About half of recent study participants who had regular periods at the time of the survey reported heavy menstrual bleeding after receiving the Covid-19 vaccine. Others who don’t normally menstruate — including transgender men, long-acting contraceptives and postmenopausal women — also experience irregular bleeding.

The new study – the largest to date – expands on research that has shown the temporary effects of Covid-19 vaccines on the menstrual cycle, but until now has mainly focused on menstruating cisgender women.

Although the vaccines mostly prevent death and serious illness with few side effects, many medical professionals brushed aside their concerns when women and gender-diverse people first began reporting irregular menstrual cycles after receiving the vaccine.

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To better understand these post-vaccination experiences, researchers at the University of Illinois at Urbana-Champaign and Washington University School of Medicine in St. Louis distributed an online survey to thousands of people worldwide in April 2021. After three months, the researchers collected and analyzed more than 39,000 responses from individuals aged 18 to 80 about their menstrual cycles. All survey respondents were fully vaccinated—with Pfizer-BioNTech, Moderna, Johnson & Johnson vaccines, or another approved outside the United States. And as far as they know, the participants did not contract COVID-19 before the vaccine.

The research, published Friday in the journal Science Advances, found that 42% of people with regular menstrual cycles experienced heavy bleeding after vaccination, 44% reported no change and 14% reported lighter periods. Additionally, 39% of responders to sex-affirming hormone treatments, 71% of long-acting contraceptives, and 66% of postmenopausal women experienced heavy bleeding after one or both shots.

“I think it’s important for people to know that this can happen, so they don’t get scared, they don’t panic and they don’t get caught without supplies,” said Kathryn Lee, a biological anthropologist at the University of Washington School of Medicine. St. Louis and first author of the study.

Lee cautioned, however, that the study did not compare the results of the vaccinated with a control group. And people who noticed changes in their cycles after vaccination may be more likely to participate in the survey. Still, the findings are in line with smaller studies that have reported changes in menstruation after more robust controls.

More importantly, the new study found that certain demographics are likely to experience menopause, which Lee said could help them be better prepared. For example, older people are more likely to have heavy menstrual bleeding. Survey respondents who used hormonal birth control, were pregnant in the past, or had been diagnosed with a reproductive condition such as endometriosis, fibroids, or polycystic ovarian syndrome were more likely to experience heavy menstrual bleeding. People who identified as Hispanic or Latino also tended to report heavy bleeding. And people who experience other side effects of the vaccine, such as fever or fatigue, are also more likely to experience irregular periods.

Postmenopausal women who are slightly younger, around age 60 on average, are more likely to experience heavy bleeding after vaccination. But the type of vaccine postmenopausal women received, whether they had other side effects such as fever, or had a previous pregnancy did not make any difference to their blood counts.

Why do these changes occur?

Some degree of variation in menstruation — the number of days you bleed, the weight of the flow, and the length of your cycle — is normal.

“Our menstrual cycle is not a perfect time,” said Dr. Alison Edelman, a professor of obstetrics and gynecology at Oregon Health & Science University, who has studied the effects of Covid-19 vaccines on menstruation.

Hormones produced by the hypothalamus, pituitary gland, and ovaries regulate the monthly cycle, and can be affected by internal and external factors. Stress and illness, weight loss or gain, calorie restriction, and intense exercise can all change the pattern of menstruation.

The endometrium, which grows in the uterus and is shed during menstruation, is also related to the immune system. Because of its role in regulating uterine cells and protecting against pathogens, vaccines can cause disruption by stimulating the immune system and causing downstream effects in the endometrium. During your period, Edelman said. And some individuals may be more sensitive to immune or hormonal changes in their bodies.

In her research, Edelman found that some women’s periods came a day or two later than usual after being vaccinated against the coronavirus. But the changes were temporary – menstruation returned to normal after one or two cycles.

What to do if you notice menstrual irregularities after the covid vaccine

Note if you have new or unusual bleeding. The menstrual cycle can be considered another vital sign, just like your body temperature or blood pressure, which gives clues about your health, said Dr. Jennifer Kawas, a reproductive endocrinologist at Emory University who was not involved in the study.

“Significant changes between menstrual cycles or bleeding patterns warrant further investigation to ensure there is no underlying endocrinological, hematological or anatomic cause,” Kawwass said. Bleeding in people who do not have regular periods can be a warning sign of cervical, uterine, uterine or vulvar cancer.

That being said, subtle differences in your menstrual cycle shouldn’t be a cause for concern if you have regular periods and won’t require you to change anything you normally do, says Kawas.

Clinical trials and other studies have shown that Covid-19 vaccines are safe and effective, and that they are unlikely to have long-term effects on fertility.

Should you vaccinate at some point in your cycle?

Experts agree that the havoc that COVID-19 can wreak on your body, including potentially lasting damage, is far worse than the side effects of a vaccine against the disease.

People who have had a fever after a previous shot can schedule the next dose on a day off, Edelman said. But you should not let temporary menstrual changes prevent you from being completely vaccinated or encouraged. Delaying vaccination by two weeks or more could significantly increase the risk of contracting Covid-19 as cases continue to rise, she said.

Still, it’s important to monitor your body’s response to the vaccine, and public health officials should not only warn people about the risk of contracting Covid-19, but also acknowledge concerns about menstrual cycle abnormalities, said Keisha Ray, a bioX specialist at UTHealth’s McGovern School of Medicine. Houston.

Increased transparency around menstruation or other vaccine side effects may have another benefit: reducing people’s vaccine hesitancy.

“We’re trying to be real. We’re trying to validate people’s lived experiences,” Lee said. For her part, she hopes the new research will improve the conversation around human health and lead to more clinical trials in the future.

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