Menstrual symptoms variation among Lebanese women before and after the COVID-19 pandemic
Main Article Content
Keywords
Women, COVID-19, Menstrual cycle, Bleeding, Distress, Lebanon
Abstract
Objectives: Pandemic diseases and the confinement measures due to COVID-19 infection have introduced acute and persistent psychosocial stressors for different individuals with a greater influence on females manifested through changes in the menstrual cycle. The objective of this study was to assess Lebanese female of reproductive age about their menstrual cycle, their mental health, and their lifestyle, throughout the COVID-19 pandemic, Beirut blast, and the economic crises. Methods: A cross-sectional online study conducted between October and December 2021, enrolled 398 Lebanese women using the snowball technique. The Menstrual Symptom Questionnaire (MSQ) was used to assess menstrual symptoms. A repeated measures ANOVA was used to assess factors associated with the variation in MSQ scores after vs before the pandemic. Results: Our results showed that a significantly higher number of days of menses, number of pads per day and total MSQ score were significantly found after the pandemic compared to before it. More distress (Beta=0.68), more post-traumatic stress disorder due to COVID-19 (Beta=0.19), a higher number of waterpipes smoked per week (Beta=1.20) and being infected by COVID-19 compared to not (Beta=3.98) were significantly associated with an increase in the MSQ score after the pandemic compared to before it. Conclusion: Our main findings indicate that females had irregular menstrual cycles, unpredictable bleeding pattern, and intense symptoms severity post COVID-19 pandemic. Furthermore, stress post COVID-19 and Beirut blast tended to be associated with increased menstrual symptoms. Thus, vulnerable women should be identified and offered appropriate care, information, and awareness regarding their menstrual period during a pandemic.
References
1. Pratt JP. The normal menstrual cycle. South Med J. 1951;44(9):812-817. https://doi.org/10.1097/00007611-195109000-00009
2. Corner GW. Our knowledge of the menstrual cycle, 1910-1950. Lancet Lond Engl. 1951;1(6661):919-923. https://doi.org/10.1016/s0140-6736(51)92447-6
3. Negriff S, Dorn LD, Hillman JB, et al. The measurement of menstrual symptoms: factor structure of the menstrual symptomquestionnaire in adolescent girls. J Health Psychol. 2009;14(7):899-908. https://doi.org/10.1177/1359105309340995
4. Sampson GA. 1 Premenstrual syndrome. Baillières Clin Obstet Gynaecol. 1989;3(4):687-704. https://doi.org/10.1016/S0950-3552(89)80060-4
5. Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int. 2012;18(2):48-51. https://doi.org/10.1258/mi.2012.012013
6. Woods NF, Most A, Dery GK. Prevalence of Perimenstrual Symptoms. 1982;72(11):8.
7. Triana P, López-Gutierrez JC. Menstrual disorders associated with sirolimus treatment. Pediatr Blood Cancer. 2021;68(3):e28867.https://doi.org/10.1002/pbc.28867
8. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. In: Feingold KR, Anawalt B, Boyce A, et al., eds.Endotext. MDText.com, Inc.; 2000. Accessed March 5, 2022. http://www.ncbi.nlm.nih.gov/books/NBK279054/
9. Triana P, López-Gutierrez JC. Menstrual disorders associated with sirolimus treatment. Pediatr Blood Cancer. 2021;68(3):e28867.https://doi.org/10.1002/pbc.28867
10. Hatch MC, Figa-Talamanca I, Salerno S. Work stress and menstrual patterns among American and Italian nurses. Scand J Work Environ Health. 1999;25(2):144-150. https://doi.org/10.5271/sjweh.417
11. Matteo S. The effect of job stress and job interdependency on menstrual cycle length, regularity and synchrony.Psychoneuroendocrinology. 1987;12(6):467-476. https://doi.org/10.1016/0306-4530(87)90081-3
12. Harlow SD, Campbell B. Ethnic differences in the duration and amount of menstrual bleeding during the postmenarcheal period. Am J Epidemiol. 1996;144(10):980-988. https://doi.org/10.1093/oxfordjournals.aje.a008868
13. Fenster L, Waller K, Chen J, et al. Psychological stress in the workplace and menstrual function. Am J Epidemiol. 1999;149(2):127-134. https://doi.org/10.1093/oxfordjournals.aje.a009777
14. Harlow SD, Matanoski GM. The association between weight, physical activity, and stress and variation in the length of the menstrual cycle. Am J Epidemiol. 1991;133(1):38-49. https://doi.org/10.1093/oxfordjournals.aje.a115800
15. Nagma S, Kapoor G, Bharti R, et al. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res JCDR. 2015;9(3):QC01-03. https://doi.org/10.7860/JCDR/2015/6906.5611
16. Wittchen HU, Perkonigg A, Pfister H. Trauma and PTSD - an overlooked pathogenic pathway for premenstrual dysphoric disorder? Arch Womens Ment Health. 2003;6(4):293-297. https://doi.org/10.1007/s00737-003-0028-2
17. Endicott J, Halbreich U, Schacht S, et al. Premenstrual changes and affective disorders. Psychosom Med. 1981;43(6):519-529.https://doi.org/10.1097/00006842-198112000-00008
18. Halbreich U, Endicott J. Relationship of dysphoric premenstrual changes to depressive disorders. Acta Psychiatr Scand.1985;71(4):331-338. https://doi.org/10.1111/j.1600-0447.1985.tb02532.x
19. Sahin N, Kasap B, Kirli U, et al. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reprod Health. 2018;15(1):13. https://doi.org/10.1186/s12978-018-0453-3
20. Mishra GD, Dobson AJ, Schofield MJ. Cigarette smoking, menstrual symptoms and miscarriage among young women. Aust N Z J Public Health. 2000;24(4):413-420. https://doi.org/10.1111/j.1467-842x.2000.tb01604.x
21. Hartz AJ, Barboriak PN, Wong A, et al. The association of obesity with infertility and related menstural abnormalities in women.Int J Obes. 1979;3(1):57-73.
22. Masho SW, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol.2005;26(1):33-39. https://doi.org/10.1080/01443610400023049
23. Rogers J, Mitchell GW. The relation of obesity to menstrual disturbances. N Engl J Med. 1952;247(2):53-55. https://doi.org/10.1056/NEJM195207102470204
24. Kwak Y, Kim Y, Baek KA. Prevalence of irregular menstruation according to socioeconomic status: A population-based nationwide cross-sectional study. PloS One. 2019;14(3):e0214071. https://doi.org/10.1371/journal.pone.0214071
25. Lim HS, Kim TH, Lee HH, et al. Fast-food consumption alongside socioeconomic status, stress, exercise, and sleep duration are associated with menstrual irregularities in Korean adolescents: Korea National Health and Nutrition Examination Survey 2009-2013. Asia Pac J Clin Nutr. 2018;27(5):1146-1154. https://doi.org/10.6133/apjcn.032018.03
26. Ohde S, Tokuda Y, Takahashi O, et al. Dysmenorrhea among Japanese women. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2008;100(1):13-17. https://doi.org/10.1016/j.ijgo.2007.06.039
27. El Othman R, Touma E, El Othman R, et al. COVID-19 pandemic and mental health in Lebanon: a cross-sectional study. Int J Psychiatry Clin Pract. 2021;25(2):152-163. https://doi.org/10.1080/13651501.2021.1879159
28. Rehman U, Shahnawaz MG, Khan NH, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown.Community Ment Health J. 2021;57(1):42-48. 10.1007/s10597-020-00664-x
29. Demir O, Sal H, Comba C. Triangle of COVID, anxiety and menstrual cycle. J Obstet Gynaecol J Inst Obstet Gynaecol.2021;41(8):1257-1261. https://doi.org/10.1080/01443615.2021.1907562
30. Phelan N, Behan LA, Owens L. The Impact of the COVID-19 Pandemic on Women’s Reproductive Health. Front Endocrinol.2021;12:642755. https://doi.org/10.3389/fendo.2021.642755
31. Buran G, Gerçek Öter E. Impact of the awareness and fear of COVID-19 on menstrual symptoms in women: a cross-sectional study. Health Care Women Int. 2022;43(4):413-427. https://doi.org/10.1080/07399332.2021.2004149
32. Bruinvels G, Goldsmith E, Blagrove RC, et al. How lifestyle changes within the COVID-19 global pandemic have affected the pattern and symptoms of the menstrual cycle. Published online February 3, 2021:2021.02.01.21250919. https://doi.org/10.1101/2021.02.01.21250919
33. Li K, Chen G, Hou H, et al. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online. 2021;42(1):260-267. https://doi.org/10.1016/j.rbmo.2020.09.020
34. Arinkan SA, Vural F. Menstrual Cycle Characteristics of Healthcare Professionals Working at COVID-19 Pandemic Clinics. J Clin Obstet Gynecol. 2021;31(2):60-64. https://doi.org/10.5336/jcog.2021-82054
35. Merchant H. CoViD-19 post-vaccine menorrhagia, metrorrhagia or postmenopausal bleeding and potential risk of vaccineinduced thrombocytopenia in women. The BMJ. 2021;(bmj.n958/rr-2).
36. Edelman A, Boniface ER, Benhar E, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19)Vaccination: A U.S. Cohort. Obstet Gynecol. Published online January 5, 2022. https://doi.org/10.1097/AOG.0000000000004695
37. Abed AE, Razzak RA, Hashim HT. Mental Health Effects of COVID-19 Within the Socioeconomic Crisis and After the Beirut Blast Among Health Care Workers and Medical Students in Lebanon. Prim Care Companion CNS Disord. 2021;23(4):21m02977. https://doi.org/10.4088/PCC.21m02977
38. Nuwayhid I, Zurayk H. The political determinants of health and wellbeing in the Lebanese uprising. Lancet Lond Engl. 2019;394(10213):1974-1975. https://doi.org/10.1016/S0140-6736(19)32907-1
39. Melki IS, Beydoun HA, Khogali M, et al. National Collaborative Perinatal Neonatal Network (NCPNN). Household crowding index: a correlate of ocioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health.2004;58(6):476-480. https://doi.org/10.1136/jech.2003.012690
40. Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behav Res Ther. 1975;13(4):237-244.https://doi.org/10.1016/0005-7967(75)90028-5
41. Blanchard EB, Jones-Alexander J, Buckley TC, et al. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther.1996;34(8):669-673. https://doi.org/10.1016/0005-7967(96)00033-2
42. Hallit S, Obeid S, Haddad C, et al. Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients. Int J Psychiatry Clin Pract. 2020;24(3):270-277. https://doi.org/10.1080/13651501.2020.1744662
43. Merhy G, Azzi V, Salameh P, Obeid S, Hallit S. Anxiety among Lebanese adolescents: scale validation and correlates. BMC Pediatr. 2021;21(1):288. https://doi.org/10.1186/s12887-021-02763-4
44. Sawaya H, Atoui M, Hamadeh A, et al. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245-52. https://doi.org/10.1016/j.psychres.2016.03.030
45. Malaeb D, Farchakh Y, Haddad C, et al. Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population. Perspect Psychiatr Care. 2022;58(1):304-313. https://doi.org/10.1111/ppc.12787
46. Heinze G, Wallisch C, Dunkler D. Variable selection - A review and recommendations for the practicing statistician. Biom J Biom Z. 2018;60(3):431-449. https://doi.org/10.1002/bimj.201700067
47. Ozimek N, Velez K, Anvari H, et al. Impact of Stress on Menstrual Cyclicity During the Coronavirus Disease 2019 Pandemic: A Survey Study. J Womens Health 2002. 2022;31(1):84-90. https://doi.org/10.1089/jwh.2021.0158
48. Prado RCR, Silveira R, Asano RY. SARS-CoV-2 (COVID-19) pandemic and a possible impact in the future of menstrual cycle
research. Health Sci Rep. 2021;4(2):e276. https://doi.org/10.1002/hsr2.276
49. Takmaz T, Gundogmus I, Okten SB, et al. The impact of COVID-19-related mental health issues on menstrual cycle characteristics
of female healthcare providers. J Obstet Gynaecol Res. 2021;47(9):3241-3249. https://doi.org/10.1111/jog.14900
50. Bruinvels G, Lewis NA, Blagrove RC, et al. COVID-19-Considerations for the Female Athlete. Front Sports Act Living.
2021;3:606799. https://doi.org/10.3389/fspor.2021.606799
51. Malloy SM, Bradley DE. The Relationship Between Perceived Stress During The Covid-19 Pandemic and Menstrual Cycles and
Symptoms. Fertil Steril. 2021;116(3):e72. https://doi.org/10.1016/j.fertnstert.2021.07.202
52. Pandemic periods: why women’s menstrual cycles have gone haywire | Menstruation | The Guardian. Accessed March 5, 2022.
https://www.theguardian.com/society/2021/mar/25/pandemic-periods-why-womens-menstrual-cycles-have-gone-haywire
53. Carp-Veliscu A, Mehedintu C, Frincu F, et al. The Effects of SARS-CoV-2 Infection on Female Fertility: A Review of the Literature.
Int J Environ Res Public Health. 2022;19(2):984. https://doi.org/10.3390/ijerph19020984
54. Sharp GC, Fraser A, Sawyer G, et al. The COVID-19 pandemic and the menstrual cycle: research gaps and opportunities. Int J
Epidemiol. Published online December 2, 2021:dyab239. https://doi.org/10.1093/ije/dyab239
55. Ding T, Wang T, Zhang J, et al. Analysis of Ovarian Injury Associated With COVID-19 Disease in Reproductive-Aged Women in
Wuhan, China: An Observational Study. Front Med. 2021;8:635255. https://doi.org/10.3389/fmed.2021.635255
56. Chadchan SB, Popli P, Maurya VK, et al. The SARS-CoV-2 receptor, angiotensin-converting enzyme 2, is required for human
endometrial stromal cell decidualization†. Biol Reprod. 2021;104(2):336-343. https://doi.org/10.1093/biolre/ioaa211
57. Kong S, Yan Z, Yuan P, et al. Comprehensive evaluation of ACE2 expression in female ovary by single-cell RNA-seq analysis.Published online 2021. Accessed March 5, 2022. https://biorxiv.org/cgi/content/short/2021.02.23.432460
58. Teuwen LA, Geldhof V, Pasut A, et al. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389-391. https://doi.org/10.1038/s41577-020-0343-0
59. Takeda T, Kai S, Yoshimi K. Association between Premenstrual Symptoms and Posttraumatic Stress Symptoms by COVID-19: ACross-Sectional Study with Japanese High School Students. Tohoku J Exp Med. 2021;255(1):71-77. https://doi.org/10.1620/
tjem.255.71
60. Ossewaarde L, Hermans EJ, van Wingen GA, et al. Neural mechanisms underlying changes in stress-sensitivity across the menstrual cycle. Psychoneuroendocrinology. 2010;35(1):47-55. https://doi.org/10.1016/j.psyneuen.2009.08.011
61. Bashirian S, Barati M, Karami M, et al. Determinants of Waterpipe Smoking Among Women: A Systematic Review. Int J PrevMed. 2021;12:25. https://doi.org/10.4103/ijpvm.IJPVM_116_20
62. Windham GC, Elkin EP, Swan SH, et al. Cigarette smoking and effects on menstrual function. Obstet Gynecol. 1999;93(1):59-65.
https://doi.org/10.1016/s0029-7844(98)00317-2
2. Corner GW. Our knowledge of the menstrual cycle, 1910-1950. Lancet Lond Engl. 1951;1(6661):919-923. https://doi.org/10.1016/s0140-6736(51)92447-6
3. Negriff S, Dorn LD, Hillman JB, et al. The measurement of menstrual symptoms: factor structure of the menstrual symptomquestionnaire in adolescent girls. J Health Psychol. 2009;14(7):899-908. https://doi.org/10.1177/1359105309340995
4. Sampson GA. 1 Premenstrual syndrome. Baillières Clin Obstet Gynaecol. 1989;3(4):687-704. https://doi.org/10.1016/S0950-3552(89)80060-4
5. Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int. 2012;18(2):48-51. https://doi.org/10.1258/mi.2012.012013
6. Woods NF, Most A, Dery GK. Prevalence of Perimenstrual Symptoms. 1982;72(11):8.
7. Triana P, López-Gutierrez JC. Menstrual disorders associated with sirolimus treatment. Pediatr Blood Cancer. 2021;68(3):e28867.https://doi.org/10.1002/pbc.28867
8. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. In: Feingold KR, Anawalt B, Boyce A, et al., eds.Endotext. MDText.com, Inc.; 2000. Accessed March 5, 2022. http://www.ncbi.nlm.nih.gov/books/NBK279054/
9. Triana P, López-Gutierrez JC. Menstrual disorders associated with sirolimus treatment. Pediatr Blood Cancer. 2021;68(3):e28867.https://doi.org/10.1002/pbc.28867
10. Hatch MC, Figa-Talamanca I, Salerno S. Work stress and menstrual patterns among American and Italian nurses. Scand J Work Environ Health. 1999;25(2):144-150. https://doi.org/10.5271/sjweh.417
11. Matteo S. The effect of job stress and job interdependency on menstrual cycle length, regularity and synchrony.Psychoneuroendocrinology. 1987;12(6):467-476. https://doi.org/10.1016/0306-4530(87)90081-3
12. Harlow SD, Campbell B. Ethnic differences in the duration and amount of menstrual bleeding during the postmenarcheal period. Am J Epidemiol. 1996;144(10):980-988. https://doi.org/10.1093/oxfordjournals.aje.a008868
13. Fenster L, Waller K, Chen J, et al. Psychological stress in the workplace and menstrual function. Am J Epidemiol. 1999;149(2):127-134. https://doi.org/10.1093/oxfordjournals.aje.a009777
14. Harlow SD, Matanoski GM. The association between weight, physical activity, and stress and variation in the length of the menstrual cycle. Am J Epidemiol. 1991;133(1):38-49. https://doi.org/10.1093/oxfordjournals.aje.a115800
15. Nagma S, Kapoor G, Bharti R, et al. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res JCDR. 2015;9(3):QC01-03. https://doi.org/10.7860/JCDR/2015/6906.5611
16. Wittchen HU, Perkonigg A, Pfister H. Trauma and PTSD - an overlooked pathogenic pathway for premenstrual dysphoric disorder? Arch Womens Ment Health. 2003;6(4):293-297. https://doi.org/10.1007/s00737-003-0028-2
17. Endicott J, Halbreich U, Schacht S, et al. Premenstrual changes and affective disorders. Psychosom Med. 1981;43(6):519-529.https://doi.org/10.1097/00006842-198112000-00008
18. Halbreich U, Endicott J. Relationship of dysphoric premenstrual changes to depressive disorders. Acta Psychiatr Scand.1985;71(4):331-338. https://doi.org/10.1111/j.1600-0447.1985.tb02532.x
19. Sahin N, Kasap B, Kirli U, et al. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reprod Health. 2018;15(1):13. https://doi.org/10.1186/s12978-018-0453-3
20. Mishra GD, Dobson AJ, Schofield MJ. Cigarette smoking, menstrual symptoms and miscarriage among young women. Aust N Z J Public Health. 2000;24(4):413-420. https://doi.org/10.1111/j.1467-842x.2000.tb01604.x
21. Hartz AJ, Barboriak PN, Wong A, et al. The association of obesity with infertility and related menstural abnormalities in women.Int J Obes. 1979;3(1):57-73.
22. Masho SW, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol.2005;26(1):33-39. https://doi.org/10.1080/01443610400023049
23. Rogers J, Mitchell GW. The relation of obesity to menstrual disturbances. N Engl J Med. 1952;247(2):53-55. https://doi.org/10.1056/NEJM195207102470204
24. Kwak Y, Kim Y, Baek KA. Prevalence of irregular menstruation according to socioeconomic status: A population-based nationwide cross-sectional study. PloS One. 2019;14(3):e0214071. https://doi.org/10.1371/journal.pone.0214071
25. Lim HS, Kim TH, Lee HH, et al. Fast-food consumption alongside socioeconomic status, stress, exercise, and sleep duration are associated with menstrual irregularities in Korean adolescents: Korea National Health and Nutrition Examination Survey 2009-2013. Asia Pac J Clin Nutr. 2018;27(5):1146-1154. https://doi.org/10.6133/apjcn.032018.03
26. Ohde S, Tokuda Y, Takahashi O, et al. Dysmenorrhea among Japanese women. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2008;100(1):13-17. https://doi.org/10.1016/j.ijgo.2007.06.039
27. El Othman R, Touma E, El Othman R, et al. COVID-19 pandemic and mental health in Lebanon: a cross-sectional study. Int J Psychiatry Clin Pract. 2021;25(2):152-163. https://doi.org/10.1080/13651501.2021.1879159
28. Rehman U, Shahnawaz MG, Khan NH, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown.Community Ment Health J. 2021;57(1):42-48. 10.1007/s10597-020-00664-x
29. Demir O, Sal H, Comba C. Triangle of COVID, anxiety and menstrual cycle. J Obstet Gynaecol J Inst Obstet Gynaecol.2021;41(8):1257-1261. https://doi.org/10.1080/01443615.2021.1907562
30. Phelan N, Behan LA, Owens L. The Impact of the COVID-19 Pandemic on Women’s Reproductive Health. Front Endocrinol.2021;12:642755. https://doi.org/10.3389/fendo.2021.642755
31. Buran G, Gerçek Öter E. Impact of the awareness and fear of COVID-19 on menstrual symptoms in women: a cross-sectional study. Health Care Women Int. 2022;43(4):413-427. https://doi.org/10.1080/07399332.2021.2004149
32. Bruinvels G, Goldsmith E, Blagrove RC, et al. How lifestyle changes within the COVID-19 global pandemic have affected the pattern and symptoms of the menstrual cycle. Published online February 3, 2021:2021.02.01.21250919. https://doi.org/10.1101/2021.02.01.21250919
33. Li K, Chen G, Hou H, et al. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online. 2021;42(1):260-267. https://doi.org/10.1016/j.rbmo.2020.09.020
34. Arinkan SA, Vural F. Menstrual Cycle Characteristics of Healthcare Professionals Working at COVID-19 Pandemic Clinics. J Clin Obstet Gynecol. 2021;31(2):60-64. https://doi.org/10.5336/jcog.2021-82054
35. Merchant H. CoViD-19 post-vaccine menorrhagia, metrorrhagia or postmenopausal bleeding and potential risk of vaccineinduced thrombocytopenia in women. The BMJ. 2021;(bmj.n958/rr-2).
36. Edelman A, Boniface ER, Benhar E, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19)Vaccination: A U.S. Cohort. Obstet Gynecol. Published online January 5, 2022. https://doi.org/10.1097/AOG.0000000000004695
37. Abed AE, Razzak RA, Hashim HT. Mental Health Effects of COVID-19 Within the Socioeconomic Crisis and After the Beirut Blast Among Health Care Workers and Medical Students in Lebanon. Prim Care Companion CNS Disord. 2021;23(4):21m02977. https://doi.org/10.4088/PCC.21m02977
38. Nuwayhid I, Zurayk H. The political determinants of health and wellbeing in the Lebanese uprising. Lancet Lond Engl. 2019;394(10213):1974-1975. https://doi.org/10.1016/S0140-6736(19)32907-1
39. Melki IS, Beydoun HA, Khogali M, et al. National Collaborative Perinatal Neonatal Network (NCPNN). Household crowding index: a correlate of ocioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health.2004;58(6):476-480. https://doi.org/10.1136/jech.2003.012690
40. Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behav Res Ther. 1975;13(4):237-244.https://doi.org/10.1016/0005-7967(75)90028-5
41. Blanchard EB, Jones-Alexander J, Buckley TC, et al. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther.1996;34(8):669-673. https://doi.org/10.1016/0005-7967(96)00033-2
42. Hallit S, Obeid S, Haddad C, et al. Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients. Int J Psychiatry Clin Pract. 2020;24(3):270-277. https://doi.org/10.1080/13651501.2020.1744662
43. Merhy G, Azzi V, Salameh P, Obeid S, Hallit S. Anxiety among Lebanese adolescents: scale validation and correlates. BMC Pediatr. 2021;21(1):288. https://doi.org/10.1186/s12887-021-02763-4
44. Sawaya H, Atoui M, Hamadeh A, et al. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245-52. https://doi.org/10.1016/j.psychres.2016.03.030
45. Malaeb D, Farchakh Y, Haddad C, et al. Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population. Perspect Psychiatr Care. 2022;58(1):304-313. https://doi.org/10.1111/ppc.12787
46. Heinze G, Wallisch C, Dunkler D. Variable selection - A review and recommendations for the practicing statistician. Biom J Biom Z. 2018;60(3):431-449. https://doi.org/10.1002/bimj.201700067
47. Ozimek N, Velez K, Anvari H, et al. Impact of Stress on Menstrual Cyclicity During the Coronavirus Disease 2019 Pandemic: A Survey Study. J Womens Health 2002. 2022;31(1):84-90. https://doi.org/10.1089/jwh.2021.0158
48. Prado RCR, Silveira R, Asano RY. SARS-CoV-2 (COVID-19) pandemic and a possible impact in the future of menstrual cycle
research. Health Sci Rep. 2021;4(2):e276. https://doi.org/10.1002/hsr2.276
49. Takmaz T, Gundogmus I, Okten SB, et al. The impact of COVID-19-related mental health issues on menstrual cycle characteristics
of female healthcare providers. J Obstet Gynaecol Res. 2021;47(9):3241-3249. https://doi.org/10.1111/jog.14900
50. Bruinvels G, Lewis NA, Blagrove RC, et al. COVID-19-Considerations for the Female Athlete. Front Sports Act Living.
2021;3:606799. https://doi.org/10.3389/fspor.2021.606799
51. Malloy SM, Bradley DE. The Relationship Between Perceived Stress During The Covid-19 Pandemic and Menstrual Cycles and
Symptoms. Fertil Steril. 2021;116(3):e72. https://doi.org/10.1016/j.fertnstert.2021.07.202
52. Pandemic periods: why women’s menstrual cycles have gone haywire | Menstruation | The Guardian. Accessed March 5, 2022.
https://www.theguardian.com/society/2021/mar/25/pandemic-periods-why-womens-menstrual-cycles-have-gone-haywire
53. Carp-Veliscu A, Mehedintu C, Frincu F, et al. The Effects of SARS-CoV-2 Infection on Female Fertility: A Review of the Literature.
Int J Environ Res Public Health. 2022;19(2):984. https://doi.org/10.3390/ijerph19020984
54. Sharp GC, Fraser A, Sawyer G, et al. The COVID-19 pandemic and the menstrual cycle: research gaps and opportunities. Int J
Epidemiol. Published online December 2, 2021:dyab239. https://doi.org/10.1093/ije/dyab239
55. Ding T, Wang T, Zhang J, et al. Analysis of Ovarian Injury Associated With COVID-19 Disease in Reproductive-Aged Women in
Wuhan, China: An Observational Study. Front Med. 2021;8:635255. https://doi.org/10.3389/fmed.2021.635255
56. Chadchan SB, Popli P, Maurya VK, et al. The SARS-CoV-2 receptor, angiotensin-converting enzyme 2, is required for human
endometrial stromal cell decidualization†. Biol Reprod. 2021;104(2):336-343. https://doi.org/10.1093/biolre/ioaa211
57. Kong S, Yan Z, Yuan P, et al. Comprehensive evaluation of ACE2 expression in female ovary by single-cell RNA-seq analysis.Published online 2021. Accessed March 5, 2022. https://biorxiv.org/cgi/content/short/2021.02.23.432460
58. Teuwen LA, Geldhof V, Pasut A, et al. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389-391. https://doi.org/10.1038/s41577-020-0343-0
59. Takeda T, Kai S, Yoshimi K. Association between Premenstrual Symptoms and Posttraumatic Stress Symptoms by COVID-19: ACross-Sectional Study with Japanese High School Students. Tohoku J Exp Med. 2021;255(1):71-77. https://doi.org/10.1620/
tjem.255.71
60. Ossewaarde L, Hermans EJ, van Wingen GA, et al. Neural mechanisms underlying changes in stress-sensitivity across the menstrual cycle. Psychoneuroendocrinology. 2010;35(1):47-55. https://doi.org/10.1016/j.psyneuen.2009.08.011
61. Bashirian S, Barati M, Karami M, et al. Determinants of Waterpipe Smoking Among Women: A Systematic Review. Int J PrevMed. 2021;12:25. https://doi.org/10.4103/ijpvm.IJPVM_116_20
62. Windham GC, Elkin EP, Swan SH, et al. Cigarette smoking and effects on menstrual function. Obstet Gynecol. 1999;93(1):59-65.
https://doi.org/10.1016/s0029-7844(98)00317-2
Article Sidebar
Published
Sep 23, 2022
Article Details
How to Cite
1.
Menstrual symptoms variation among Lebanese women before and after the COVID-19 pandemic. Pharm Pract (Granada) [Internet]. 2022 Sep. 23 [cited 2024 Apr. 19];20(3):01-8. Available from: https://pharmacypractice.org/index.php/pp/article/view/2699
Section
Original Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Author Biography
Souheil Hallit
Lebanon