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.