Pollack Beth, von Saltza Emelia, McCorkell Lisa, Santos Lucia, Hultman Ashley, Cohen Alison K, Soares Letícia
Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.
Patient-Led Research Collaborative, Washington, DC, United States.
Front Rehabil Sci. 2023 Apr 28;4:1122673. doi: 10.3389/fresc.2023.1122673. eCollection 2023.
Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation. Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID. These associated illnesses, whose patients are 70%-80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth. Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.
长新冠对绝经前女性的影响尤为严重，但相对较少的研究探讨了长新冠对女性生殖健康的影响。我们对记录长新冠对女性生殖健康影响的文献进行了综述，这些影响可能包括月经周期紊乱、性腺功能、卵巢功能、绝经和生育能力，以及月经期间症状加重。鉴于研究有限，我们还综述了重叠和相关疾病对生殖健康的影响，包括肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）、体位性直立性心动过速综合征（POTS）、埃勒斯-当洛综合征（EDS）等结缔组织疾病以及子宫内膜异位症，因为这些疾病可能有助于阐明长新冠患者的生殖健康状况。这些相关疾病的患者中70%-80%为女性，痛经、闭经、月经过少、性交困难、子宫内膜异位症、不孕、外阴痛、月经间期出血、卵巢囊肿、子宫肌瘤和出血、盆腔充血综合征、妇科手术以及先兆子痫、孕产妇死亡和早产等不良妊娠并发症的发生率均有所增加。此外，在长新冠及相关疾病中，症状可能会受到月经周期、妊娠和绝经的影响。基于对文献的综述，我们提出了长新冠未来研究和生殖保健的重点。这些重点包括对长新冠患者进行合并症和相关疾病筛查；研究月经周期、妊娠和绝经对症状及疾病进展的影响；揭示性别差异和性激素在长新冠及相关疾病中的作用；以及解决历史研究和医疗保健不平等问题，这些问题导致了该患者群体存在有害的知识空白。
