Researchers try to tease out possible ties between long Covid and menopause

When she stopped getting her period in March 2022, Daryn Schwartz wasn’t especially concerned. At 42, she had recently come off birth control, and figured her cycles were still adjusting. When it hadn’t come back by the summer, she sought gynecological care, but was told to wait it out. So she did, with no changes.

She was having other symptoms, too — fatigue, chronic pain, and difficulty focusing. She would forget names, words even. “I started joking with my friends about cognitive decline,” she said, but “it was terrifying. It really scared me a lot.”

Eventually, an integrative care doctor offered an explanation. “She looked at me and she said: ‘You’re in menopause,’” said Schwartz, who had none of the risk factors for early menopause. She started hormone replacement therapy. It made her feel worse.

She was eventually connected with Traci Kurtzer, a gynecologist and menopause specialist at the Northwestern Medicine Center for Sexual Medicine and Menopause, who validated Schwartz’s feeling that something was off. “I don’t think that this is just a naturally occurring spontaneous menopause,” Schwartz recalled Kurtzer telling her.

Lab results found markers for autoimmune disease, and Epstein-Barr virus. “I think that this is long Covid,” said Kurtzer. Schwartz had tested positive for the Covid-19 in December when the Omicron variant was dominant.

Women have been reporting period disturbances after a Covid infection or after receiving a Covid vaccine, though research has often minimized the relevance of such symptoms. A 2022 systematic review of research found that women can experience a range of symptoms following the administration of a Covid vaccine, including temporary increased bleeding and longer and more painful periods. But research specifically on long Covid and menopause is scarce, and mostly preliminary.

So far, the evidence collected is primarily anecdotal, and Kurtzer is one of the few menopause specialists in the country working on the possible ties between long Covid and menopause. Awareness of the impact of the viral infection on the female reproductive system is gaining more attention, though.

Kurtzer said Schwartz was hardly the first of her patients to present such symptoms. Ever since the onset of the Covid-19 pandemic, the gynecologist has noticed a troubling trend among her patients who had been diagnosed with Covid-19.

“I’ve been experiencing absolutely a change in the number of women I’m seeing with earlier menopausal symptoms, and the severity of symptoms being quite a bit more intense than it used to be,” she said. “And I’m seeing menopausal women who have been menopausal for years and stable, whether on hormones or not, starting to have symptoms again.”

Other period disturbances include irregular and heavy bleeding, both following Covid-19 infections and the administration of vaccines, though those typically resolve more quickly. Kurtzer believes most of these issues, which can improve and even resolve themselves in a matter of weeks or months, though sometimes linger on, are linked to some ovarian abnormality caused by the viral infection.

Earlier this year, Kurtzer was asked to join specialists working at the Northwestern Medicine Comprehensive Covid-19 Center. “The physicians there who are quote-unquote long Covid physicians started to recognize one, [that] the majority of the patients they were seeing were women or people with ovaries. And two, it was not unusual for them to hear reports of menstrual changes or menopausal-type symptoms,” she said.

Kurtzer, too, experienced long Covid, with symptoms including fibrosis of her heart, damage to her lungs, and extreme fatigue. Despite her initial hesitation in joining the roster of specialists at Northwestern, mainly due to the toll long Covid has taken on her, she decided to see patients at the clinic.

“I’m really almost the only person here that could have done that. I am the menopause expert for Northwestern. … I do take care of a lot of women, you know, menstrual disorders and premature ovarian insufficiency for their hormonal needs,” she said. “And I’m also somebody who has lived experience with long Covid. So I’m very familiar with and empathetic to what that experience is like for people.”

“It’s very, very clear that some people, after they get the SARS-CoV-2 infection … start having menstrual irregularities or some pain and other symptoms. Why is this really happening? We don’t really know,” said Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis who studies long Covid. Three years ago, he said, he would have been quite uncertain about any link between long Covid and earlier or worsening menopause symptoms. Now he sees this as an important, if still overlooked, area of research.

“There is actually not a whole lot of research in this area,” he said. Al-Aly thinks Kurtzer’s working hypothesis that the cause may be damage inflicted to the ovaries by the Covid virus is worth exploring.

Al-Aly said the investment in trying to understand the mechanism leading to reproductive health symptoms — in women and, often less visibly, in men — has been insufficient so far. “I really think it’s a much, much more important problem than we’re paying attention to. And … there are pockets where people are paying attention to it — but I emphasize the word pockets. You don’t you don’t see nearly in any way the amount of research that is needed to help us more deeply understand what’s happening,” he said.

Even with limited treatment options and no full understanding of the mechanism causing menstrual and fertility disruptions following Covid, Kurtzer said being part of the long Covid clinic gives her a chance to better help her patients.

Since she sees many women who experience menopause-like symptoms, she is able to identify what indeed is menopause, and what may be long Covid, as in Schwartz’s case. “Certainly perimenopause and menopause symptoms have a lot of overlap with a lot of the other long Covid symptoms,” she said. But she has ways to distinguish, such as looking out for post-exertional malaise, which is very different from the fatigue that can be caused by menopause, or noticing significant weight loss, which is rare in menopause.

Unfortunately the help she can offer is limited; as she knows from her own experience, a diagnosis of long Covid doesn’t come with a treatment. At times symptoms improve marginally with hormone therapy, although for some they don’t. “All I can do right now is say some of your symptoms may also be related to your ongoing long Covid symptoms. And right now, there are no approved treatments for long Covid. So it means really just symptomatic management,” she said. With that can come help from other specialists at the clinic, as well as important acknowledgement of symptoms that can often be puzzling, as well as debilitating for patients.

“On the one hand, just having some answers was really validating and helpful and eased a lot of my fears,” said Schwartz. “But on the other hand, to know that there is no quote-unquote cure, there’s no specific treatment for long Covid, that’s really frustrating.”