Bleeding Through a Pandemic: Women's Lived Experiences with Heavy Menstrual Bleeding During the COVID-19 Pandemic

Heavy menstrual bleeding (menorrhagia) affects 10 million reproductive-age women. Stress is a mechanism for menstrual disorders, and during the COVID-19 pandemic, women reported worsening premenstrual and menstrual symptoms. We hypothesized that there would be a positive association between COVID stress and menorrhagia and a negative association between menorrhagia and mental health. A third objective was to explore women's lived experiences with menorrhagia during the pandemic, including menstrual pain and impact on socialization, sex life, and product use.

This was a secondary data analyses of a cross-sectional study that recruited adult women between the ages of 18-45 years using Dynata, a survey sampling company that maintains a web panel of survey takers across the United States. Menorrhagia was assessed with the Aberdeen Menorrhagia Severity Scale (AMSS), COVID stress with the COVID-19 Pandemic-related Perceived Stress Scale (PSS-10-C), and mental health with the Mental Health Continuum Scale (MHC-SF). We grouped the participants into mild menorrhagia (AMSS score 0-33)" and moderate/severe menorrhagia (AMSS score 34-100) and compared the outcomes using descriptive statistics, correlations, and linear regression.

The survey was conducted in May 2021. Among 1,037 initial responses, 360 naturally cycling women met the study eligibility criteria. Women with heavy bleeding reported more COVID-stress than those without heavy bleeding (p < 0.01) and heavy bleeding intensified with increasing COVID-related stress (adj. β = 0.37, 95% CI: 0.21, 0.53). Adjusting for baseline depression, mental health worsened as heavy bleeding increased (adj. β = -0.1, 95% CI: -0.24, -0.03). Compared to those without heavy bleeding, women with heavy bleeding were more likely to report severe pain and bed confinement, less socialization, a negative impact on sex life, and greater use of menstrual products.

COVID-related stress affects menstrual physiology and also complex interactions between life-course, social functioning, financial strain, and psychological stress. Our findings support increased awareness of these interactions in gynecologic care during a global pandemic.