Menstrual concerns during Covid pandemic

Menstruation is the cyclical shedding of the uterine lining due to the influence of the fluctuating hormones estrogen and progesterone released by the ovaries. Menstruation typically starts in most young girls around 11 to 14 years. The first onset of menses is called menarche.Menarche is controlled by hormones released by the hypothalamus and pituitary which are partsof the brain. These hormones in turn act on the ovary and stimulate them to release hormones andeggs. During the Covid-19 pandemic, it has been observed that in some girls their menarche hassetin asearly aseightyears.

The reason for accelerated and increased incidence of puberty in females during the covid-19 pandemic has been a subject of study world over. An Italian study of 37 patients published in Italian journal of Paediatrics concluded that triggering environmental factors such as sudden increase in weight, over usage of electronic devices during the lockdown probably contributed to accelerated puberty andprogression to menarche. In the city of Bangalore as well,we had some young girls brought to us by panic-stricken mums with the complaint of menarche having set in much earlier than expected. The contributing factors have been a remarkable change in lifestyle in these young girls due to closure of schools, stoppage of sports activity, over usage of electronic devices due to e-learning platforms and influence of social media as well. To compound the problem further has been high calorie consumption of comfort foods and conflict with parents. Young girls must reduce screen time to a bare minimum, follow healthy eating habits and enroll in physical activity like cycling or sports permissible during the pandemic.

The pandemic seems to have affected menses in all age groups as well. Few women in their productive age group have also had concerns with irregular periods. Stress mounted by lifestyle changes due to work from home, lack of physical activity, and bizarre eating habits may becontributing to the same. Women must keep aside some me-time for their recreation and ensureadequatetimeissetasidefor someintensephysicalactivity daily.

Some women around the menopausal age group tend to have irregular or heavy cycles.Some of the common causes are hormonal imbalance due to the depletion of egg reserves in theovary Besides this the heavy bleeding may be due to problems within the uterus such as fibroidsor polyps within the cavity of the uterus. Due to lockdown and other such concerns, women withthese problems are unable to come to the hospital, and they seem to be the silent sufferers. Such women need to seek consultation with a health care provider either physically or by teleconsultation. An ultrasound can help to rule out causes hailing from the uterus. Hormonalimbalance in these women can be offset by inserting a progesterone releasing intrauterine device such as Mirena.

Some social media platforms were strongly advocating not taking the Covid-19 vaccine during the menstruation. There is no scientific basis for this. The ability to mount an immuneresponse after a vaccine administration does not depend on any of the hormones released by the ovary. Hence it is safe to take the vaccine at any time of the menstrual cycle, including the menses.

To all women out there, stay safe, ensure enough physical activity, and engage in any recreational hobby during this period. Also, maintain a well-balanced diet and get vaccinated at the earliest possible opportunity.

(Dr Gayathri D Kamath,Senior Consultant - Obstetrics & Gynecology, Fortis Hospitals, Bannerghatta Road, Bangalore)