The impact of the COVID-19 pandemic is evident in many ways, including subtle, secondary problems that specifically affect women. The stress of the pandemic can cause changes in menstrual patterns and delays in seeking diagnosis and treatment of illnesses specific to women. By being aware of these secondary effects, women may be able to navigate through the pandemic with less stress and in better health.

The challenges of the pandemic can be stressful and overwhelming. Social distancing, homeschooling, unemployment, financial worries, isolation and many other changes over the past year have made us physically and emotionally exhausted. Because women of reproductive age are not as likely to get very sick or die from COVID-19 as men and the elderly, they are often tasked with increasing domestic responsibilities while also caring for others. Women have reported more stress related to the pandemic than their male counterparts. The emotional supports that women typically rely on, like school, youth sports and social organizations, are mostly inaccessible. This diminished social connection is more likely to make women feel lonely and overwhelmed. In addition to their children and partner, they may have worries about their parents and older generations. 

Researchers have recognized a connection between stress and menstrual changes even before the pandemic. Menstrual changes can include a heavier or lighter flow, abnormal cycle length, increased pain with menses or no menstruation whatsoever. Pandemic stress can cause these menstrual cycle abnormalities by temporarily interfering with the part of the brain that controls the hormones that regulate menstrual cycles. Cortisol from the adrenal glands is released to help control the body's stress response. This, in turn, suppresses normal levels of reproductive hormone production from the ovaries. 

The pandemic may also be keeping women from seeking necessary gynecologic care. Fear of infection with the coronavirus, resulting in avoidance of health care, has been a widespread and under-recognized problem during the pandemic. Additionally, many women fear they won't be able to pay their health care bills due to layoffs, rising care costs and loss of insurance. This phenomenon has been demonstrated by the decline in uterine cancers diagnosed during the first 12 weeks of the coronavirus pandemic. Endometrial cancer, or cancer of the lining of the uterus, is usually detected after women report continued abnormal menstrual cycles. Endometrial cancer diagnoses were 35% lower during the first 12 weeks of the pandemic, and patients' phone calls to medical offices for abnormal menstrual cycles declined by 33% compared to the previous year. Reasons for this may include avoidance of health care due to fear of infection, shelter-in-place orders, and postponing of routine screening visits that lead to reduced opportunities for reporting of symptoms and detection of disease. 

The COVID-19 pandemic has influenced women in many ways over the past year. By exercising, getting restful sleep, keeping a normal weight, eating a healthy diet, and confiding in friends and family, we can potentially reduce the effects of pandemic stress on women's health.  Routine, preventive health care is one of the best ways to ensure wellness. While now may not be the time to be going out for anything nonessential, it's important to stay healthy. Women need not delay evaluation of serious problems, such as persistent abnormal menstrual cycles, and should not hesitate to seek care for an emergency medical situation, even during a pandemic.