Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 15 , ISSUE 5 ( September-October, 2023 ) > List of Articles

Original Article

Transient Alterations in Menstrual Pattern Following COVID-19 Vaccination: An Exploratory Survey in Indian Women

Priyanka Sharma, Sonam Jindal, Namrata Kahlon, Avir Sarkar, Anil Kumar Pandey, Jagadish Chandra Sharma, Pragathi Kollabathula, Saroj Jaggarwal

Keywords : Coronavirus disease-2019, Irregular menstruation, Vaccines

Citation Information : Sharma P, Jindal S, Kahlon N, Sarkar A, Pandey AK, Sharma JC, Kollabathula P, Jaggarwal S. Transient Alterations in Menstrual Pattern Following COVID-19 Vaccination: An Exploratory Survey in Indian Women. J South Asian Feder Obs Gynae 2023; 15 (5):564-568.

DOI: 10.5005/jp-journals-10006-2303

License: CC BY-NC 4.0

Published Online: 31-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Menstrual cycle is an important indicator of a woman's health, and innocuous alterations in menstrual pattern can affect women profoundly. With the increase in the vaccination drive across the Indian subcontinent, women have reported irregularities in menstrual pattern after coronavirus disease-2019 (COVID-19) vaccination. Through this study, we aimed to assess the pattern and severity of menstrual irregularities observed in Indian women post COVID-19 vaccination and determine its association with vaccine type and dosage. Materials and methods: It was a prospective cohort study conducted over a period of 1 year. Women visiting gynecology outpatient department who voluntarily consented to participate in the survey and who had received at least one dose of Government-of-India-approved COVID-19 vaccine at least 3 months prior were eligible for recruitment in the study. All symptomatic or asymptomatic COVID-19-infected individuals with confirmed reverse transcriptase polymerase chain reaction (RT-PCR) positive report within the past 14 days were excluded from the study. A structured survey questionnaire was used to obtain data pertaining to alterations in menstrual pattern, duration, and severity of menstrual dysfunction. During the first 6 months, eligible participants were recruited. All recruited patients were prospectively followed up for the next 6 months to assess the persistence and severity of their menstrual irregularity. Results: A total of 355 women participated. Majority of the study population were less than 30 years of age. Among the recruited women, 82% had previously regular menstrual cycles and 6.5% had a polycystic ovarian morphology. Almost 91.8% women had received at least two doses of the COVID vaccine. Of them, 87.9% women had received Covishield (Astra Zeneca/Serum Institute of India) and 11.5% had received Covaxin (Bharat Biotech). Five women had a history of recent (within 3 months of vaccination) use of hormonal contraception. Of the 33 women afflicted with disordered menstrual pattern, 57.6% were less than 30 years of age. Early onset of menstrual flow (30.3%) followed by reduced flow in 24.2% and heavy flow in 21.2% was the most common complaint recorded. Around 72.7% experienced symptoms within the first month of vaccination. Only two cases required medical attention. Of the 33 women who reported experience symptoms of menstrual alteration after COVID-19 vaccine, all have recovered at 6-months follow-up. Conclusion: Transient menstrual abnormalities have been reported to succeed vaccination with Covishield (Astra Zeneca/Serum Institute of India) and Covaxin (Bharact Biotech). Most alterations were mild and self-limiting. Further large-scale multicentric trials are needed to confirm the findings of this exploratory survey.

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  1. Ministry of Health and Family Welfare. COVID-19 Vaccine Operational Guidelines. Ministry of Health and Family Welfare, Government of India. 2020. (Accessed on 19 July 2022).
  2. Wang YX, Arvizu M, Rich-Edwards JW, et al. Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: Prospective cohort study. BMJ 2020;371:m3464. DOI: 10.1136/bmj.m3464.
  3. Medicines and Healthcare Products Regulatory Agency. Coronavirus vaccine - weekly summary of yellow card reporting. 2021.
  4. Male V. Menstrual changes after COVID-19 vaccination. BMJ 2021;374:n2211. DOI: 10.1136/bmj.n2211.
  5. Merchant H. COVID-19 post-vaccine menorrhagia, metrorrhagia or post-menopausal bleeding and potential risk of vaccine-induced thrombocytopenia in women. A letter in response to Re: Thrombosis after COVID-19 vaccination. BMJ 2021;373:n958. DOI: 10.1136/bmj.n958.
  6. Klein SL, Jedlicka A, Pekosz A. The Xs and Y of immune responses to viral vaccines. Lancet Infect Dis 2010;10(5):338–349. DOI: 10.1016/S1473-3099(10)70049-9.
  7. Giefing-Kroll C, Berger P, Lepperdinger G, et al. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 2015;14(3):309–321. DOI: 10.1111/acel. 12326.
  8. Fish EN. The X-files in immunity: Sex-based differences predispose immune responses. Nat Rev Immunol 2008;8(9):737–744. DOI: 10.1038/nri2394.
  9. Hamidovic A, Karapetyan K, Serdarevic F, et al. Higher circulating cortisol in the follicular vs. luteal phase of the menstrual cycle: A meta-analysis. Front Endocrinol (Lausanne) 2020;11:311. DOI: 10.3389/fendo.2020.00311.
  10. Cruz-Topete D, Cidlowski JA. One hormone, two actions: Anti- and proinflammatory effects of glucocorticoids. Neuroimmunomodulation 2015;22(1–2):20–32. DOI: 10.1159/000362724.
  11. Talaat KR, Halsey NA, Cox AB, et al. Rapid changes in serum cytokines and chemokines in response to inactivated influenza vaccination. Influenza Other Respir Viruses 2018;12(2):202–210. DOI: 10.1111/irv. 12509.
  12. Gong L, Ji HH, Tang XW, et al. Human papillomavirus vaccine-associated premature ovarian insufficiency and related adverse events: Data mining of Vaccine Adverse Event Reporting System Sci Rep 2020;10(1):10762. DOI: 10.1038/s41598-020-67668-1.
  13. Hviid A, Thiesson EM. Association between human papillomavirus vaccination and primary ovarian insufficiency in a nationwide cohort. JAMA Netw Open 2021;4(8):e2120391. DOI: 10.1001/jamanet workopen.2021.20391.
  14. Nazir M, Asghar S, Rathore MA, et al. Menstrual abnormalities after COVID-19 vaccines: A systematic review. Vacunas 2022;23:S77–S87. DOI: 10.1016/j.vacun.2022.07.001.
  15. Male V. Effect of COVID-19 vaccination on menstrual periods in a retrospectively recruited cohort. MedRXiv 2021. DOI: 10.1101/2021.11.15.21266317.
  16. Anjorin AA, Odetokun IA, Nyandwi JB, et al. Public health surveillance for adverse events following COVID-19 vaccination in Africa. Vaccines (Basel) 2022;10(4):546. DOI: 10.3390/vaccines10040546.
  17. Alvergne A, Kountourides G, Argentieri MA, et al. COVID-19 vaccination and menstrual cycle changes: A United Kingdom (UK) retrospective case-control study. medRxiv 2021. DOI: 10.1101/2021.11.23.21266709.
  18. Laganà AS, Veronesi G, Ghezzi F, et al. Evaluation of menstrual irregularities after COVID-19 vaccination: Results of the MECOVAC survey. Open Med (Wars) 2022;17(1):475–484. DOI: 10.1515/med-2022-0452.
  19. Morsi AA, Mersal EA, Hassanein AM, et al. The association between COVID-19 Pfizer vaccine and the reported post-vaccination menstrual changesi citizen and resident women in KSA: Results of Riyadh survey study. Egypt J Hosp Med 2022;87(1):1442–1448. DOI: 10.21608/EJHM.2022.224911.
  20. Vassallo A, Shajahan S, Harris K, et al. Sex and gender in COVID-19 vaccine research: Substantial evidence gaps remain. Front Glob Womens Health 2021;2:761511. DOI: 10.3389/fgwh.2021.761511.
  21. Ella R, Vadrevu KM, Jogdand H, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: A double-blind, randomised, phase 1 trial. Lancet Infect Dis 2021;21(5):637–646. DOI: 10.1016/S1473-3099(20)30942-7.
  22. Ella R, Reddy S, Blackwelder W, et al. Efficacy, safety, and lot-to-lot immunogenicity of an inactivated SARS-CoV-2 vaccine (BBV152): Interim results of a randomised, double-blind, controlled, phase 3 trial. Lancet 2021;398(10317):2173–2184. DOI: 10.1016/S0140-6736(21)02000-6.
  23. Madhi SA, Baillie V, Cutl CL, et al. Efficacy of the ChAdOx1 nCoV-19 Covid-19 vaccine against the B.1.351 variant. N Engl J Med 2021;384:1885–1898. DOI: 10.1056/NEJMoa210221.
  24. Falsey AR, Sobieszczyk ME, Hirsch I, et al. AstraZeneca AZD1222 Clinical Study Group. Phase 3 safety and efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 vaccine. N Engl J Med 202116;385(25):2348–2360. DOI: 10.1056/NEJMoa2105290.
  25. Zhang B, Yu X, Liu J, et al. COVID-19 vaccine and menstrual conditions in female: Data analysis of the Vaccine Adverse Event Reporting System (VAERS). BMC Womens Health 2022;22(1):403. DOI: 10.1186/s12905-022-01934-4.
  26. MHRA. Coronavirus Vaccine – Summary of Yellow Card Reporting. Updated November 2022. London. Available at: Coronavirus vaccine - summary of Yellow Card reporting - GOV.UK (
  27. Pulla P. How covid-19 vaccines exposed India's adverse events reporting system. BMJ 2022;376:n3146. DOI: 10.1136/bmj.n3146.
  28. Garg R, Lal P, Agrawal P, et al. Menstrual cycle changes after COVID-19 infection: Does coronavirus-induced stress lead to hormonal change? J South Asian Feder Obstet Gynaeolc 2022;14(3):248–252. DOI: 10.5005/jp-journals-10006-2027.
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