The potential bidirectional relationship between long COVID and menstruation

Jacqueline A. Maybin (), Catherine Walker, Marianne Watters, Natalie ZM. Homer, Joanna P. Simpson, Cara Robb, Douglas A. Gibson, Luna Jeanjean, Hilary O. D. Critchley, Gabriella Kountourides, Zuzanna Olszewska and Alexandra Alvergne
Additional contact information
Jacqueline A. Maybin: University of Edinburgh
Catherine Walker: University of Edinburgh
Marianne Watters: University of Edinburgh
Natalie ZM. Homer: University of Edinburgh
Joanna P. Simpson: University of Edinburgh
Cara Robb: University of Edinburgh
Douglas A. Gibson: University of Edinburgh
Luna Jeanjean: EPHE
Hilary O. D. Critchley: University of Edinburgh
Gabriella Kountourides: University of Oxford
Zuzanna Olszewska: University of Oxford
Alexandra Alvergne: EPHE

Nature Communications, 2025, vol. 16, issue 1, 1-19

Abstract: Abstract Women have reported menstrual changes following SARS-CoV-2 infection and variation in long COVID symptoms across the menstrual cycle. We examined (i) whether COVID is linked to abnormal uterine bleeding (AUB), (ii) if long COVID symptoms vary with the menstrual cycle, and (iii) potential underlying mechanisms. Here we show long COVID was associated with AUB in a UK population. When compared to those never infected (n = 9423), long COVID participants (n = 1048) reported increased menstrual volume, duration and intermenstrual bleeding, while those who recovered from acute COVID (n = 1,716) reported minimal menstrual disruption. Long COVID symptoms examined in 54 women across the menstrual cycle revealed that severity was highest during the perimenstrual and proliferative phases. Serum and endometrial analysis revealed higher serum 5α-dihydrotestosterone and lower endometrial androgen receptors in long COVID versus no COVID. Other ovarian hormones showed no significant differences. Serum cytokine profiling indicated increased menstrual inflammation with long COVID and immune cell aggregates were observed in menstrual endometrium. In conclusion, long COVID was associated with AUB but not impaired ovarian function. Differences in peripheral and endometrial inflammation may contribute to AUB and long COVID symptom severity. We anticipate our findings will instigate exploration of new therapeutic strategies for women with long COVID.

Date: 2025
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DOI: 10.1038/s41467-025-62965-7

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