Small studies coming out of China this year have revealed that 25% of people with COVID have menstrual changes. As part of International Women’s Day I am going to do a series of blogs covering these little talked about aspects of the Covid-19 infection.
Many women in the first phase of the Covid -19 infection experience amenorrhoea - the medical term for "no periods".
What is amenorrhoea?
It is generally expected that most people will start their period by the age of 15. If someone we would expect to have periods, has never had a period, this is known as ‘primary amenorrhoea’. In simpler terms, it is when a person never starts their periods.
If someone has had regular periods, but then their periods stop completely for more than 3 months, it is called ‘secondary amenorrhoea'.
Sometimes periods can be missed for a couple of months due to stress, lifestyle changes, or for no clear reason. Only when the missed periods continue for a few months does it become amenorrhoea.
Amenorrhoea is different from oligomenorrhoea - the medical term for ‘irregular periods’, but they often have the same causes. Oligomenorrhoea occurs when the gaps between your periods keep changing. You still have periods, unlike amenorrhoea, but the time between the periods changes unpredictably.
Each month women’s bodies prepare for them to become pregnant. A host of hormones thicken the endometrium (lining) of the uterus (womb). During the month this lining becomes thicker and spongier, for an egg to implant into. If we don’t become pregnant and the egg isn’t fertilised, this layer sheds, and we get the bleeding we know as a period or menstruation. The cycle then begins again and the process repeats itself, month in and month out. The average cycle length of a period is 28 days with 5 days of bleeding, but some women may have longer or shorter cycles and periods.
The hormones that regulate our periods are released from the brain. They travel through the body through a pathway known as the ‘hypothalamic-pituitary-ovarian’ axis, or the HPO axis. The hypothalamus (deep in the centre of our brains) releases a hormone called gonadotrophin-releasing-hormone, or GnRH. GnRH, just as its name suggests, signals to the pituitary gland (also found deep in our brains) to release hormones known as gonadotrophins.
The gonadotrophins crucial in menstruation are follicle stimulating hormone (FSH) and luteinising hormone (LH). They help with the release of an egg ready for potential fertilisation, and the stimulation of more hormones oestrogen and progesterone. Oestrogen is involved in the development of the lining of the uterus wall , while progesterone is crucial in maintaining it.
This complex pattern of hormones is finely regulated and inter-connected. It therefore follows that if the pattern of hormone release from the hypothalamus or pituitary changes, our periods may change, too.
What are the causes of secondary amenorrhoea?
These may be physiological (normal, natural), pathological (disease, unnatural) and iatrogenic (due to medicine or surgery).
1. Physiological causes include:
2. Pathological causes include:
PolyCystic Ovarian Syndrome (PCOS)
Premature ovarian failure - due to chemotherapy, radiotherapy or an autoimmune condition
Thyroid disease - hypothyroidism or hyperthyroidism
Pituitary gland dysfunction - including hypopituitarism, head injury or prolactinoma
Hypothalamic dysfunction - due to stress, excessive exercise, weight loss or an abnormal BMI. These can lead to ‘Functional Hypothalamic Amenorrhea’ where the hypothalamus, and so the HPO axis, is affected, leading to amenorrhoea.
Iatrogenic causes include:
Surgery - hysterectomy, endometrial ablation, ovarian surgery
Medication - including steroids, opiates, cocaine or antipsychotic medication
Contraception - including the oral contraceptive pill, mini pill, depot injection or Mirena coil
The physical stress , exercise which our bodies are unable to cope with , weight loss due to poor appetite or chronic diarrhoea, and the anxiety that can result from these can be experienced by someone with Long Covid. This can result in Functional Hypothalmic Amenorhoea leading to the stopping of periods.
For many of us, and this is backed up by the Chinese research, our cycles appear to return to their normal baseline after the person recovers. However for some periods haven’t returned. There is a great blog on “Getting Your Period Back” https://gracefueled.com/blog/2019/2/25/getting-your-period-back
Here the benefits of decent quality sleep, good balanced nutrition and low impact exercise, amongst others, are discussed and how this can naturally restore your HPO axis and hence your periods.
Seeking further help
First and foremost, a visit to your GP should be the first port of call if you’re worried about your periods and have missed more than 3 in a row. They will take a history and should send off some blood tests if they think it’s suitable. These should include a thyroid check and possibly a cortisol check.
The take home message is that having had an acute Covid-19 infection and subsequent Long Covid may cause a temporary stop in your periods. With rest, pacing, good sleep and a balanced diet the issue hopefully will work itself out without any need for medical intervention.
Of course there are increasing reports that a Covid-19 infection has tipped women into the menopause, a different type of amenorrhoea, and I will be discussing this soon.