Background
Women reported increased incidence of irregular menstruation (IM) during the COVID-19 (COVID) pandemic. No research has evaluated IM among women living with HIV (WWH) during the COVID pandemic, which is key to understanding reproductive health during co-infections.
Methods
From 2021-2023, cross-sectional data were collected from the Study of Treatment and Reproductive Outcomes (STAR) cohort of WWH and women without HIV (WWoH) ages 18-45 years in the southern US. Women completed surveys on history of COVID testing (we defined “self-reported COVID” as any self-report of a positive COVID test), COVID vaccination, IM in the past year (spotting, missed periods, early/late periods), and the Perceived Stress Scale. For the current analysis (n = 188), women were excluded for conditions or medications known to interfere with menses. Women in Atlanta and Miami had plasma tested for COVID antibodies (n = 86); in this sub-sample, we defined “COVID infection” as having detectable antibodies to nucleocapsid or self-report of a positive COVID test in any setting. We defined “vaccination” as self-reported vaccination or having detectable antibodies to receptor binding domain (RBD) not explained by COVID infection. We examined IM by vaccination and COVID infection groups stratified by HIV status.
Results
Among 188 women, 61% were WWH, 49% had IM, 34% self-reported COVID, and 58% reported vaccination. When assessed via a combination of self-report and antibody tests (n = 86), 69% had COVID infection, and 62% were vaccinated. IM, COVID infection, and vaccination did not differ by HIV status. Among WWoH (n = 73), IM was associated with lower age (32 vs. 35, p = 0.04), higher stress (17 vs. 13, p = 0.04), and self-reported COVID (70% of WWoH with self-reported COVID had IM compared to 43% without, p = 0.03), but not with self-reported vaccination, BMI, race, or ethnicity. Among WWoH with antibody testing (n = 42), 61% with COVID infection (per self-report and antibody testing) had IM compared to 27% without COVID. IM was reported by a similarly low percent of WWoH with neither COVID infection nor vaccination (33%) and only vaccination (25%). Among WWH, neither vaccination nor COVID were associated with IM.
Conclusions
IM occurred in half of women during the COVID pandemic regardless of HIV status, with higher rates among WWoH with COVID infection; no association was found between IM and COVID vaccination. Further research is needed to understand mechanisms underlying IM, including stress and infection.