Reena Khanna (name changed), a teacher, who got infected with COVID-19 in August 2020, didn’t get her periods on time that month. But the problem persisted and now she regularly gets delayed periods coupled with “unusual clotting”. “Now, my periods are usually delayed by 10 days and beyond,” she said. Similarly, Muskan Arora, a student, had just got her periods when she tested positive for the respiratory infection. “Since I already had a fever and was weak, my periods were very painful with irregular flow. But after testing positive for Covid, I got heavy flow on the first day, hardly any flow on the second, and then third day was the heaviest, which is unlike my usual cycle when I often have heavy flow on the first two days and it gets lighter thereon,” she said, adding that after recovering, she “didn’t get periods the following month”.

Something similar was shared by Dr Sumaiya Shaikh, a neuroscientist, on Twitter, when she posed a question to women about their menstrual cycles post-Covid while recalling her own experience. “Not only did the onset of mentruation trigger a longer low, motivation less, energy less phase (severe depression), what I really started to notice was the length + amount of the menstruation. And the occurrence of blood clots that lasted for days,” she shared on Twitter.

TW & thread: COVID-19, menstruation & depression

Gynaecologists, Obstetrics & women that have recovered from COVID-19:

(Or keen beaners of Covid-19)

Women, How were your menstrual cycles post COVID-19 recovery? Want to know what may have happened?

Read on… 1/n

— Dr Sumaiya Shaikh (@Neurophysik) July 8, 2020

Highlighting how mental health and women’s period-related problems are “hushed because we should suck it and move on”, she stated that because it was “unspoken, it lacked efficient female support and clinical support. At the start, I couldn’t even link it to Covid-19,” she shared.

Missed periods during the course of infection, irregular cycles after recovery, spotting, heavy flows, abnormally longer period duration are some of the issues women have reported related to their menstrual cycle amid pandemic.

Delayed periods or irregular flow are often associated with stress and anxiety. Could that be a reason? “Stress is directly associated with women’s menstrual patterns. It has so much to do with female hormones, uneven cycle, pain during periods, mood swings, unnecessary fatigue etc. Hence it’s not surprising if women are complaining about such experiences. Also, women are forced to manage household work and office work together, many even don’t get a helping hand at home. Hence, stress generated in such environments can massively affect a woman’s overall wellbeing including menstrual patterns,” said Dr Renu Gupta, senior consultant, obstetrics and gynecology, Sri Balaji Action Medical Institute.

Concurred Dr Anubha Singh, gynecologist and IVF specialist from Shantah Fertility Centre, who said, “Stress itself is well-known to cause period irregularities by disrupting the hypothalamic-pituitary ovarian axis- the hormonal system the brain uses to speak to the ovaries. Stress also causes hormonal imbalance and even PCOS (Polycystic Ovary Syndrome) in women. If you had been borderline PCOS all along, this stress induced by the pandemic might push you over to the other side.”

While Dr Shaikh agreed it could be a stress-induced temporary change, “blood clots bleeding/heavy bleeding was found in people post-Covid”. “Since Covid affects many organs of the body including intestines, kidneys, walls of the artery which affects one’s blood pressure, in women, what happens is when you have inflammation in the body, the blood vessels swell up which does not let the blood release. We don’t have a lot of research around menstrual cycles in general. And till now, Covid and the menstrual cycle have not been studied, so, therefore, there is no clarity yet,” Dr Shaikh described to indianexpress.com.

Dr Shobha Gupta, medical director of Mother’s Lap IVF Centre, said, “Many patients have informed us their menstrual cycles were also affected by the stress of pandemic and the various practices such as work-from-home becoming additional pressures. ”

“Women, ever since the beginning of the pandemic, have shared that their periods are irregular whether or not they have been infected with Covid 19. Nevertheless, many psychiatrists and psychologists have given their own arguments about the issue that this problem doubles in women who live in stress and depression,” she mentioned.

Dr Vaishali Joshi, obstetrician and gynaecologist, Kokilaben Ambani Hospital, Mumbai, however, stated Covid infection “doesn’t affect menstrual cycle or flow”. “Any viral illness, unless it is severe or critical, usually doesn’t affect periods or hormones,” she said.

So, what could be the possible reasons for a ‘noticeable’ change in periods?

Arora, who was supposed to get her periods two days ago, blames “anxiety and weakness coupled with no workout” to be what has led to a “major hormonal imbalance in my body”.

“As your whole body is coping with the pressure of Covid infection and in recovering stage, you can very well expect that it will interfere in your cycles, too. Stress can increase the imbalance of insulin in the body which causes the secretion of the leptin hormone. Women who used to cycle period within the first 30 days, now their cycle can be delayed by 7-8 days or even more. This is called oligomenorrhea,” said Dr Shweta Goswami, senior consultant, gynecologist and IVF specialist from Jaypee Hospital and Zeeva Fertility Noida.

Can lack of routine activities like sleep pattern, eating habits, physical activity have an impact on periods?

Dr Joshi believes so. “Healthy lifestyle, which includes regular exercises and balanced diet is the most important factor in women’s health. Weight-bearing exercises keep bones strong and weight in check which prevents hormonal imbalances,” she said.

Obesity leads to an increase in lipid profile which affects the menstrual hormone ratio. Even in PCOD, increased fat increases the level of testosterone hormone which surely affects the right ratio of female hormones, said Dr Renu.

While Dr Singh suggests that “one or two delayed or changed periods should not cause too much anxiety”, she recommends women talk to their gynecologist.

“It is apt to let your doctor know that you have had some menstrual irregularities. They may wish to perform some tests such as blood counts to check for anaemia, possible pregnancy or thyroid disorder,” she said.

So, what should you be doing? Experts recommend one key factor in reducing stress levels is coming to terms with the fact that the current situation is not in anyone’s hands, and working on oneself is really the best way to deal with it. Try and make a fixed routine for your day, eat healthy foods, sleep on time, and try to be happy as much as possible. Do not take stress unnecessarily. Help is there and do not panic.

Dr Renu suggested the following tips:

*Positive outlook — Although the situation is tough, we all are supposed to fight back. It is alright to get mentally affected by the pandemic but it is also necessary to maintain mental sanity. Keep your mental health prime which is associated with one’s overall wellbeing.
*Meditation — Make a schedule for meditation. Take some peaceful time out of your schedule to calm your mind down. It helps to rejuvenate the mind. Pranayama, breathing exercises can help.
*Nutrition — Take good care of nutrition. Avoid eating unhealthy. Lack of nutrition can make you anaemic which can affect bleeding patterns during periods. Take iron and calcium-rich food.
*Exercise — As a sedentary lifestyle has already somehow restricted body movement, one should balance it with exercises. There are exercises which can be done in confined rooms. Do stationary jogging in front of an open window; opt for some yoga postures under the proper supervision of an expert.
*E-consultation — Many of us are fortunate to have an internet connection and necessary gadgets at home. Hence, make the best use of it for your health. Be in touch with your doctor through online platforms if already suffering from any severe disease.

“Never ignore uneven menstrual cycle. If you are experiencing heavy bleeding, spotting, unnecessary fatigue, abnormal delay in period dates, then consult a doctor and start the prescribed treatment without delay,” she said.

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