COVID-19: A Discussion on the Potential Effects on Women's Health
Preface: Given the relative new nature of COVID-19 as a virus in our society, alongside the newer nature of the COVID-19 vaccine, more research is indisputably needed. The information below is a combination of known scientific evidence and facts, as well as some anecdotal evidence seen at this practice by our practitioners and patients, as well as many others around the country. Anecdotal evidence is a claim relying only on personal observation, collected in a casual or non-systematic manner without definitive data. It is often evidence that is in the form of stories that people tell about what has happened to them or their patients (in the case of healthcare providers). Anecdotal evidence is often the trigger for further scientific research to determine correlation or causation or really any relationship, between things such as vaccines and side-effects or outcomes. We will do our best below to make it clear when information we discuss is anecdotal or based on previous scientific research, as well as our resources for this information. The best place to go for the most up-to-date information and recommendations regarding COVID and the COVID vaccine is the website for the Center of Disease Control and Prevention (CDC). A link has been attached below for your convenience.
CDC - Coronavirus Information
Can COVID-19 or the COVID Vaccine Affect My Menstrual Cycle?
While there is currently not enough research to say anything definitively on this topic, research regarding vaccines in general, the immune system and their relationship with the menstrual cycle exists. Research shows that there are possible biological mechanisms linking immune stimulation with menstrual changes, including influences on the hormones driving the menstrual cycle, which affect immune cells in the lining of the uterus. These hormones are involved in the cylical build-up and breakdown of this tissue, which heavily relates to the timing and flow of menstrual bleeding. In other words, it is very possible the vaccine and/or COVID infection, which directly affect your immune system, can influence the hormones that directly affect your period. This can influence duration, flow and accompanying syptoms such as pain. Anecdotally, many women's healthcare professionals are reporting that their patients are coming to them reporting menstrual changes such as those mentioned above. Some women are reporting missing a period, a heavier period, or more painful period directly following their diagnosis with COVID or directly after recieving the COVID vaccine. These women often report that there are no other explanations for these changes and insist that the virus or vaccine has affected their cycle. However, research has also demonstrated that things such as stress, changes in weight and exercise, and other major lifestyle changes can affect menstrual cycles. All of those changes are common during the COVID-19 pandemic, and therefore there may be influences affecting your period that you may not have considered in the past. Research on this topic has begun, and there will likely be information soon regarding the specific effects of the COVID vaccine, and COVID, on the menstrual cycle. However, a more likely explanation for all of this, is that changes in your cycle have been caused by many of these things, and that it was not simply one thing alone leading to these sometimes drastic changes. The best way to address these changes, especially if you are concerned or uncomfortable, is to discuss them with your healthcare provider. The practitioners at Holistic OBGYN are happy to discuss this with you and advise on both holistic, and traditional medicinal ways, to address your concerns.
What Should I Know About the Johnson & Johnson (J&J) Vaccine & Birth Control?
Using birth control that has hormones in it alone has inherit risks. These are risks your provider likely discussed with you when you were prescribed this medication. Many of the signs and symptoms your provider may have told you to watch out for, such as headaches, leg cramps, abdominal pain and changes in vision, are side effects that are related to extra and potentially dangerous blot clots in your body caused by the hormones in many forms of birth control. It is rare that someone using birth control with hormones ever experiences any of these issues, but due to the increased risk with hormones versus without hormones, it is important to monitor for signs of excess clotting. The Johnson & Johnson vaccine has been proven to be safe and effective after a series of intensive clinical studies. However, there are very rare risks associated with receiving this vaccine, which includes complications involving the development of blood clots. This is exremely rare but has been seen in women, mostly under the age of 50. Due to the slight risk of increased blot clots with birth control, as well as the small risk of blot clots with the J&J vaccine, some people question whether it is safe for women using birth control. The benefits of the vaccine have demonstrated to far outweigh the risks of the vaccine, regardless of whether or not someone is using birth control. However, hesitation to take this particular vaccine, understanding the potential risks, is understandable. Fortunately, there are other vaccine options, such as the Moderna or Pfizer two series vaccines. Ultimately, it is up to you if you receive any vaccine, and if the J&J vaccine is the only one available to you, you may elect to receive the vaccine (even if you are using birth control) with the understanding that the benefits of the vaccine outweigh the risks overall.
Can COVID-19 or the COVID Vaccine Affect My Fertility or Ability to Become Pregnant?
Early on, with the release of the various COVID vaccines, there was essentially a "rumor" that the vaccine may affect people's fertility. Unfortunately, this was incredibly false information spread by people who have since been proven to have used false evidence to support these claims. There is no scientific evidence that shows that any of the COVID vaccines will affect fertility. This is true for both men and women, and therefore there should be hesitation to take any of the vaccines as related to fertility concerns. In fact, there has been research demonstrating that COVID infection itself, nor the COVID vaccine, affect sperm production, motility or general well-being. Additionally, further research demonstrated that COVID and the COVID vaccine has no effect on ovarian reserve, sex hormones and menstruation of women of child-bearing age.
Can COVID-19 or the COVID Vaccine Affect My Pregnancy?
As part of this aforementioned "rumor", there was some misinformation spread that the COVID vaccine has the potential to affect the placenta in pregnancy. The placenta is the critical gland/organ that supplies the baby with oxygen, nutrients, and all of the things a growing fetus needs. The concern in the rumor reported that anti-SARS-CoV-2 spike protein antibodies (COVID antibodies) and Syncytin-1 (a critical protein involved in the development and function of the placenta), had potentially for cross-reactivity. Meaning that the COVID antibodies had potential to interfere with the critical placental protein and affecting the development of an existing, or newly establishing pregnancy. This has been scientifically proven to be UNTRUE. There is no cross-reactivity between the COVID antibodies and any of the plaental proteins necessary to establish or maintain a pregnancy. The COVID vaccine has been deemed safe in pregnancy by many key organizations, such as the WHO, ACOG and AWHONN. The only effects on pregnancy that have been demonstrated from the vaccine is that the antibodies that a child-bearing person's body creates are transferred to the fetus. This does not transfer the virus to the fetus, but simply the antibodies, giving the fetus some inherit protection from COVID-19 upon birth. Additionally, COVID antibodies from vaccinated women have been found in breastmilk. This demonstrates that more COVID antibodies, that can protect the newborn against COVID, are transferred to them through the breastmilk. Research on how COVID infection may effect pregnancy has begun and will take some time for us to understand definitive risks. However, we have seen that COVID definitely affects pregnant women worse than those who are not pregnant. This has to do with the well-known fact that pregnant women have weakened immune systems during pregnancy. This change in the immune system is critical for the maintenance of the pregnancy, but does put prengnant women at an increased risk for worse side-effects and overall illness from COVID-19. Anecdotally, many practitioners have seen some negative effects of COVID infection direclty on a pregnancy. Unforuntately, this has sometimes included intrauterine fetal demise (or fetal death), which is suspected by practitioners to be related to the COVID infection and its effect on clotting. Some practitioners, anecdotally, think that there may be a connection between COVID antigens, clotting, and the health and safety of the placenta and pregnancy overall. However, plenty of pregnant women also demonstrate no real effect on their pregnancy, and their pregnancy, birth and postpartum period continue as normal with or immediately following a COVID infection. More research is definitely needed on this topic and is in the works for upcoming years, but will definitely take time for definitive information to come out. For this reason, pregnant women are advised to be extremely cautious around others, which includes wearing masks, social distancing and vaccination against COVID-19. Ultimately, choosing whethere or not to get vaccinated is your choice, understanding that thus far, the benefits of getting the vaccine have far outweighed the risks of getting it. The practitioners at Holistic OBGYN are happy to discuss this with you and ensure you understand all of your options as it relates to pregnancy, COVID-19, and the COVID vaccine. This will always be a judgement free, and open conversation that includes all of the information we have available to us at the time.
Is it Safe to Get the COVID-19 Vaccine while I am Pregnant? What About the Booster, is it Necessary?
As aforementioned in the previous section, there is research demonstarting that the COVID-19 vaccines (J&J, Moderna and Pfizer) are safe during pregnancy. The risks of the COVID-19 infection while pregnant are considered greater than the small risks associated with receiving the vaccine. The booster, is also recommended for pregnant women to ensure that you have enough antibodies to effectively protect you from COVID infection. It is recommended to get the booster at least 2 months after your first dose if you got the Johnson & Johnson vaccine, and at least 6 months after your second dose of either Moderna or Pfizer. The booster has demonstrated to be critically effective in preventing life-threatening infections by the new variants of COVID that have started circulating world-wide. Overall however, it is always important to understand the risks and benefits of getting and not getting the vaccine and discuss this with your healthcare provider. The practitioners at Holistic OBGYN are happy to discuss this with you and ensure you understand all of your options as it relates to pregnancy, COVID-19, and the COVID vaccine and booster. This will always be a judgement free, and open conversation that includes all of the information we have available to us at the time.
Is it Safe to Breastfeed When I Have COVID? Is it Safe to Breastfeed When I Have Recieved the COVID Vaccine (and/or Booster)?
As aforementioned in the section, "Can COVID-19 or the COVID Vaccine Affect My Pregnancy?", research demonstrates that a birthing persons antibodies against COVID-19 are transferred via breastmilk. These antibodies are safe for a baby, and show to give some minor form of protection from COVID-19 for the baby. This has shown to be true whether a person has antibodies from a previous or even current COVID-19 infection, or the COVID vaccine. Antibodies have been shown to be in much higher numbers in those who have recieved the vaccine, versus much lower numbrs in those who have had a COVID infeciton alone. For this reason, it is demonstrated that more COVID antibodies are transferred via breastmilk to a newborn from a vaccinated breast or chestfeeding person, than a non-vaccinated but previously or currently COVID infected breast or chestfeeding person. In addition, whether vaccinated or not, when infected with COVID-19, research has demnostrated that breastfeeding or chestfeeding, outweighs the risks of breastfeeding or chestfeeding while infected. It is advised however, the breast or chestfeeding people that are infected with COVID-19 take caution and wear a medical-grade mask while feeding and holding their baby. Newborns and young babies CAN contract COVID-19, and due to their newly developed or developing immune systems, they are inheritly at risk for complications including hospitalization from the infection. In addition, we recommend washing your hands thoroughly before and after feeding, as well as avoiding face to face contact with your baby as much as possible when breast or chestfeeding. If you are concerned about infecting your baby, there is alternatives such as pumping that can still allow you to get your baby the breastmilk and all of the incredible benefits that breastmilk provides. Ultimately, the decision to breast or chestfeed (with or without COVID infection or vaccine) is up to you. Understanding the risks and benefits of COVID and breast or chestfeeding, as well as breast or chestfeeding in general, is critical in making this decision. The practitioners at Holistic OBGYN are happy to discuss this with you and ensure you understand all of your options as it relates to breast and chestfeeding, COVID-19, and the COVID vaccine and booster. This will always be a judgement free, and open conversation that includes all of the information we have available to us at the time.
Can COVID-19 or the Vaccine (and/or Booster) Affect the Outcome of My Mammogram?
Both COVID-19 and the vaccine, have not demonstrated to have any negative effects on breasts or breast tissue. There has not been any data to demonstrate a relationship between COVID, or the vaccines, and breast cancer, cysts or any other breast condition. However, COVID infection and COVID vaccine have demonstrated potential to cause temporary lymph node enlargement and result in a “false positive” mammogram. John Hopkins recently released an article nothing that, "lymph nodes under the arm where a person has gotten a vaccine can become enlarged as part of the normal immune response to the vaccine". However, they are sure to note that, "your lymph nodes will return to normal size a few weeks after your vaccination regimen is complete". Therefore, receiving your vaccine is NOT a reason to delay your mammogram, and swollen lymph nodes can be easily followed-up on and will demonstrate a return to normal in a short time-frame. The COVID pandemic has definitely lead to some delayed general healthcare screenings, including Mammograms. However, regardless of the status of the pandemic, it is very important to get your annual or biannual mammogram and/or ultrasound. The practitioners at Holistic OBGYN are happy to discuss this with you and ensure you understand all of your options as it relates to a mammogram, COVID-19, and the COVID vaccine and booster.
Resources for this Blog are as Follows: *as indicated in the Preface some of this information above is anecdotal and reflects the experiences of the practitioners and patients of our practice*
ACOG Blog: Coronavirus (COVID-19) and Women's Health Care: A Message for Patients
ACOG Blog: Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients
CDC: COVID Information
National Institutes of Health: COVID-19 Vaccine and the Menstrual Cycle
Research Article (Li et al.): Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age
Research Article (Prasad et al.): No crossreactivity of anti-SARS-CoV-2 spike protein antibodies with Syncytin-1
COVID-19 Vaccine: Can It Affect Your Mammogram Results?