Secondary Amenorrhea due to Primary Ovarian Insufficiency Following COVID-19 Vaccine: A Case Report

Background: Secondary amenorrhea is defined as the absence of menses for 3 months in a woman with previously regular cycles, or 6 months in a woman with previously irregular cycles. It’s mainly due to genetic abnormalities, autoimmune damage, iatrogenic factors, viral infections, and toxins affecting ovary, hypothalamus, pituitary, and uterus. Ovarian etiologies account for 10% of cases. The global prevalence of primary ovarian insufficiency is 3.7%. Some case reports have linked primary ovarian insufficiency with immunizations and the development of anti-ovarian antibodies. Case Report: A 38-year-old female presented with secondary amenorrhea for 2 years following the administration of mRNA COVID-19 vaccine. She had a history of endometriosis and multiple fibroids, which were previously managed with oral combined contraceptive pills and two laparotomy surgeries. After discontinuing her medications, she experienced recurrent hospitalizations because of heavy uterine bleeding, which was eventually treated with bilateral uterine arterial embolization. Her menstrual bleeding became very light after receiving the first vaccine dose, and completely stopped after the second dose. The patient had no significant physical findings except for being overweight. A gynecological evaluation confirmed primary ovarian insufficiency, and further investigations ruled out other potential causes of secondary amenorrhea. Conclusion: The safety and benefits of the COVID-19 vaccines are crucial considerations when deciding whether to administer them. Risk assessment should be conducted and discussed with each patient, which may be challenging, particularly for individuals who are at a higher risk of getting vaccine-related complications.