As we continue to discover the possible long-term and short-term outcomes following a COVID-19 diagnosis, one such area involves the possible effects of menopause.

In fact, researchers are trying to determine whether postmenopausal women are more susceptible to more severe disease outcome from COVID-19.

Researchers are also looking into how hormonal fluctuations during premenopause — and even menstruation — could play a role in disease outcomes.

While more research needs to be done in this area, here’s what the evidence suggests about COVID-19 severity and menopause, as well as the possible effects of a COVID-19 diagnosis and vaccines on menstrual cycles overall.

Menopause typically develops between ages 47 and 55 years, according to the Endocrine Society, and it marks the end (cessation) of monthly menstrual cycles. It’s also driven by a significant drop in estrogen, a type of female sex hormone.

The possible link between estrogen and COVID-19 severity

Interestingly, researchers are also discovering a possible protective role behind estrogen and COVID-19 severity. This could potentially suggest more severe infection outcomes during and after menopause.

One retrospective study found that while men had a higher risk of severe outcomes from COVID-19 than premenopausal women, the risk factors were similar between men and postmenopausal women.

These results also confirm early suspicions about the possible role of menopause in overall COVID-19 severity in patients observed early in the pandemic.

Such findings suggest that more aggressive treatment may be warranted in postmenopausal women. In fact, some experts advocate for the use of hormone replacement therapy (HRT), such as estradiol.

While HRT is not the right treatment for everyone, some research suggests that estradiol may have anti-inflammatory effects that could potentially improve COVID-19 outcomes in postmenopausal women.

The possible link between long-haul COVID-19 and menopause

Another potential area of interest is menopause and the chances of experiencing long-haul COVID-19. This describes enduring symptoms that continue for weeks or months following an acute case of COVID-19.

One such study involving 460 women found reports of brain fog, sleep disturbances, changes in periods, and other symptoms for several months after developing COVID-19.

However, researchers could not conclude whether such symptoms were attributed to long-COVID symptoms, menopause, or both. The authors of the study also suggest that some menopausal and perimenopausal COVID-19 patients could be misdiagnosed with long COVID.

Additionally, while researchers believe long COVID affects more women than men, more studies are needed to explore the exact causes.

Anecdotally, some women have reported changes in their menstrual cycles during and after a COVID-19 diagnosis.

Based on such reports, researchers have started investigating how COVID-19 may affect premenopausal women and whether changes in periods could be related to the viral infection, hormone changes, or both.

For example, in the same study involving 460 women who had COVID-19, researchers found that 50 percent reported cessation or other changes in their menstrual cycles. Also, 80 percent said that their periods were not the same as they were before having COVID-19.

Chronic inflammation or a serious illness may disrupt hormones

While premenopause may play a role in such menstrual cycle changes, the study authors also hypothesize that COVID-19 may possibly cause chronic inflammation that could disrupt sex hormones.

Other research suggests that COVID-19 is just one type of potentially serious illness that could disrupt menstrual cycles. It’s thought that severe infections may cause hypothalamic hypogonadism, where the body produces fewer sex hormones. This can lead to temporary changes, such as irregular periods.

Treatment for COVID-19 may also cause menstrual irregularities

Another possible explanation for menstrual irregularities attributed to COVID-19 is the treatment used for the infection itself. Researchers note that monoclonal antibodies and dexamethasone steroid treatment may alter menstrual cycles, but no studies have confirmed such changes to date.

Aside from COVID-19 infections possibly impacting hormones related to menstruation, researchers are also looking at whether COVID-19 vaccines and boosters could pose similar effects.

One recent study analyzed changes in menstrual cycles of individuals ages 18 to 45 years before, during, and after COVID-19 vaccination. Based on the results, the authors concluded that some people may experience temporary changes in cycle length (about 1 day) but not in the length of menstruation itself.

Other possible temporary changes to your periods could include:

  • worsening cramps
  • heavier bleeding
  • early bleeding
  • delayed onset of bleeding

Overall, the benefits of COVID-19 vaccination far outweigh the possible risk of temporary changes to menstrual cycles. Additionally, according to recent research, there’s no evidence to suggest that COVID-19 vaccines affect fertility.

It’s also important to note that any temporary changes to menstrual cycles are not unique to the COVID-19 vaccine.

As researchers note, vaccines for the flu and human papillomavirus (HPV) have also been associated with temporary menstrual cycle changes.

While hormone changes — most notably drops in estrogen — during menopause may influence the severity of COVID-19 in some people, more research is needed to determine whether being postmenopausal is an official risk factor for severe disease from a SARS-CoV-2 infection.

It’s also important to discuss other known risk factors for severe COVID-19 outcomes, including older age and preexisting conditions such as obesity, diabetes, and high blood pressure (hypertension), with a doctor.

If you’re experiencing possible symptoms of COVID-19, it’s important to get tested as soon as possible and to discuss next steps with a doctor.