Northwestern Medicine conducted a survey to evaluate the impact pandemic stress has on women’s menstrual cycles, which is the first U.S. study to evaluate the impact of pandemic stress on periods.
The COVID-19 pandemic has had a major effect on our lives. As the pandemic and the resulting economic recession have negatively affected many people’s mental health as well as created new barriers for those already suffering from mental illness or substance use disorders.
Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make us feel isolated and lonely and can increase both stress and anxiety. During the pandemic, about 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder. Intense feelings of fear, uncertainty, and anxiety related to the pandemic, in addition with the disruption of daily routines and behaviors spawned a global secondary mental health crisis.
The pandemic has introduced persistent psychosocial stressors for many individuals, with emerging gender differences that suggest women may be at a greater risk for poorer mental health outcomes. Women in particular have higher prevalence of anxiety, depression, and other stress-related disorders imparted by biological and social determinants to health.
According to the U.S. Bureau of Labor Statistics, the number of unemployed people in the United States is 6.8 million greater in October 2020 than in February 2020, with women disproportionately affected, particularly those who identify as Black, Latina, or disabled.
Therefore, the detrimental impacts of the pandemic on women's mental health may have additional unintended health consequences we are not aware of yet.
At baseline, disadvantage has been associated with worse mental and physical health in women. This may have unintended consequences for women’s overall health and well-being, including disruptions to the reproductive function as elevated stress is often associated with menstrual cycle irregularities. The objective of this study was to determine if, and how the pandemic and its related stressors have impacted women’s menstrual cyclicity.
Reports of disruptions in menstrual cyclicity were reported in the popular press during the pandemic although there is little to no data that exists to confirm these reports. In order to address a possible association between stress during the pandemic and women’s reproductive health, Northwestern Medicine developed a retrospective survey to assess self-reported changes in menstrual cyclicity and perceived stress levels both before and during the COVID-19 pandemic.
Recruitment of the survey included a social media-based snowball sampling strategy which was used to distribute an online survey. An invitation to participate in the survey read, “Help us learn more about how the Covid 19 pandemic impacts women's reproductive health” was shared on the author’s social media pages, in hopes that post viewers would share the invitation within their own social networks. The survey link received a total of 807 clicks, 46% received from Facebook, 31% from email or text message, 10% from Reddit, and the remaining 13% came from other sources.
“We know added stress can negatively impact our overall health and well-being, but for women and people who menstruate, stress can also disrupt normal menstrual cycle patterns and overall reproductive health,” said lead and corresponding author Nicole Woitowich, research assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine.
This online survey instrument designed to capture self-reported information on menstrual cycle changes and perceived stress levels was distributed between July and August 2020 in order to better understand how stress during the pandemic influenced these women’s menstrual cycles.
Out of all of the participants of the survey, a total of 210 women between the ages of 18-45 years met stringent inclusion and exclusion criteria.
Out of the 210 respondents to the survey, more than half (54%) of the individuals in the study reported that they had in fact experienced changes in their menstrual cycle following the start of the COVID-19 pandemic in March 2020.
Out of the 54% of the individuals that did in fact experience changes to their menstrual cycle, 50% reported change in their menstrual cycle length, 34% reported change in the duration of menses, and 50% reported changes in premenstrual symptoms.
Respondents with high perceived stress scale (PSS) scores during the pandemic were more likely to experience a longer duration of menses and heavier bleeding during menses, compared to those with moderate PSS scores.
The study found that those who experienced higher levels of stress during the COVID-19 pandemic were more likely to experience heavier menstrual bleeding as well as a longer duration of their period, in comparison to those with moderate stress levels.
Even though it is well known that increased psychosocial stress can result in menstrual cycle irregularities, this is one of the first studies to assess menstrual cycle irregularities in the context of the Covid-19 pandemic, and even the first to associate such alterations with perceived stress. This study found that 46% of women self-reported an increase in menstrual cycle irregularities during the Covid-19 pandemic.
Contrary to popular belief, self-reported essential and nonessential employee status had no significant impact on stress scores reported throughout the pandemic period assessed in this study. This may have been due to the homogeneity of the study that consisted of predominantly white women who may have experienced similar stressors outside of their work environment. Even though much of the current literature addressing the psychological impact of the pandemic has focused on essential worker status and its correlation with stress, this study suggests that the impact of pandemic on perceived stress was uniform throughout the population studied, regardless of employee status. The similarities between PSS scores, irrespective of essential worker status, suggest that the pandemic is a shared stressor regardless of worker status.
Despite these limiting factors, the data presented in this study suggest that the Covid-19 pandemic may have directly contributed to menstrual cycle irregularities in women experiencing both moderate and high degrees of stress. The association of high perceived stress and menstrual cycle irregularities is important because it supports findings that stress has downstream effects on reproductive function. This study identifies a critical need to assess the long-term reproductive implications of the pandemic.