Document Type : Original Article


Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India


While battling the life‑threatening complications of COVID‑19, its effect on the menstrual
cycle and infertility has been somewhat ignored. This brief review aims on highlighting the
importance of menstrual abnormalities being experienced during the post‑COVID period
and to make the clinicians aware about what to expect in regard of menstrual abnormalities
by learning from various studies that have been conducted worldwide. This review article
was written with systematic literature review with the help of data search machine such
as PubMed, Scopus, Web of Sciences, and Google Scholar.A search strategy leads to the
extraction of 160 related articles that after the removal of inappropriate and duplicate
articles, 33 articles were selected for the review. To find other potentially relevant articles,
the references of the extracted articles were thoroughly examined. The search was carried
out using keywords including “COVID‑19,” “Menstrual abnormalities,” and “Infertility.”
Using OR and AND, the keywords mentioned above were combined and then utilized in
the search box of the databases. Articles published from January 2020 to September 2021
were included in this study. It includes worldwide data ranging from studies done in China,
India, Ireland, Turkey, Jordan, and Germany. During the post‑COVID period, there is a
significant alteration in the sex hormones of females infected by COVID‑19 which may
manifest as menstrual cycle abnormalities such as decreased cycle length or prolonged
menstrual cycle bleeding. It may also manifest as infertility due to ovarian failure due
to suppression of ovarian function COVID‑19 a novel coronavirus which is presently a
pandemic has affected the world in manner reminding the world of 1918 Spanish flu.
However, while battling the deadly pandemic, the clinicians should also be aware of the
repercussions of the effect this infection has on multiple organs such as ovarian suppression
leading to infertility, oligomenorrhea, or menorrhagia.


1. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS‑CoV‑2 and
COVID‑19. Nat Rev Microbiol 2021;19:141‑54.
2. Batiha O, Al‑Deeb T, Al‑Zoubi E, Alsharu E. Impact of
COVID‑19 and other viruses on reproductive health. Andrologia
3. Phelan N, Behan LA, Owens L. The impact of the COVID‑19
pandemic on women’s reproductive health. Front
Endocrinol (Lausanne) 2021;12:642755.
4. Wang YX, Arvizu M, Rich‑Edwards JW, Stuart JJ, Manson JE,
Missmer SA, et al. Menstrual cycle regularity and length across the
reproductive lifespan and risk of premature mortality: Prospective
cohort study. BMJ 2020;371:m3464.
5. Li R, Yin T, Fang F, Li Q, Chen J, Wang Y, et al. Potential risks of
SARS‑CoV‑2 infection on reproductive health. Reprod Biomed
Online 2020;41:89‑95.
6. Li K, Chen G, Hou H, Liao Q, Chen J, Bai H, et al. Analysis
of sex hormones and menstruation in COVID‑19 women of
child‑bearing age. Reprod Biomed Online 2021;42:260‑7.
7. Moradi F, Enjezab B, Ghadiri‑Anari A. The role of androgens in
COVID‑19. Diabetes Metab Syndr 2020;14:2003‑6.
8. Iliodromiti S, Anderson RA, Nelson SM. Technical and
performance characteristics of anti‑Müllerian hormone and antral
follicle count as biomarkers of ovarian response. Hum Reprod
Update 2015;21:698‑710.
9. Rotshenker‑Olshinka K, Volodarsky‑Perel A, Steiner N,
Rubenfeld E, Dahan MH. COVID‑19 pandemic effect on early
pregnancy: Are miscarriage rates altered, in asymptomatic
women? Arch Gynecol Obstet 2021;303:839‑45.
10. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single‑cell RNA‑seq
data analysis on the receptor ACE2 expression reveals the
potential risk of different human organs vulnerable to 2019‑nCoV
infection. Front Med 2020;14:185‑92.
11. Stanley KE, Thomas E, Leaver M, Wells D. Coronavirus disease‑19
and fertility: Viral host entry protein expression in male and
female reproductive tissues. Fertil Steril 2020;114:33‑43.
12. Fu J, Zhou B, Zhang L, Balaji KS, Wei C, Liu X, et al. Expressions
and significances of the angiotensin‑converting enzyme 2
gene, the receptor of SARS‑CoV‑2 for COVID‑19. Mol Biol Rep
13. Sharma I, Kumari P, Sharma A, Saha SC. SARS‑CoV‑2 and the
reproductive system: Known and the unknown.!! Middle East
Fertil Soc J 2021;26:1.
14. Henarejos‑Castillo I, Sebastian‑Leon P, Devesa‑Peiro A, Pellicer A,
Diaz‑Gimeno P. SARS‑CoV‑2 infection risk assessment in the
endometrium: Viral infection‑related gene expression across the
menstrual cycle. Fertil Steril 2020;114:223‑32.
15. Aassve A, Cavalli N, Mencarini L, Plach S, Livi Bacci M. The
COVID‑19 pandemic and human fertility. Science 2020;369:370‑1.
16. Sills ES, Wood SH. An experimental model for peri‑conceptual
COVID‑19 pregnancy loss and proposed interventions to optimize
outcomes. Int J Mol Cell Med 2020;9:180‑7.
17. Talwar D, Kumar S, Acharya S, Raisinghani N, Madaan S, Hulkoti
V, et al. Interleukin 6 and Its Correlation with COVID-19 in Terms
of Outcomes in an Intensive Care Unit of a Rural Hospital:A
Cross-sectional Study. Indian J Crit Care Med. 2022,26(1):39-42.
18. Dhama K, Khan S, Tiwari R, et al. Coronavirus Disease
2019‑COVID‑19. Clin Microbiol Rev. 2020;33(4):e00028‑20.
19. Dhama K, Patel SK, Pathak M, Yatoo MI, Tiwari R, Malik YS, et al.
An update on SARS‑CoV‑2/COVID‑19 with particular reference
to its clinical pathology, pathogenesis, immunopathology and
mitigation strategies. Travel Med Infect Dis 2020;37:101755.
20. Mahdian S, Shahhoseini M, Moini A. COVID‑19 mediated by
basigin can affect male and female fertility. Int J Fertil Steril
21. Chen L, Bi J, Nakai M, Bunick D, Couse JF, Korach KS,
et al. Expression of basigin in reproductive tissues of
estrogen receptor‑{alpha} or ‑{beta} null mice. Reproduction
22. Moreno‑Perez O, Merino E, Alfayate R, Torregrosa ME,
Andres M, Leon‑Ramirez JM, Boix V, Gil J, Pico A; COVID19‑ALC
Research group. Male pituitary‑gonadal axis dysfunction in
post‑acute COVID‑19 syndrome‑Prevalence and associated
factors: A Mediterranean case series. Clin Endocrinol (Oxf).
2021,23:10.1111/cen. 14537.
23. Lundholm MD, Poku C, Emanuele N, Emanuele MA, Lopez N.
SARS‑CoV‑2 (COVID‑19) and the endocrine system. J Endocr Soc
24. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development
and validation of a clinical risk score to predict the occurrence
of critical illness in hospitalized patients with COVID‑19. JAMA
Intern Med 2020;180:1081‑9.
25. Yuksel B, Ozgor F. Effect of the COVID‑19 pandemic on female
sexual behavior. Int J Gynaecol Obstet 2020;150:98‑102.
26. Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A,
Parish SJ. Hypoactive sexual desire disorder: International
society for the study of women’s sexual health (ISSWSH) expert
consensus panel review. Mayo Clin Proc 2017;92:114‑28.
27. Madaan S, Jaiswal A, Kumar S, Talwar D, Halani D. Premature
ovarian failure ‑ A long COVID sequelae. Med Sci 2021;25:1286‑90.
28. Hayes RD, Dennerstein L, Bennett CM, Koochaki PE, Leiblum SR,
Graziottin A. Relationship between hypoactive sexual desire
disorder and aging. Fertil Steril 2007;87:107‑12.
29. Rahman SA, Grant LK, Gooley JJ, Rajaratnam SM, Czeisler CA,
Lockley SW, et al. Endogenous circadian regulation of female
reproductive hormones. J Clin Endocrinol Metab 2019;104:6049‑59.
30. Shechter A, Boivin DB. Sleep, hormones, and circadian rhythms
throughout the menstrual cycle in healthy women and women
with premenstrual dysphoric disorder. Int J Endocrinol
31. Alzwain F, Bashatwa M, Hamadneh B. Psychological stress and
its relation to social distancing among a sample of Saudi during
COVID‑19 pandemic. J Educ Health Promot 2021;10:281.
32. Javed S, Parveen H. Adaptive coping strategies used by people
during coronavirus. J Educ Health Promot 2021;10:122.
33. Holtmann N, Edimiris P, Andree M, Doehmen C, Baston‑Buest D,
Adams O, et al. Assessment of SARS‑CoV‑2 in human semen ‑ A
cohort study. Fertil Steril 2020;114:233‑8.
34. Singh B, Gornet M, Sims H, Kisanga E, Knight Z, Segars J. Severe
acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) and
its effect on gametogenesis and early pregnancy. Am J Reprod
Immunol 2020;84:e13351.
35. Liu X, Chen Y, Tang W, Zhang L, Chen W, Yan Z, et al. Single‑cell
transcriptome analysis of the novel coronavirus (SARS‑CoV‑2)
associated gene ACE2 expression in normal and non‑obstructive
azoospermia (NOA) human male testes. Sci China Life Sci