community, leading us to create a recent survey for our mama heath members to delve further into how COVID-19 infections and the recovery process could differentially affect women.??

What does ‘menopause’ mean??

Menopause is a natural yet critical transition point in women’s health, with the risk of cardiovascular disease, type 2 diabetes, osteoporosis, obesity and dementia all increasing after menopause. Let us first refresh on some of the key definitions surrounding menopause and menstrual health. Women undergo a natural decline of reproductive hormones as they age, meaning that the ovaries slowly produce less of the hormones estrogen and progesterone, which regulate menstruation and fertility. Usually around age 45, this decline of hormones often causes women to begin to experience symptoms during a phase known as ‘perimenopause’.? Over the next few years, menstrual periods become shorter and more infrequent, until eventually stopping altogether. A woman has reached what we term menopause once they have stopped having their period for 12 months.?

A few of the more ‘tell-tale’ signs of going through menopause include hot flashes, difficulty sleeping, vaginal dryness and weight gain, as the body changes the way it consumes energy. However, reduced libido, energy levels, sleep quality as well as more sinister symptoms such as memory problems, anxiety and depression can also arise. It is important to realize that all women experience menopause differently because of variations in the body’s hormone production. This means that menopausal symptoms are difficult to clinically define, recognize and treat.??

Is it menopause? Or Long Covid??

Enter Long Covid. A newly-appearing chronic condition that, albeit being widely-recognized, is also difficult to define due to a high variability in symptoms. Common symptoms include fatigue, muscle aches, cognitive impairment and sleep disturbances, yet the exact mechanisms causing prolonged COVID-19 recovery are not yet clarified. What is clear, however, is the overlap of many typical LC and menopause symptoms, in particular changes in energy levels, sleep patterns, memory and concentration problems, as well as emotional health.? Given the high occurrence of LC in women on the brink of entering menopause, we need to raise the question as to whether there could be a correlation.?

Some research into the potential effect of COVID-19 women’s health has begun to emerge. A recent study highlighted the important clinical and immunological differences between sexes in acute COVID-19 infection. Here, women had lower mortality, lower levels of inflammation, higher lymphocyte counts, and faster antibody responses than men. Women who are close to the average age of menopause (around 50 years), have a higher prevalence of LC.? This raises the question of whether a decline in reproductive hormones as women age could affect their immune response to COVID-19, and impact their susceptibility to developing LC.??

What does our survey data say??

Menopausal symptoms:?

Data from our Italian LC community has already shown us the most commonly-associated symptoms. In our latest ‘Community Insights’ survey, we wanted to move our focus onto the menstrual symptoms women in our community are experiencing in relation to their COVID-19 Infection. Survey participants from our mama health cohort were divided according to the groups pre-menopause (below ages 35), perimenopause (above ages 35 and experiencing menopausal symptoms) and postmenopause (women without a menstrual period for 12+ months).?

Our survey showed differences in the menstrual symptoms experienced by LC community members according to their menopausal phases. Premenopausal women (below age 35) had higher rates of headaches, mood swings and concentration, while perimenopausal women had higher complaints of difficulty sleeping, irregular periods and change in libido.?

Some research has shown that premenopausal women with LC may experience worsening of menstrual symptoms and/or exacerbation of LC symptoms linked to menstrual cycle changes when compared to the general population of women without LC. One study found premenopausal women with LC to be reporting in particular menstrual cycle irregularities, heavier periods and reduced libido since their COVID-19 infection, aligning with the results of our survey.?

We found that around half of menstruating women yet to reach menopause began experiencing new menstrual and menopausal-like symptoms following their COVID-19 infection, with some? reporting that these symptoms only started following their second infection. and these at higher rates - could LC be influencing the onset of menopause??

Women with pre-existing menstrual or menopausal symptoms often reported that their symptoms worsened after COVID-19. One recurrent complaint was that the menstruation got more painful and irregular, and that no effective means were found to alleviate the symptoms, with or without support from healthcare professionals.?

Long COVID symptoms:

Following a COVID-19 infection, ongoing fatigue was the most common symptom reported by women in our mama health community across all menopausal stages (35-42%). As age increased, we found women approaching menopause were more likely to be experiencing joint pain, tiredness, difficulty walking and breathlessness. Tachycardia, chest pain and anxiety were experienced more frequently among premenopausal or perimenopausal women, compared to women who have already reached menopause.?

Breaking the menopause myths?

Menopause has long been a void in public and cultural discourse, meaning women starting to undergo a decline in reproductive hormones to either feel like they are invisible or don’t attribute their symptoms to menopause. Contributing to this problem is the fact that menopause is also heavily under-recognised and unter-treated by healthcare professionals, meaning that even if they were to go to the doctor with their symptoms, many women won’t receive the appropriate support and care they need. This is leaving many women are not aware of what to expect from menopause and feeling uninformed. A UK survey of more than 5,000 women experiencing menopause or perimenopause found that although 79% visited their GP about menopause symptoms, only 37% were offered menopausal hormone therapy. We also asked our mama health community if they had discussed the menopausal symptoms with their primary healthcare - 86% said no.?

Given suggestions in our survey findings that LC correlates with the onset as well as severity of menopausal symptoms, it is even more critical that women initiate the conversation around their symptoms with their healthcare provider. Regular check-ups are an important preventative healthcare measure - both during and after menopause - for an improved quality of life. Hormone replacement therapy (HRT) can be transformational in relieving menopausal symptoms, as well as help prevent cardiovascular disease and osteoporosis. Alternative treatments such as lifestyle modifications and cognitive behavior therapy (CBT) for helping to improve sleep and mood can also be considered.???

To summarize, we can see that LC has been impacting the menstrual health of women in our mama health community. Our recent survey has shown an exacerbation in menstrual symptoms among our female premenopausal patients following COVID-19 infections, as well as a general overlap between reported menopausal symptoms and LC symptoms. Research is urgently needed to better understand how LC impacts the menstrual cycle when the immune system is compromised, as well as how the menstrual cycle can drive LC symptom exacerbation.