Coronavirus (covid-19) and reproductive health: Heavy periods, sex drive changes, hormonal switches

Filed Under: Costs, Patients

- photo by Photo by Josefin on Unsplash

As the list of symptoms associated with Covid and post-Covid syndrome continues to expand, a growing number of men and women are reporting reproductive system changes they believe are associated with the virus.

These changes have been primarily reported by women, but some men have noted changes as well. As with other Covid-related symptoms, these issues may vary from person to person. There have been a few scientific studies, but much of the evidence is anecdotal, gathered from the patients themselves.

Covid patients we spoke to said doctors often told them their reproductive symptoms could not possibly be related to Covid. Since formal research on Covid is still rare, it is common practice for Covid patients to gather online, in groups such as the Survivor Corps and the Covid-19 Long-Haulers Discussion Group on Facebook, or the Body Politic Slack group, to compare notes about their symptoms and about the trajectories of their illness.

Here is a compilation of some of the commonly reported reproductive system symptoms, based on conversations with a number of men and women, as well as news reports and posts in online groups for Covid sufferers.

Menstrual cycle changes

This was by far the most commonly reported reproductive system symptom we came across. From changes in cycle regularity and volume, to debilitating cramps, and even the return of menses in menopausal women, patients have reported a wide variety of menstrual cycle changes.

Angelene Jenson, 39, from Yuma, Az., has polycystic ovary syndrome (PCOS), which typically causes her to get her period every two weeks. Since she became ill with Covid five months ago, she has been menstruating constantly, alternating between light and heavy weeks without stop. “But since my labs don’t show anemia or anything like that,” Jenson said in a post in a Facebook group for Covid long-haulers, “there is little they can do unless I go on birth control.” She gave us permission to use her observations for this article.

Jenni Green, 45, from Pottstown, Pa., says she has had a consistent, 25-day cycle for years, with five days of bleeding per cycle, and no irregularities. Since becoming ill with Covid six months ago, she has been experiencing “super heavy [bleeding], painful cramps, back pain, cluster headaches [and] really sore breasts” each cycle, she said in an exchange of Facebook messages with ClearHealthCosts. The duration of her cycle has also changed, she said, with her most recent cycle consisting of 18 straight days of bleeding.

Cassidy Roell, 25, of Boise, Id., became ill with Covid in early June, she said in a phone interview. She usually experiences some back pain at the time of her period, she said, but in June, she started experiencing extreme back pain and swelling in her spine two weeks before her period was supposed to start.

Doctors were confused, Roell said, and tentatively diagnosed her with endometriosis. Her period is typically very regular, but in August, two weeks after her period, when she should have been ovulating, she started bleeding heavily. It wasn’t regular bleeding, she said, but was very heavy and discolored. She said she also experienced severe nausea that resembled morning sickness.

Since becoming ill with Covid, Roell said, she has also developed premenstrual dysphoric disorder (PMDD), a premenstrual disorder recognized by the National Institute of Mental Health as causing severe and distressing mood changes one to two weeks before the start of a period. She said she has started having severe panic attacks leading up to her period since getting Covid, and has experienced hallucinations and psychosis, all of which is new to her.

Roell is not the only woman to have reported hallucinations around the time of her period since becoming ill. Serena Santos, 35, of Nampa, Id., was quarantining with her friend after testing positive for Covid, and at one point, while on her period, she saw her friend standing by her bed, not answering when Santos tried to speak with her. When she confronted her friend about it later, her friend said she had not been in her room. “I don’t think I’m crazy,” Santos said in a phone interview, “but now I’m seeing stuff, I get the brain fog, I lose my balance…it comes and goes.”

“Brain fog” is what long-haul Covid patients online have dubbed the feeling of disorientation, murky thinking and inability to access thoughts and words that they say often accompanies their illness or the after-period, known among long-haul patients as “post-Covid syndrome.”

Santos also said she had two seizures since becoming ill with Covid, and has been having persistent nausea so severe that she has lost 15 pounds since her Covid symptoms began in August. She said her period started early after she became ill, was very heavy, and lasted well over a week, and she said she’s had the worst cramps she has ever had in the weeks since becoming sick.

Her doctor laughed at her

Rebekah Pennington-Jones, 46, of Ionia, Mich., said she started displaying symptoms of Covid in mid-March. At first, she said, her period came at the expected time, but it was incredibly light. This concerned her, because she had experienced regular periods for more than 20 years. She asked her doctor about it.

“He laughed at me,” she said in a phone interview with ClearHealthCosts. “He’s like, ‘well, there’s nothing weird about that.’ They had been regular for 20-something years — 28 days on the dot and the same thing every month!”

Since then, she said, she has been menstruating approximately every two and a half weeks — a deviation from her typical 28-day cycle. She also has been having excruciating cramps which, like Santos, she said are the worst she has ever had

Pennington-Jones never would have associated these symptoms with post-Covid syndrome, she said, until she started speaking with other women online who were sharing a similar experience. Her doctor told her that all of her symptoms were due to anxiety.

“I thought I must be crazy,” she said in a phone interview. “Then I found the [COVID-19 Long-Haulers Discussion Group], and I was like, you know what? No. There’s lots of people feeling the same thing…I do have anxiety, but this is different. This is not anxiety…It actually gave me a lot of relief to know that there are other people going through the same silly stuff that I am.”

Marissa Thornton, 40, of Lafayette, Ga., said she had a procedure after the birth of her son, known as endometrial ablation, in which the inner lining of the uterus is destroyed in order to reduce or stop menstrual flow. She has not had a period in more than 15 years. However, after her Covid symptoms started in March, she said she began passing red tissue, which soon developed into a regular period. Her gynecologist was baffled.

Thornton also began experiencing severe anxiety in the week leading up to her period. “The week before, my anxiety is through the roof,” she said in a phone interview.

Jennifer Curtis, 39, of Forest Lake, Minn., had bloodwork done shortly after her Covid symptoms started. She said her D-dimer levels were elevated, indicative of a potential blood clot, so doctors started her on the blood thinner, Xarelto. A CT scan of her lungs revealed no blood clots, but did show evidence of pneumonia, and Curtis tested positive for Covid that very day.

Curtis said her period started shortly afterwards and was so heavy that she rushed to the emergency room. “I was filling a super tampon in about 25 minutes,” Curtis said in a phone interview. A pelvic ultrasound and vaginal exam revealed normal results, and doctors stopped the blood thinners. Curtis said she continued to bleed at that volume for another two days before her period finally stopped. She said her next period was 10 days early and, although not as heavy as the previous one, was much heavier than usual.

Curtis also says she experienced cramping that was much more severe than usual, but lasted for a shorter duration than her typical cramps. She also says that the body aches she had been experiencing since contracting Covid were much more severe during the time of her period.

Darcy Havel-Sturdevant, 33, of Iowa City, Ia., has been ill since early March, with recurring physical and cognitive symptoms that she said feel “never-ending.”

She wrote in an email that her period seemed normal in March and was a bit clotty in April. “By May it was starting to get lighter but still lasted 5 days,” Havel-Sturdevant wrote. “June, my period only lasted three days then stopped. July skipped and no period, and in August it lasted for just two days. I used one tampon on day one, which was excessive for how much bleeding I actually had.

“Every month since contracting Covid (except for July since it was non-existent), aside from the length and amount of menstrual bleeding, PMS symptoms are really bad,” Havel-Sturdevant wrote. “They flare up a week and a half to two weeks prior to when my period is supposed to start. Sorest breasts I’ve experienced other than right after giving birth, and the brain fog gets even worse around that time too. It’s weird because [my] breasts feel swollen and painful, but then it subsides as soon as my period starts, even if [the period] only lasts for 2 days.”

Havel-Sturdevant said she contacted her physician and had hormonal testing done, but they were not able to find any abnormalities. “After the hormone blood tests, the doctor said there was no explanation for why I was experiencing these light, two-day periods,” Havel-Sturdevant said. “So I have no idea what is going on with my body unless it is something post-viral.”

Heather-Elizabeth Brown, 35, of Detroit, Mi., started having Covid symptoms in early April. She eventually became so ill that she was placed in a medically induced coma for 31 days. Brown said in a phone interview that she had previously been diagnosed with polycystic ovary syndrome (PCOS), a condition that can cause menstrual irregularities in some women, but that her periods had always been “normal and very predictable.”

Brown was not conscious for her period in April, but since waking from the coma, she said, her period has been very irregular. “I didn’t have it in May, didn’t have it in June,” Brown said. “I had one in July while I was in the hospital in inpatient rehab, but it was shorter and lighter than usual. And then I haven’t had one in August, and I don’t know if I’ll have one this month.”

Brown was very concerned about this development, and sought medical help. “I consulted with the hospital OB/GYN and had a transvaginal ultrasound.” She said. “I’ve had two pelvic exams. I’ve had an external ultrasound. I’ve consulted with my personal OB/GYN outside of the hospital, and everyone says, ‘you had bloodwork done. No hormones seem to be off; nothing seems to be different.’ It’s not like anything has gotten worse, or they found anything troubling or anything different, but no one can explain why I haven’t gotten a cycle like normal. It is so, so frustrating.”

Brown said that she worries about how her health may be affected in the long-term by these new changes in her body. “I’m not sure how this will affect the whole totality of my reproductive health,” she said. “I don’t know if it will affect me reproductively in any way. Will I have more issues getting pregnant? Will I have more issues carrying a pregnancy? Will I have complications or issues with breathing or with my heart when it comes time to actually have the baby? All those things are kind of gray questions that no one knows the answer to yet.”

A 14-year-old’s experience

Another woman wrote to say that her 14-year-old daughter has been sick since late March.

“The most distressing symptoms appeared [in my daughter] in early May,” Karen, who asked that we not use her last name to protect her daughter’s privacy, told ClearHealthCosts via email. “[These symptoms were] severe GI pain with intermittent diarrhea. Over the next few months, these GI issues were intermittent, and later in the summer it became clear that they were co-occurring more strongly as her period approached, and during her period.”

Karen said that her daughter also began having menstrual cramps far worse than anything she had experienced before. “She did have two ultrasounds of her ovaries and uterus and nothing surfaced,” Karen said, “likewise IBS was investigated and ruled out. Still, the pain was excruciating, and she was avoiding food to the point that, very unusually, she dropped several pounds.”

Karen said that her daughter was started on birth control, and that the severe intestinal symptoms stopped approximately three weeks later. Other symptoms do however continue to persist in her daughter, Karen said, including intermittent fevers.

“While I’m overjoyed to have found a way to alleviate those GI symptoms,” Karen wrote, “it is concerning to me that we don’t know more about long-term effects. My daughter very much wants to be a mother one day, and this is just so frightening in many ways.”

Menopausal women speak up

These long-haulers are not alone; other sufferers have reported unusual symptoms to media. Some post-menopausal women have even been reporting the return of PMS or menopause-related symptoms after becoming ill with Covid. One woman reported to Medpage Today that her period returned in full force after contracting the virus — two years after she went through menopause.

Sandra Washington, 58, of Chicago, Il., said in a phone interview that, a few months after contracting Covid, she began experiencing what essentially felt like a second bout of menopause. “I already had one bout with menopause,” she said. “The bout came back and this time when it came back, it came back with a vengeance!” Most notably, she said, she began to have severe hot flashes and night sweats. She also said that, despite not having menstruated in two years, she began to experience breast tenderness that she had only ever felt before right at the onset of a period.

It felt like “my body reproductive or hormonal-wise was acting as if it was trying to restart a dead cycle,” said Washington. “I haven’t had a cycle in two years. What the heck is going on?”

Signe Redfield, 49, who lives in Pomfret, Md., is also two years post-menopause. However, she told ClearHealthCosts via email that her “entire post-Covid experience has felt very hormonal.”

“In the fourth month,” Redfield said, “my belly distended and I felt nauseous and exhausted and gained weight in a way that felt very similar to being pregnant. I’ve experienced extremely strange, Covid-specific, intensely sweaty hot flashes, as well as three rounds of the full suite of my pre-menopausal PMS symptoms — vivid dreams and insomnia, clumsiness, cramps, irritability and bloating. [This was] followed by light spotting in lieu of an actual period. Over the last two months [these symptoms] have been gradually decreasing in intensity along with the rest of my symptoms.”

“The thing that’s important to emphasize is: Any illness can cause menstrual irregularities,” Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University told Everyday Health in an interview. “When you look at the combination of a serious infection [such as COVID-19] and the stress of the pandemic, it’s to be expected. How much of this is due to this specific infection versus any chronic stress or infection isn’t known and hasn’t been studied.”

Sex drive

A number of women reported to ClearHealthCosts that they experienced changes in sex drive since becoming ill. As with other symptoms, this varied from person to person.

Marissa, 36, of California, told ClearHealthCosts via email that, in addition to her typically regular period now consistently starting two weeks earlier than usual, she had no sex drive for the first five months after becoming ill with Covid, and was also unable to climax. “The latter has since changed,” she said, “but it’s still not the same. I haven’t seen this in any news and I think it’s important to bring up.”

Santos too reported an extremely low sex drive since becoming ill with Covid. Pennington-Smith also reported having no sex drive, which she says makes her not feel like herself.

Roell, on the other hand, said her sex drive is usually quite low, and has increased greatly since contracting Covid. Thornton, meanwhile, said she experienced a decrease in sex drive for several weeks when she was most ill, followed by a great increase that coincided with her starting to feel a bit better.

“When you’re sick, you don’t really want [sex],” Thornton said in a phone interview. “Lately, I’ve actually wanted it more than I have in a long time. I’ve been feeling good for about 11 days now. I still have symptoms of Covid, but it’s not like I can’t live with it. It’s not like it was before…I don’t know if I’m getting excited because I’m starting to feel better [or if ] it’s my hormones…The scariest [part] of this whole entire thing is that nobody knows enough about it. They can only treat the symptoms.”

Other changes

The women we spoke with also mentioned a variety of other changes they had noticed since becoming ill.

Thornton said she has been having severe breast pain since the onset of her illness; mammogram results revealed no abnormalities. She also said that her hair and nails have been growing much faster than usual. Roell began lactating when she first became ill, she said, and doctors noted elevated prolactin levels, but could not determine a cause.

Santos has a condition known as vulvodynia, which causes chronic pain in the vulva. She said she had not had a flare-up in a long time, but experienced her worst one yet after becoming ill with Covid. It lasted for three weeks, she said, and her mother took her to the E.R. a few times because the pain was so severe. Santos said that she had spoken with other women in her vulvodynia support group, who also said that becoming ill with Covid had brought on the worst flare-up of their lives.

Danielle Biskner, 27, of Lansing, Mi., who first became ill in late February, said in a phone interview that, among the first symptoms she started experiencing were symptoms “similar to what a U.T.I. would be like,” as well as vaginal pain and pain during intercourse. She said she saw her gynecologist, who tested her for infection, as well as performing a manual exam and an ultrasound. Everything came back clear, but Biskner said that the symptoms have persisted.

These symptoms “kind of come and go, along with all my other symptoms,” said Biskner. “So it’ll flare up for a couple days, and then a few days later it’ll be okay…then it’ll just randomly come back unprovoked. It’s so frustrating.”

Like many other women, Biskner says she has also been experiencing heavier than normal periods with more severe cramping, and a complete absence of sex drive — “lower,” she says, “than it has ever been.”

“I feel like, as women, we’re often not believed about our health in general,” Biskner said. “But then…as a COVID long hauler, we’re like, extra not believed as women. So I’m just thankful that our voices are being heard, and it’s starting to get talked about.”

Erectile dysfunction

Some men have also reported reproductive system-related symptoms that they believe stem from their infection with Covid.

A number of outlets, including the New York Post, have reported an increase in erectile dysfunction in certain patients since the onset of the pandemic.

ClearHealthCosts noted early in the pandemic that the site saw booming traffic on a post on Viagra sales, as well as birth control pill posts, with sagging traffic on the post on abortion costs (read about it here).

Some physicians attribute the record numbers of men experiencing impotence to psychological stress and increased alcohol consumption during quarantine. However, there are some indications that the virus itself may be affecting male reproductive health.

A recent study by researchers in Italy suggested that men infected with Covid may be more likely to experience erectile dysfunction as a combined effect of Covid on cardiovascular and pulmonary health, as well as psychological distress that may accompany the illness.

Testicular pain

In March, researchers at Harvard Medical School published a case report on a 42-year-old man with what was deemed to be an “atypical presentation of Covid-19.” The man was referred to the emergency department for abdominal, back and testicular pain – the only symptoms he was experiencing – and went on to test positive for Covid.

Researchers at the University of Modena and Reggio Emilia in Italy also reported the case of a 43-year-old man experiencing severe testicular pain as his first symptom of Covid infection.

SARS-CoV-2 is thought to enter into the host cell by binding to angiotensin-converting enzyme 2 (ACE2) so, “theoretically, any cells expressing ACE2 may be susceptible to SARS-CoV-2 infection,” the Italian study noted. The researchers in this study also noted that “this receptor seems to be widely expressed in different testicular cell types,” suggesting a potential vulnerability of the male gonads to Covid infection.

Another study in Wuhan, China, compared the sex hormone profiles of men with Covid to healthy, age-matched individuals. Researchers found that serum luteinizing hormone (LH) levels were elevated and “the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19.”

“This study,” the researchers in China said, “provides the first evidence about the alteration of sex-related hormones under COVID-19…[and should alert] more attention to gonadal function evaluation among patients recovered from SARSCoV-2 infection, especially in reproductive-aged men.”

What you can do

We never give medical advice. If you have questions about your symptoms, take them to your medical professional. There seems to be mounting evidence that covid can affect the reproductive system in sometimes mysterious and conflicting ways, just as it affects the respiratory system, neurological system, cardiological system and other body systems in mysterious and conflicting ways. Here are some other thoughts:

  1. Document your symptoms, for yourself and your medical professionals, so you have an accurate reflection of your experiences.
  2. Join patient groups to compare experiences. Medical science has not caught up to the situation on the ground. You may find that your doctor pushes back on the idea that patient knowledge is very important in the case of an onrushing new illness like Covid, or you may find that your doctor welcomes your expertise. In any case, advocate for yourself.
  3. Show this article to your doctor. By doing so, you may be able to contribute to their knowledge of the topic.
  4. Show this article to your friends or others who might find it useful or illuminating. Again, maybe you can contribute to the body of knowledge on this topic.
  5. Email the reporter (phoebe@clearhealthcosts.com) to let her know if there are things she’s missing.

(Updated to add Curtis, Havel-Sturdevant, Washington, Redfield, Biskner, Karen, and Marissa.)