After being vaccinated against COVID-19, many people have reported symptoms like swollen lymph nodes, “COVID arm” and blood clots. These reactions can be concerning, as many of us have never experienced them before. Some of the side effects reported appear to be associated with your body’s immune response to the vaccine. But what about the reports of altered menstrual cycles after vaccination?
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The evidence that COVID-19 vaccines can have a direct effect on menstrual cycles is still evolving. That said, several studies have shown an association between the vaccines and menstrual changes. Experts suggest that those changes are likely due to your body’s immune response, and aren’t a cause for concern.
Ob/Gyn George Fyffe, MD, FACOG, shares his insight about why this might be happening.
Research on COVID-19 vaccines and menstruation
Talk about the connection between vaccination and menstruation has been happening since COVID-19 vaccines became available. Interest grew following the publication of four different studies. Two examined the relationship between the vaccines and periods (also known as menses). The other two looked at the relationship between the vaccines and the entire menstrual cycle.
COVID-19 vaccination and menstrual flow
We’ll start by talking about menses: The period itself.
A study published in Science Advances in April 2022 shared the results of a survey about menstrual bleeding following COVID-19 vaccination. Of the 16,000 menstruating people who responded, 42% reported bleeding more than they usually do during their period.
Interestingly, people who don’t menstruate — either because they’re post-menopausal, on certain long-term contraceptives or taking gender-affirming hormones — also reported breakthrough or otherwise-unexpected bleeding.
42% is an eye-popping number. It’s also probably inaccurate. That’s because a person’s more likely to respond to a web-based survey about their menstrual cycle if they’ve noticed something unusual about it.
The findings of a January 2022 study out of Norway were less dramatic, with only 13% of respondents reporting a heavier-than-normal flow.
Neither of these studies was designed to establish a cause-and-effect relationship between COVID-19 vaccines and menses. They do, however, demonstrate a need for more research into the phenomenon.
COVID-19 vaccination and menstrual cycle
So, you may have a heavier period after your COVID-19 vaccine. What about the whole menstrual cycle? Can the jab affect that, too?
In July 2022, Obstetrics and Gynecology published a study that showed a small increase in the length of menstrual cycles following COVID-19 vaccination. In September 2022, a National Institutes of Health (NIH)-funded international study confirmed that finding in BMJ Medicine.
According to current research, the vaccine has a very small impact on the length of the menstrual cycle, increasing it by fewer than one day on average. While we traditionally think of the menstrual cycle as a 28-day-long thing, variation is completely normal. Most doctors tend not to worry about cycle variation unless it’s greater than eight days.
As was the case with the studies on COVID-19 vaccination and menses, these findings are observational. That means they can’t tell us why the vaccine is impacting menstrual cycle length. Lucky for us, doctors already know enough to venture a theory explaining these findings.
How your immune system can affect your menstrual cycle
We might not realize that there’s a connection between the uterus and the immune system, but there is. Dr. Fyffe says that as you’re about to ovulate, your immune system ramps itself up to prevent anything from interfering with fertilization and implantation of the egg. Once the egg is fertilized and implants, your immune system goes down again, in order to accept the pregnancy.
According to Dr. Fyffe, the lining of your uterus also has immune cells. Those cells can be affected by hormonal changes.
“The hypothalamus in the brain is the hormonal control center,” he explains. “It works with the anterior pituitary gland. Together, they send messages, in the form of hormones, to the ovaries and the uterus. Those messages tell the ovaries to increase or decrease hormone levels to facilitate ovulation, pregnancy or — if fertilization doesn’t occur — the return of the menstrual cycle. Those same messages impact the immune system, too.
“Emotional stress, physical stress and chemical stress can all affect the hormonal control center, which can result in menstrual cycle changes,” he adds.
Getting a vaccine qualifies as a form of chemical stress, but that doesn’t make it dangerous. Changes to your period are a sign your immune system is responding, which is, of course, the goal of vaccination.
What if you experience period changes after being vaccinated for COVID-19?
In most cases, post-vaccination period changes are minor and shouldn’t cause concern. If you’re noticing a serious disruption in your cycle or significant changes to your menses, talk to a doctor. Dr. Fyffe says you and your healthcare provider can work together to determine the best course of action.
Bottom line: COVID-19 vaccinations remain safe, effective and vitally important to our collective health. And you can roll up your sleeve confident that any period-related side effects will be short term.