ORIGINAL RESEARCH

published: 22 March 2021

doi: 10.3389/fendo.2021.642755

The Impact of the COVID-19

Pandemic on Women’s
Reproductive Health
Niamh Phelan 1,2, Lucy Ann Behan 1,3 and Lisa Owens 1,2*
1 Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland, 2 Department of Endocrinology,

St. James’s Hospital, Dublin, Ireland, 3 Department of Endocrinology, Tallaght University Hospital, Dublin, Ireland

Background: The COVID-19 pandemic has profoundly affected the lives of the global
population. It is known that periods of stress and psychological distress can affect
women’s menstrual cycles. We therefore performed an observational study of women’s
reproductive health over the course of the pandemic thus far.
Materials and Methods: An anonymous digital survey was shared by the authors via
social media in September 2020. All women of reproductive age were invited to complete
the survey.
Edited by:
Qi Chen, Results: 1031 women completed the survey. Mean age was 36.7 ± 6.6 years (range, 15–
The University of Auckland, 54). 693/70% reported recording their cycles using an app or diary. 233/23% were using
New Zealand
hormonal contraception. 441/46% reported a change in their menstrual cycle since the
Reviewed by:
Renato Fraietta, beginning of the pandemic. 483/53% reported worsening premenstrual symptoms, 100/
Federal University of São Paulo, Brazil 18% reported new menorrhagia (p = 0.003) and 173/30% new dysmenorrhea (p <
Ljiljana Marina,
0.0001) compared to before the pandemic. 72/9% reported missed periods who not
University of Belgrade, Serbia
previously missed periods (p = 0.003) and the median number of missed periods was 2
*Correspondence:
Lisa Owens (1–3). 17/21% of those who “occasionally” missed periods pre-pandemic missed periods
[email protected] “often” during pandemic. 467/45% reported a reduced libido. There was no change in the
median cycle length (28 days) or days of bleeding (5) but there was a wider variability of
Specialty section:
This article was submitted to cycle length (p = 0.01) and a 1 day median decrease in the minimum (p < 0.0001) and
Reproduction, maximum (p = 0.009) cycle length. Women reported a median 2 kg increase in self-
a section of the journal
Frontiers in Endocrinology
reported weight and a 30-min increase in median weekly exercise. 517/50% of women
Received: 16 December 2020
stated that their diet was worse and 232/23% that it was better than before the pandemic.
Accepted: 15 February 2021 407/40% reported working more and 169/16% were working less. Women related a
Published: 22 March 2021
significant increase in low mood (p < 0.0001), poor appetite (p < 0.0001), binge eating (p <
Citation:
0.0001), poor concentration (p < 0.0001), anxiety (p < 0.0001), poor sleep (p < 0.0001),
Phelan N, Behan LA and Owens L
(2021) The Impact of the COVID-19 loneliness (p < 0.0001) and excess alcohol use (p < 0.0001). Specific stressors reported
Pandemic on Women’s included work stress (499/48%), difficulty accessing healthcare (254/25%), change in
Reproductive Health.
Front. Endocrinol. 12:642755.
financial (201/19%) situation, difficulties with home schooling (191/19%) or childcare (99/
doi: 10.3389/fendo.2021.642755 10%), family or partner conflict (170/16%), family illness or bereavement (156/15%).

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Phelan et al. Reproductive Disturbance Due to COVID-19 Pandemic

Conclusions: The COVID-19 pandemic has significantly impacted the reproductive

health of women. The long term health implications of this are yet to be determined and
future studies should address this.
Keywords: menstrual abnormalities, COVID-19 pandemic, psychological distress, oligomenorrhea/amenorrhea,
libido, dysmenorhea, menorrhagia

INTRODUCTION MATERIALS AND METHODS

The COVID-19 pandemic, caused by severe acute respiratory Study Design
syndrome coronavirus 2 (SARS-CoV-2) (1, 2), has caused over This was an anonymous observational study. A digital survey was
106 million infections and 2.3 million deaths worldwide, as of created using the Typeform platform (www.typeform.com). A link
February 2021, according to the WHO COVID-19 Dashboard to the survey was shared by the authors via social media (Facebook,
(3). The virus itself, as well as the measures taken to reduce its Twitter) and all women of reproductive age were invited to
spread, have profoundly affected the lives of the global participate. The survey contained 50 questions on demographic
population. The pandemic has significantly impacted the information, menstrual cycle and mental health symptoms, diet,
mental health of many people within the population, resulting exercise and working patterns from before and since the beginning
in loneliness, social isolation, financial strain, as well as the of the pandemic. It took between 5 and 10 min to complete. Ethical
anxiety and fear of contracting the virus, and uncertainty for approval was granted for the study by the St James’s and Tallaght
the future. Analysis of a national, longitudinal cohort study University Hospital Research Ethics Committee (JREC 2020-10-
found that by late April 2020, mental health in the UK had CA-10). Written consent was not required as all data was collected
deteriorated compared with before the COVID-19 pandemic (4). anonymously. The survey was circulated over a 2-week period in the
A US study in April 2020 found higher rates of psychological second half of September 2020. The study was conducted and
distress among adults, compared with 2018 (5). In this study the reported according to published best practice guidelines for
increase in psychological distress was greatest in women and reporting observational studies (17). A full list of survey questions
young people aged 18–24 years. On the other hand, there is can be found in Supplementary Table 1.
theoretically a group who have experienced reduced stress and
improved mental well-being, for example those with financial Participants
security, those who have spent more time with their families and In total 1031 women completed the survey. All women of
less time commuting since the outbreak of the pandemic. reproductive age were invited to participate via digital link.
It is known that periods of stress and psychological distress Menstrual cycle and BMI data were excluded from women who
can affect women’s menstrual health. Stressors can activate the became pregnant or delivered a baby during the pandemic.
hypothalamic-pituitary-gonadal (HPG) axis and can alter the Menstrual cycle data was also excluded from women who stated
neuro-modulatory cascade that drives gonadotropin releasing they were amenorrhoeic for any reason (i.e. due to an intrauterine
hormone (GnRH) regulation (6). This can result in functional system, intrauterine device or implant, menopause, breastfeeding).
hypothalamic amenorrhoea (FHA), chronic anovulation which
is not due to an underlying organic cause (7, 8). Behavioural Statistical Analysis
modification such as cognitive behavioural therapy can reverse Data was analysed using Graphpad Prism version 8.4.3.
this amenorrhoea (9). FHA also occurs secondary to excessive Parametric data is reported as mean and standard deviation
exercise, dieting and caloric restriction and disordered eating (SD). Non-parametric data is reported as median and
(10, 11). interquartile range (IQR). A p-value < 0.05 was considered
Psychological distress is not only associated with missed statistically significant. A paired t-test was used to compare
periods but also worsening of symptoms associated with parametric data for data comparing before and during the
menstruation and psychosexual health. Dysmenorrhoea has pandemic (e.g. comparing dysmenorrhoea experienced before
been shown to be associated with high stress levels (12), and since the beginning of the pandemic). A Wilcoxon matched
emotional instability and depression (13). Pre-menstrual pairs rank test was used to compare non-parametric paired data.
symptoms (PMS) and menorrhagia are also associated with
high psychological distress (14, 15). Higher perceived stress is
also associated with lower libido in women (16). RESULTS
Our objective therefore was to survey the general female
population of reproductive age with regards to their menstrual Patient Demographics
cycle, libido and changes in their lifestyle over the course of the A total of 1031 women completed the survey. The participants
pandemic thus far. We performed an anonymous observational demographic information is summarized in Table 1. The mean age
study by circulating a survey via social media and text message. of the women was 36.7 ± 6.6 years (range, 15–54 years). The mean self-

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Phelan et al. Reproductive Disturbance Due to COVID-19 Pandemic

TABLE 1 | Participant demographics/medical history. TABLE 2 | Menstrual history and contraceptive use.

Demographics Parameter Result

Age (mean ± SD), years 36.7 ± 6.6 (range, 15–54) Contraception use None—747/72%
BMI (mean ± SD), kg/m2 25.8 ± 5.5 (range, 16.6–65.5) Combined contraceptive pill/patch—
Ethnicity 1000/97% White (White Irish, White British) 110/11%
23/2% Asian Intrauterine system—77/7%
3/0.3% Black Progesterone only pill—31/3%
5/0.5% Other Intrauterine device—24/2%
Location 862/84% Ireland Implant—13/1%
145/14% UK Depot—2/0.2%
24/2% other countries Other—27/3% ( Barrier, tubal ligation,
Marital status Single 249/25% vasectomy)
Married 567/57% Cycles recorded using app/diary/ Yes 693/70%
Cohabiting 150/15% smartphone/other No 297/30%
Separated/Divorced 25/3% Regular periods under normal Yes 834/81%
Widowed 1/0.1% circumstances No 163/16%
Occupation 301/29% Healthcare workers (HCW) N/A 32/3%
175/17% Doctors, 57/6% nurses, 69/7% Median cycle length (days) 28 (27–30)
other HCWs Median no. of days of bleeding 5 (4–6)
Work status and location during Full time in the workplace 392/38% Minimum length of cycle (days) (median) 27 (25–28)
pandemic Full time from home 311/30% Maximum length of cycle (days) 30 (28–32)
Part time in the workplace 130/13% (median)
Part time from home 64/6% Missed periods 131/13% (occasionally 82/8%, often
Maternity leave 47/5% 49/5%)
Unemployed before pandemic 56/5% Heavy periods 420/42%
Made redundant/unemployed during Painful periods 416/42%
pandemic 23/2%
Participants with children (yes/no) Yes 593/58%
No 435/42%
Currently breastfeeding 74/7.2%
women were not using any form of contraception and 231/22%
Pre-existing medical conditions Polycystic Ovary Syndrome 68/7% were using hormonal contraception (Table 2). The median cycle
Excess unwanted hair 308/30% length was 28 days (27–30) with a 5 day bleed (4–6) and the
Hypothalamic amenorrhoea 3/0.3% minimum usual cycle length was 27 (25–28) days and the
Endometriosis 65/6%
maximum usual cycle length was 30 days (28–32) (Table 2). 131/
Premature ovarian insufficiency 22/2%
Osteopenia/Osteoporosis 13/1%
13% of women reported missing periods, 82/8% reported missing
Acne 115/11% them occasionally and 49/5% often. 420/42% reported heavy
Thyroid disorder 91/9% periods and 416/42% painful periods (Table 2).
Covid-19 history Yes and tested positive 35/3.4%
“Did you have Covid-19?” Yes, had symptoms but did not get tested
63/6.1%
Menstrual Cycle Changes During the
No 870/83% COVID-19 Pandemic
No, but had contact with a confirmed case 441/46% of women who got periods reported an overall change
63/6% in their menstrual cycle during the COVID-19 pandemic. See
Table 3 for menstrual cycle changes. 483/53% reported a
reported body mass index (BMI) was 25.8 ± 5.5 kg/m2. (range, 16.6– worsening in premenstrual symptoms (PMS), whereas 60/7%
65.5 kg/m2). 1000/97% of the women were of white ethnicity and felt that their PMS improved. The median cycle length was 28
1007/98% were based in Ireland or the United Kingdom. 717/72% days, similar to before the pandemic but with a significantly
were married or cohabiting, 249/25% were single and 25/3% were wider range (25–30) (p = 0.01). 255/29% noted a reduced cycle
separated or divorced. 593/58% stated that they had children and 74/ length and the median reduction was 3 days (2–6) and 28%
7.2% were currently breastfeeding. 897/88% of women were working reported a longer cycle with a median increase of 3 days (2–6).
during the pandemic, 522/51% in the workplace and 375/37% from The median number of days of bleeding was 5 (4–6) and was
home. 326/59% of women who had children, home-schooled them unchanged compared to before the pandemic (p = 0.3). The
when schools were closed and 369/66% had to provide childcare while minimum length of the cycle was 26 days (22–28), a median of 1
also trying to work. 301/29% were healthcare workers (HCW); 175/ day shorter than before the pandemic (p < 0.0001). The
17% Doctors, 57/6% nurses and 69/7% were other HCWs. 35/3.4% maximum length of the cycle was 29 days (22–28), also a
stated that they had contracted COVID-19 and tested positive, 63/ median of 1 day shorter than before the pandemic (p = 0.009).
6.1% had symptoms of COVID-19 but did not get tested. 158/17% had missed periods during the pandemic, 4%/27
more than pre-pandemic (p = 0.0003). 72/9% reported new
Menstrual History missed periods, of which 56/7% were “occasional” and 16/2%
834/81% of women stated they usually had regular periods. 693/70% were “often.” The median number of missed periods was 2 (1–3).
of those who had periods recorded them using an app, diary, 17/21% who “occasionally” missed periods pre-pandemic missed
smartphone or other recording method (Table 2). 747/72% of periods “often” during pandemic. 40/31% of those who had

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TABLE 3 | Menstrual cycle changes during the Covid-19 pandemic.

Change Result, n/% p-value

Overall change in menstrual cycle Yes—441/46%

No—523/54%
Change in libido/sex drive No change—429/42%
Increased libido—131/13%
Decreased libido—467/45%
Change in premenstrual symptoms (PMS) PMS unchanged—366/40%
PMS better—60/7%
PMS worse—483/53%
Median cycle length (days) 28 (25-30) 0.01
255/29% reduced cycle length −3 days (2–6, range 1–55)
239/28% increased cycle length +3 days (2–6, range 1–103)
No. of days of bleeding (median, IQR) 5 (4–6) P = 0.3
Minimum length of cycle (days) (median, IQR ) 26 (22–28) p < 0.0001
Maximum length of cycle (days) (median, IQR) 29 (28–32) p = 0.009
Missed periods −158/17% (+4%/27) (occasional—93/10%, often—65/7%) p = 0.0003
−72/9% new missed periods (occasional—56/7%, often—16/2%)
-Median missed periods= 2 (1–3)
-17/21% who ‘occasionally’ missed periods pre-pandemic missed periods ‘often’ during pandemic
-40/31% who had missed periods previously had no missed periods during pandemic
Heavy periods 447/47% P = 0.003
18%/100—new heavy periods
15%/63—less heavy periods
Painful periods 469/49% p < 0.0001
173/30%—new painful periods
49/12%—previously painful periods improved
Conceived during pandemic 84/8%

missed periods previously had no missed periods during TABLE 4 | Changes in lifestyle during the COVID-19 pandemic.
pandemic. 467/45% of women reported a decrease in their
Question Result P-
libido and 131/13% reported an increase in their libido. 447/ value
47% of women reported heavy periods, 27/5% more than before
the pandemic (p = 0.003). 469/49% reported painful periods, 53/ Change in weight Median +2 kg (0–4) <0.0001
7% more than before the pandemic (p < 0.0001). 173/30% (n = 964) (median, IQR) 184/19% no change in weight
158/16% lost weight, median −3
reported new painful periods and 49/12% reported that kg (2–5 kg)
previously painful periods improved during the pandemic. 622/65% gained weight, median
+3 kg (2–5 kg)
Lifestyle and Mental Health Change During Change in minutes of exercise/ + 30 (40–270) 0.02
week (median, IQR)
the COVID-19 Pandemic Type of exercise Running—350/34%
The overall median change in self-reported weight was an increase Yoga/pilates—300/29%
of 2 kg (0–4 kg) (p < 0.0001) (Table 4). 622/65% of women gained HiiT—202/20%
weight, and the median weight gain was 3 kg (2–5 kg) (Table 4). Strength training—209/20%
158/16% lost weight, and the median weight loss was also 3 kg (2– Walking—193/19%
Other—51/5%
5 kg) (Table 4). Women carried out on average 150 (40–270) None—65/6%
min of exercise per week during the pandemic, 30 min (60–220) Diet Overall diet is unchanged—281/
more than before the pandemic (p = 0.02) (Table 4). 517/50% 27%
of women felt that overall their diet was worse during the Overall diet is better—232/23%
pandemic. 232/23% felt that their diet overall had improved Overall diet is worse—517/50%
Change in work practices No change—453/44%
(Table 4). 127/12% reported drinking excess alcohol compared Working more—407/40%
to 72/7% before the pandemic (Table 5). 407/40% reported Working less—169/16%
working more than before the pandemic and 169/16% were
working less (Table 4).
Women reported a significant increase in suffering from mental loneliness (373/36%, p < 0.0001), poor appetite (373/36%, p <
health symptoms (Table 5). 868/84% of women reported suffering 0.0001) and excess alcohol use (373/36%, p < 0.0001). There was no
from at least one symptom, including low mood (519/50%, p < change in illicit drug use (1%, p = 0.34). Women reported
0.0001), anxiety (514/50%, p < 0.0001), poor sleep (509/49%, p < experiencing a number of stressors as outlined in Table 6, the
0.0001), significant stress (373/36%, p < 0.0001), binge eating (373/ most prevalent of which was work stress (499/48%), followed by
36%, p < 0.0001), poor concentration (373/36%, p < 0.0001), difficulties accessing healthcare (254/25%) (Table 6).

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TABLE 5 | Mental health symptoms. experienced reproductive health disturbance as a result of the
Before pandemic During pandemic P-value
COVID-19 pandemic. These disturbances are associated with a
significant increase in suffering from mental health symptoms, as
Low mood 359/34% 519/50% <0.0001 well as weight gain, longer working hours and an unhealthier
Anxiety 382/37% 514/50% <0.0001
diet. A minority of women have described improvement in their
Poor sleep 341/33% 509/49% <0.0001
Significant stress 268/26% 373/36% <0.0001
reproductive health and lifestyle over the course of the pandemic.
Binge eating 236/23% 335/32% <0.0001 Women reported disturbances in their menstrual cycles that
Poor concentration 172/17% 360/35% <0.0001 are known to be associated with psychological distress. Stress has
Loneliness 136/13% 299/29% <0.0001 an inhibitory effect on the hypothalamic pituitary gonadal axis
Poor appetite 64/6% 129/12% <0.0001
(HPG). Stress and stress hormones inhibit GnRH release from
Excess alcohol use 72/7% 127/12% <0.0001
Illicit drug use 11/1% 7/1% 0.34 the hypothalamus, and glucocorticoids inhibit luteinising
hormone (LH) release and oestrogen and progesterone
production by the ovary (18, 19). Stress regulates HPG axis
TABLE 6 | Stressors. “Have you had any of the following stressors over the
through activation of hypothalamic sympathetic neural pathways
course of the pandemic?”
that result in norepinephrine release in the ovary (20).
Stressor n/% Functional hypothalamic amenorrhoea (FHA), chronic
anovulation which is not due to an underlying organic cause, is
Work stress or change in employment status 499/48%
Difficulties accessing healthcare 254/25%
associated with vigorous excess and an energy deficit, as well as
Change in financial situation 201/19% stress, anxiety and mood disorders (7, 8, 21, 22). FHA has long-term
Difficulties with home schooling 191/19% health consequences including subfertility, osteoporosis, increased
Family illness or bereavement 169/16% risk of cardiovascular disease and psychiatric disease (23). There was
Change in living situation 156/15%
a significant increase in missed periods, likely as a result of
Family or partner conflict 170/16%
Difficulties providing or arranging childcare 99/10%
psychological distress and an increase in the amount of exercise
being carried out. Whether these missed periods will ultimately
progress to chronic anovulation is as yet unknown. Women who
Women who reported experiencing one or more of low mood,
missed periods occasionally before the pandemic reported missing
anxiety, or significant stress were significantly more likely to report
them often during the pandemic. Given that many women gained
an overall change in their menstrual cycles since the beginning of the
weight and reported that their diet had worsened, this amenorrhoea
pandemic (50% versus 34%, p < 0.0001). These women with mental
is likely related to not only stress related amenorrhoea, but also
health symptoms were also more likely to report painful periods
overweight/obesity and worsening of PCOS symptoms, both known
(54% versus 36%, p < 0.0001), worsening pre-menstrual symptoms
to be affected by incremental increases in weight (24, 25).
(62% versus 32%, p < 0.0001), as well as decreased libido (51% versus
Over half of respondents reported worsening symptoms of
31%, p < 0.0001). 18% of women who experienced low mood,
pre-menstrual syndrome (PMS). Studies have demonstrated a
anxiety, and/or significant stress reported missing periods since the
higher prevalence of PMS among women with a high
beginning of the pandemic, whereas 13% of those who did not
psychosocial stress level (15). PMS can have a significant
experience these mental health symptoms reported missed periods,
impact on women’s health and is associated with impairment
however this difference was not significant (p = 0.08). Those women
of activities of daily living and mental health disorders such as
who reported an overall change in their menstrual cycles were more
anxiety disorders, postnatal and perimenopausal depression (26).
likely to have reported poor sleep (41%) than those who did not
Almost half of women reported periods that were heavy and
report a change in their menstrual cycles (28%), p < 0.0001.
painful, a significant increase compared to before the pandemic.
The final question of the study asked “do you have any other
Again this is largely unsurprising as both have been shown to be
comments related to the impact of COVID-19 pandemic on your
associated with stress, psychological distress and low mood (12–
life?” 420/41% of respondents added a comment. Selections of
15). 45% of women also reported a reduction in their libido.
the responses are provided in Supplementary Table 2. We
Hypoactive sexual desire disorder, when symptoms persist for
labelled the comments as “positive,” “negative,” “mixed” or
over 6 months and are accompanied by distress, affects 6% to
“neutral” depending on what impact was described by the
13% of the European adult female population (27, 28). Self-
respondents. 322/77% of comments described a negative
reported reduced sexual desire has been shown to be associated
impact of the pandemic on their lives, 41/10% described an
with lower quality of life, poor self-esteem and hopelessness, as
overall positive impact of the pandemic, 27/6% commented that
well as depression and anxiety (27).
the pandemic had both positive and negative impacts on their
Women reported no change in the median length of their
lives, and 30/7% of comments were neutral.
cycle but there was a significantly wider range in the length of
their cycle and a shortening of the minimum and maximum
DISCUSSION cycle length recorded. It is known that for those trying to
conceive, shorter or longer menstrual cycles are less likely to
This large, anonymous observational study has demonstrated be ovulatory and be followed by conception and are more likely
that a large proportion of the female population have to end in spontaneous abortion (29).

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Phelan et al. Reproductive Disturbance Due to COVID-19 Pandemic

There was a significant increase in reported acute mental health was 25.8 kg/m2, similar to previous large studies in women of
suffering since the outbreak of the pandemic. Approximately half reproductive age (36). Another potential limitation is that there
reported low mood and anxiety and approximately one third may have been sampling bias, where those who opted to
reported stress, binge eating, poor concentration and loneliness. complete the survey were those who were more likely to have
Those who experienced low mood, anxiety and/or significant stress suffered menstrual disturbance. While we acknowledge that self-
were more likely to report an overall change in their menstrual reported data collection is subject to bias, using digital surveys is
cycle, as well as worsening pre-menstrual symptoms, more painful a safe way to perform research during the pandemic, and given
periods, and reduced libido. Almost half of women reported poor the anonymous nature of the study, the results have merit and
sleep, and those who reported poor sleep were more likely to have provide a valuable insight into reproductive disturbances women
experienced alteration in their menstrual cycle. It is known that sex have experienced as a result of the pandemic.
hormones influence circadian rhythm, and vice versa (30, 31). Another limitation is the population of women that
PMS, which increased during the pandemic, is also associated with completed the survey. The majority were of white ethnic
sleep disturbance (32). Sleep disturbance may actually affect background, so the data may not be representative of all
fertility, as it has found to be more prevalent in those with women. The pandemic has disproportionately affected certain
infertility and those with diminished ovarian reserve (33). sectors of society, such as women of black, Asian or minority
Women also recorded lifestyle changes which may have ethnic (BAME) background, who are more likely to be severely
impacted their menstrual cycles. There was an overall increase affected if they contract COVID-19 (37) and more likely to be
in the amount of exercise being undertaken, by half an hour per from lower socio-economic backgrounds (38). 88% of
week. Despite this women gained weight, a median of 2 kg, likely respondents were in employment, which is higher than the
because half of the women reported that their diet was worse and European Union average for women of 66.5% (39). The
almost one third reported binge eating since the beginning of the average age was 36, and it is known younger women are more
pandemic. 40% of women were also working more during the likely to develop hypothalamic amenorrhoea (40), so it is
pandemic, which would limit the time available for preparing possible that a younger cohort of women may have worse
healthy meals. symptoms. There was also a high number of healthcare
While a significant proportion of women described the workers surveyed, who may be more significantly affected by
negative impact of the pandemic on their menstrual cycle and the pandemic due to enhanced workplace stressors and fear of
lifestyle, there was a minority who described a positive effect. Some exposure to COVID-19. Lastly, the reported mental health
women had noted more regular periods, and periods that were less symptoms were intended only to provide a snapshot of how
heavy and painful with less PMS. Some women reported an women were feeling subjectively, and are not an objective,
increase in their libido. There was an increase in average qualitative measure of symptoms using validated mental health
exercise per week, and 1 in 6 women lost weight. When they questionnaires. The main focus of this study was on the
were invited to comment about the impact of the COVID-19 reproductive symptoms women were experiencing.
pandemic one in ten women described positive aspects of the While it is clear from this study that women have suffered
pandemic; including a slower pace of life, less commuting and significant reproductive health disruption since the beginning of
getting to spend more time with their families. Some women (6%) the pandemic, the medium and long term impacts of this are, as
recognised both a positive and negative impact of the pandemic on yet, unknown. This study captured the first approximately 6
their lives. It is as yet impossible to know if any positive effects will months of the pandemic (February/March 2020 to September
endure as the pandemic continues and progresses. 2020). The longer term health implications are likely to also
The major strength of this study is the large number of depend on the duration of the pandemic and other uncertainties
women surveyed, as well as the novel nature of the data. such as the economic impact and the distribution of and access to
Another strength of the study is the fact that the majority COVID-19 vaccines. Future work should include continued
(70%) of women were recording their menstrual cycle pattern multi-modal assessment at different intervals over the course of
using diary or smartphone app, therefore the menstrual cycle the pandemic, including ongoing validated assessment of mental
data is likely to be largely unbiased. In addition, the survey was health and measurements of BMI, hormone levels and ovulation.
anonymous, reducing the effect of social desirability bias, where
people are more likely to report experiences that are considered
to be socially acceptable. DATA AVAILABILITY STATEMENT
There are several limitations to this observational study. The
first is that the study recorded self-reported data, which is subject The raw data supporting the conclusions of this article will be
to bias. Self-reporting of menstrual cycle has been shown to have made available by the authors, without undue reservation.
measurement error (34). However the majority of women in our
study were recording their cycles using an app or a diary,
reducing recall bias. Self-reported weight can also be ETHICS STATEMENT
inaccurate, however a study showed that when young people
self-report weight they under-estimate by an average of only The studies involving human participants were reviewed and
0.4 kg (35), a modest under-estimate. In addition the mean BMI approved by St James’s and Tallaght University Hospitals REC.

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Phelan et al. Reproductive Disturbance Due to COVID-19 Pandemic

Written informed consent for participation was not required for ACKNOWLEDGMENTS
this study in accordance with the national legislation and the
institutional requirements. The authors would like to acknowledge the women who kindly
gave of their time and completed the survey, and the PMGUK
Facebook group who completed and shared the survey.
AUTHOR CONTRIBUTIONS
LO is the primary investigator and completed data analysis and
wrote the manuscript. NP wrote the manuscript and was SUPPLEMENTARY MATERIAL
involved in setting up and completing the study. LB wrote the
manuscript and was involved in setting up and completing The Supplementary Material for this article can be found online
the study. All authors contributed to the article and approved at: https://www.frontiersin.org/articles/10.3389/fendo.2021.
the submitted version. 642755/full#supplementary-material

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