Period Symptoms Are Possible After COVID Vaccine—Even if You Don't Usually Menstruate

There is a growing body of anecdotal reports and scientific evidence showing that COVID-19 vaccines can affect menstruation.

A recent study, presented at the experimental biology conference EB 2022, found that people who take testosterone and/or gender-affirming hormones and usually do not menstruate experienced menstrual side effects from their COVID-19 vaccination. These side effects include breakthrough bleeding, chest or breast soreness, cramping, and bloating.

Previous studies that looked into the menstrual side effects of vaccination largely focused on cisgender women, whose gender identity matches the gender they were assigned at birth. However, this study had a gender-diverse sample with transgender, nonbinary, or gender non-conforming respondents.

How Do COVID-19 Vaccines Affect Non-menstruating People?

Out of the 552 respondents who used testosterone or other gender-affirming hormones and said that they did not usually menstruate, about 33% reported breakthrough bleeding after taking the COVID-19 vaccine, and 9% experienced chest soreness. Roughly 46% also had symptoms that are generally associated with periods, such as bloating and cramping.

“Menstruation is a complex interplay of natural, environmental, and medical treatments,” Jen Villavicencio, MD, MPP, an OB-GYN and the lead for equity transformation at the American College of Obstetricians and Gynecologists (ACOG), told Verywell. “Understanding how a treatment impacts or does not impact menstruation may be important, particularly for those for whom menstruation may be undesired.”

The results of survey showed that vaccine-associated breakthrough bleeding also occurred among other people who usually do not menstruate, such as post-menopausal people or those who use long-acting reversible contraceptives. 

“Evidence-based medicine is a critical aspect of comprehensive healthcare and therefore it is incredibly important to understand how medical treatments impact all people who are capable of menstruation,” Villavicencio said. “This knowledge is important for individual patients’ lives and experiences, and equally critical when it comes to identifying trends that can lead to varying experiences like this study found.”

Knowing the menstrual side effects non-cisgender people are experiencing is critical information that helps clinicians provide health care to all individuals, Gloria A. Bachmann, MD, MMS, a professor of obstetrics and gynecology and associate dean for women’s health at the Rutgers Robert Wood Johnson Medical School, told Verywell.

“By not having these clinical data, clinicians will not have all of the information that they can utilize in order to provide optimal health care to everyone, including reproductive-aged transgender men who have not had gender-affirming surgery to remove their uterus,” she added.

Why Continue Studying Menstrual Side Effects?

It’s important to know the risks, benefits, and side effects of vaccination so the patient is fully informed and the healthcare team is able to counsel them about what to expect and how to manage symptoms, Bachmann said.

“Menstrual issues—be it menstrual irregularity, heavy menstrual bleeding, or menstrual bleeding happening after months or years of not having a menses—are not only distressing to the individual experiencing these menstrual changes, but also can be accompanied by cramping, bloating, and adverse emotional changes,” she added.

According to the study, some respondents reported anxiety, depression, gender dysphoria, and panic attacks as a result of experiencing menstrual symptoms.

“Ensuring that people are adequately informed about potential side effects and whether or not those side effects are concerning for other aspects of their health is critical,” Villavicencio said. “We don’t want people to be unpleasantly surprised by the impact of important preventive medications.”

A recent study published in Obstetrics & Gynecology found that COVID-19 vaccination slightly increases the length of menstrual cycles. It’s not yet clear whether all types of COVID-19 vaccines result in the same range of menstrual side effects to a similar extent. Further research is needed to understand the entire scope of post-vaccination menstrual side effects to help people with uteruses have a better idea of what to expect.

The Vaccines Are Safe

Individuals of all gender identities are still recommended to get the COVID-19 vaccine, despite the potential menstrual side effects, experts said.

The ACOG, the American Society for Reproductive Medicine (ASRM), and the Society for Maternal-Fetal Medicine (SMFM) assured people that the vaccines do not result in the loss of fertility in a joint statement last February.

“Everyone who is eligible should get the COVID-19 vaccine and a booster when it is time,” Villavicencio said. “Unfortunately, COVID cases are once again on the rise and people of all gender identities are still becoming critically ill and dying across the country. Everyone should be protected against this fatal virus.”

It must be emphasized that, so far, research has shown that the impact of vaccination on menstruation is temporary and does not have a long-term effect on reproductive functions, she added. A recent study published in Open Medicine found that half of the cases of vaccine-associated menstrual irregularities from both the first and second doses resolved by themselves within two months.

“With every pharmacologic, medical, and surgical intervention, there are risks, but knowing in advance what the risks are can better prepare both the clinician and the patient to manage them in the best way possible,” Bachmann said. “The benefits of the COVID-19 vaccinations are far greater than potential side effects.”

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