Abstract
Objectives . Our objectives were (1) to evaluate the prevalence of menstrual changes following vaccination against COVID-19, (2) to test potential risk factors for any such changes, and (3) to identify patterns of symptoms in participants' written accounts. Design . A secondary analysis of a retrospective online survey titled The Covid-19 Pandemic and Women's Reproductive Health , conducted in March 2021 in the UK before widespread media attention regarding potential impacts of SARS-CoV-2 vaccination on menstruation. Setting . Participants were recruited via a Facebook ad campaign in the UK. Participants . Eligibility criteria for survey completion were age greater than 18 years, having ever menstruated and currently living in the UK. In total, 26,710 people gave consent and completed the survey. For this analysis we selected 4,989 participants who were pre-menopausal and vaccinated. These participants were aged 28 to 43, predominantly from England (81%), of white background (95%) and not using hormonal contraception (58%). Main outcome measure . Reports of any menstrual changes (yes/no) following COVID-19 vaccination and words used to describe menstrual changes. Results . Among pre-menopausal vaccinated individuals (n=4,989), 80% did not report any menstrual cycle changes up to 4 months after their first COVID-19 vaccine injection. Current use of combined oral contraceptives was associated with lower odds of reporting any changes by 48% (OR = 0.52, 95CI = [0.34 to 0.78], P<0.001). Odds of reporting any menstrual changes were increased by 44% for current smokers (OR = 1.16, 95CI = [1.06 to 1.26], P<0.01) and by more than 50% for individuals with a positive COVID status [Long Covid (OR = 1.61, 95CI = [1.28 to 2.02], P<0.001), acute COVID (OR = 1.54, 95CI = [1.27 to 1.86], P<0.001)]. The effects remain after adjusting for self-reported magnitude of menstrual cycle changes over the year preceding the survey. Written accounts report diverse symptoms; the most common words include 'cramps', 'late', 'early', 'spotting', 'heavy' and 'irregular', with a low level of clustering among them. Conclusions . Following vaccination for COVID-19, menstrual disturbance occurred in 20% of individuals in a UK sample. Out of 33 variables investigated, smoking and a previous history of SARS-CoV-2 infection are found to be risk factors while using oestradiol-containing contraceptives was found to be a protective factor. Diverse experiences were reported, from menstrual bleeding cessation to heavy menstrual bleeding.