Read Part one of the series here.
ME/CFS research about menstruation, pregnancy and menopause
Around 45% of Long COVID patients develop ME/CFS, a complex neuroimmune condition marked by neurological, vascular, and cognitive symptoms, along with pain, persistent fatigue unaffected by rest, and often exacerbation of symptoms after physical or cognitive exertion (PEM). ME/CFS has long been an under-researched disease, yet, the limited available ME/CFS research is a valuable source for understanding Long COVID.
Female sex stands as a significant and consistent risk factor for ME/CFS, with hormonal events often impacting the illness. Many women with ME/CFS note that menstrual cycles, pregnancy, and menopause exacerbate symptoms. Compared to healthy counterparts, women with ME/CFS commonly report irregular menstrual cycles, amenorrhea (lack of periods), excessive bleeding, intermenstrual bleeding, pelvic pain unrelated to menstruation, endometriosis, prior gynecological surgeries (especially hysterectomy), and a history of polycystic ovarian syndrome (PCOS) and ovarian cysts.
Between 53% and 67% of female ME/CFS patients report increased symptoms preceding menstruation, though these findings lack comparison to healthy controls. A longitudinal case-controlled study unveiled early onset menopause as a ME/CFS risk factor, with the average age of menopause notably earlier in ME/CFS patients compared to healthy individuals. Menopause exacerbates symptoms in a considerable number of women with ME/CFS.
Pregnancy can serve as a trigger for ME/CFS in 3% to 10% of cases. A study with matched controls revealed that women who had been pregnant in the year prior were significantly more likely to develop ME/CFS. Symptomatology during pregnancy among ME/CFS patients varies, with nearly equal subsets experiencing symptom improvement, maintenance, or worsening.
POTS research about menstruation, pregnancy and menopause
POTS, a form of dysautonomia characterized by orthostatic tachycardia without orthostatic hypotension (see this blogpost), commonly presents symptoms like lightheadedness, tachycardia, presyncope, and headaches. Among Long COVID patients, studies found POTS prevalence to be 28% and 30%.
Before the pandemic, POTS prevalence was estimated between 0.2% to 1%, with around 41% of POTS patients attributing an infectious trigger to their condition. Menstruation notably impacts POTS symptoms, with hormonal fluctuations affecting blood flow in POTS patients.
Studies indicate that elevated estrogen and progesterone during the mid-luteal phases may lead to increased blood volume retention and higher levels of renal-adrenal hormones. Research involving POTS patients and healthy controls revealed fluctuating levels of dizziness throughout the menstrual cycle, peaking during menses and decreasing during the follicular phase.
The menstrual cycle: POTS symptoms peak during menstruation and decrease during the follicular phase. (Source: Adobe Stock)
Additionally, POTS patients exhibit higher rates of various gynecological issues like dysfunctional uterine bleeding, secondary amenorrhea, uterine fibroids, endometriosis, ovarian cysts, and pelvic congestion syndrome. In pregnant POTS patients, symptoms worsen for the majority, although some subsets may experience improvement. Similar to ME/CFS, a proportion of POTS patients report pregnancy as a trigger for their condition.
Endometriosis
Approximately 36% of women diagnosed with ME/CFS (n = 36) and 20% of women diagnosed with POTS (n = 65) report experiencing endometriosis. Meanwhile, endometriosis patients may face a heightened risk of developing Long COVID, as indicated by a population-based retrospective cohort-matched study utilizing data from electronic health records of non-hospitalized Long COVID patients. However, further research is required to elucidate contributing factors.
Long COVID, ME/CFS and POTS can impact many hormonal and reproductive events in females. (Source: Pollack et al.)
The first two parts of this series summarized what we currently know about the impact of Long COVID and associated diseases on female reproductive health. Follow this series to learn more about reproductive health effects in men and transgender individuals and how testosterone levels could play a role in all genders.
