Why doesn’t menstruation follow the rules after the COVID-19 pandemic?

This is the 4231st article of Da Yi Xiao Hu

"Aunt aunt" does not follow the routine performance

Recently, Dr. Wu has encountered many patients with menstrual disorders after testing positive for the new coronavirus. Let’s first take a look at what are the manifestations of “menstruation” that do not follow the routine~

"High heat to collect juice" type

"Surging" type

"Runaway" type

The "Lost Self" Type

Tongji Hospital of Huazhong University of Science and Technology conducted a study and found that 25% of 177 infected women of childbearing age had changes in menstrual volume, of which 20% had a decrease in menstrual volume and 5% had an increase in menstrual volume. 28% of patients had changes in their menstrual cycle, of which 19% had a longer cycle and 9% had a shorter cycle.

A study by Başkent University in Turkey on changes in menstrual patterns after women were infected with the new coronavirus surveyed 241 women aged 18-50 who were infected with the coronavirus. 86 (35.7%) said that their menstrual patterns changed in the first three cycles after infection, mainly shortening the cycle (34 cases, 14.1%) and delaying the cycle (42 cases, 17.4%).

Normal "Aunt"

The menstrual cycle

The menstrual cycle refers to the time between the first days of two menstrual periods; the normal menstrual cycle is 21-35 days, with an average of 28 days. If it exceeds 35 days, it is called a long menstrual cycle/late menstruation; if it is shorter than 21 days, it is called a short menstrual cycle/early menstruation.

"Aunt" menstrual period

Refers to the duration of menstruation; a normal period lasts 3-7 days, with an average of 4-6 days.

"Aunt" quantity

Refers to the total amount of blood lost during a menstrual period. Menstrual volume of more than 80ml is menorrhagia, and less than 5ml is hypomenorrhea (5ml is equivalent to about two bottle caps). Normal menstruation is generally 20-60ml, so the more "period" is not necessarily better, the right amount is the best.

Why does "Aunt Flo" not follow the routine?

So far there is no evidence that the new coronavirus has an impact on our reproductive system. The new coronavirus does affect women's menstrual cycle, but it does not directly attack the human reproductive system.

Women's periods are regulated by the hypothalamic-pituitary-ovarian gonadal axis, which is a very strict reproductive endocrine axis. When the body is affected by various internal and external factors, such as mental tension, anxiety, stress, physical discomfort, insomnia, irregular work and rest, loss of appetite, environmental changes, short-term weight gain or loss, etc., the neuroendocrine function of the cerebral cortex will be disturbed, thereby affecting the hypothalamic-pituitary-ovarian axis and then affecting menstruation.

After being infected with the novel coronavirus, many people have developed a variety of symptoms such as fever, sore throat, nasal congestion, cough, insomnia, etc. Most people will feel anxious: worried about whether they will infect their family members? Worried about whether there will be sequelae after recovery? Countless questions linger in the mind. When the human body is nervous and anxious, the secretion of neurotransmitters such as dopamine and endorphins secreted by the hypothalamus increases, thereby inhibiting the release of gonadal hormone-releasing hormone. This change in hormone levels can cause endocrine dysfunction in women, thereby affecting menstruation, resulting in changes such as prolonged, delayed, heavy or light menstruation.

Secondly, most people who are infected with the new coronavirus will have symptoms such as high fever, severe cough, body aches, etc., which will cause insomnia at night and drowsiness after taking medicine during the day. This disordered sleep state will greatly affect the secretion of ovarian hormones. The menstrual cycle will be shortened or prolonged; most people will also have a decrease in menstrual flow or continuous bleeding.

In addition to mental and psychological factors, changes in lifestyle and eating habits, some disease factors, such as endometrial polyps, endometrial lesions, uterine fibroids, adenomyosis, polycystic ovary syndrome, hypothyroidism/hyperthyroidism, hyperprolactinemia, coagulation dysfunction and other diseases may also lead to menstrual disorders.

How to deal with your period not playing by the rules?

If you only experience transient menstrual disorders after being infected with the new coronavirus, you can observe it for a while. After Yang Kang recovers, your stress is reduced, your emotions are stable, and your work and rest schedule is regular, your menstruation is likely to return to normal.

If you continue to experience menstrual disorders such as infrequent menstruation, shortened menstrual cycles, prolonged menstruation for more than 7 days, excessive menstrual flow, or too little menstrual flow, please do not put yourself under unnecessary psychological pressure. This is indeed possible. It is recommended that you go to the gynecology clinic for standardized diagnosis and treatment.

In the view of traditional Chinese medicine, this period is the best time to adjust the body constitution. For people with "yang excess" of COVID-19, the yin blood in the body is almost "burned dry" after the fever, and the person is also very tired and weak. At this time, nourishing yin and blood is the key; at the same time, properly replenishing kidney yang to plant the "fire" first. People with yang deficiency constitution should especially seize this opportunity to adjust. It is recommended that everyone combine traditional Chinese and Western medicine for syndrome differentiation and treatment, and use traditional Chinese medicine internal and external treatment to regulate menstruation and improve physical constitution, such as Chinese medicine, paste prescriptions and other internal adjustment methods and acupuncture, moxibustion, acupoint application, ear acupuncture and other external treatment projects, to adjust their bodies during this special period.

It is said that "period" is a "barometer" of women's health. Many women whose "period" does not follow the routine will have different degrees of anxiety after Yang Kang, especially pregnant women who are preparing for pregnancy. How long after being infected with the new coronavirus can you get pregnant has become a problem that many pregnant women are worried about. To be realistic, there is currently no strong evidence-based guide to guide the time to prepare for pregnancy.

We also mentioned earlier that for women, existing studies have not shown that new coronavirus infection has a negative impact on ovarian function and assisted reproductive outcomes. Therefore, for asymptomatic and mild patients, Yang Kang can start preparing for pregnancy after one menstruation. Of course, if you are really worried and not in a hurry to prepare for pregnancy, you can wait for three months (or three menstruations). On the one hand, it takes about 85 days for the development of preantral follicles to mature follicles through the continuous growth phase (level 1-4 follicles) and the exponential growth phase (level 5-8 follicles), which actually spans 3 menstrual cycles. On the other hand, this period of time can also wait for the recovery of the male's sperm. For patients with more severe infection, they need to follow the doctor's advice and wait until their bodies recover before considering preparing for pregnancy.

In addition, I would like to tell you that if you don't wait so long and suddenly become a "squadron leader" one day, don't be too anxious. Although there is no research in this area, if you have plans to get pregnant, you can have a routine prenatal checkup after pregnancy and follow the doctor's advice.

For men who are planning to have a baby after their penis is restored and they have no discomfort, they can have their semen checked. If the result is not ideal, they can wait for about three months and have another check. They can start planning to have a baby after the semen result is roughly back to normal. If there are still abnormalities, they can consult an andrologist to see if medical intervention is needed.

It takes a certain amount of time for the body to recover after a positive COVID-19 test, which requires us to have a regular work and rest schedule, a reasonable diet and proper exercise to improve immunity and strengthen our physical fitness. No matter when, protecting your body is the most important thing. Whether you are a woman with positive, healthy or no positive, you should pay close attention to your "period"!

Author: Shanghai First Maternity and Infant Health Care Hospital

Wu Shengnan Attending Physician