INTRODUCTION
Coronavirus disease (COVID-19) is a viral infectious disease that
affects many organs of the body, most commonly the lungs, and has short-
and long-term consequences.1 Regardless of disease
severity, the most frequently reported persisting symptoms after
COVID-19 are fatigue and dyspnea.2
The World Health Organization has revealed that women’s health is more
adversely affected by COVID-19 than that of men.3Angiotensin-converting enzyme 2 (ACE2), which plays a key role in the
entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
into cells, is expressed in high amounts in the female genital organs,
such as the ovaries, uterus, vagina, and placenta,4which may pose a risk for female reproductive functions, leading to
infertility, fetal distress, or menstrual cycle
disorders.5 ACE2 is responsible for balancing the
levels of angiotensin II enzyme, which initiates
menstruation.5 ACE2 expression in the uterine tissue
varies according to age and menstrual cycle phase,6and these changes may result in impaired uterine
bleeding.5
Limited number of studies have examined the effects of COVID-19 on the
menstrual cycle. Li et al. examined menstrual cycle in women who had
recovered from COVID-19 and determined that one-fifth of infected women,
more commonly those with severe disease, have decreased menstrual volume
or prolonged menstrual cycle.7 Different phases of
menstruation are associated with distinctive hormonal, physical, and
mental changes.8 Stress, exercise, and life changes
can cause menstrual problems.9 Dysmenorrhea is the
most common menstrual problem.10 In a study examining
the effect of pandemic stress on the menstrual cycle, 36.9% of women
had irregular menstrual cycles and 38.8% experienced
dysmenorrhea.11 In addition, 52.6% of women have
reported a change in their menstrual cycle during the quarantine period.
Therefore, stress during the pandemic is significantly associated with
changes in the menstrual cycle.12
The effects of COVID-19 on body systems and functions are being
investigated from the different perspectives. The studies examining the
effects of COVID-19 on the menstrual cycle are limited and to the best
of our knowledge, no study evaluated the changes in menstrual symptoms
of women who have had COVID-19.7,11,12 We hypothesized
that menstrual symptoms may worsen in women who had recovered from
COVID-19. Therefore, we aimed to examine the changes in menstrual
symptoms of women who had recovered from COVID-19 and determine the
factors affecting these changes.