The association between menstrual cycle abnormalities and the COVID-19 vaccine

The association between menstrual cycle abnormalities and the COVID-19 vaccine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The association between menstrual cycle abnormalities and the COVID-19 vaccine Asma Khalil, Mada Sultan, Albara Raggam, Mohammed Khan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2330401/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction COVID-19 vaccines are considered safe and offer great protection from the virus. However, they can have several side effects including fever, fatigue, and local pain and swelling. Recently a trend in the drug adverse events reporting systems showed an increased number of female vaccine recipients having menstrual cycle abnormalities post-vaccination. Aim This study aimed to determine the association between menstrual cycle abnormalities and the COVID vaccines. Subjects and methods This is a cross-sectional study conducted among reproductive-age women aged between 18 and 50 years old. A self-administered questionnaire was distributed among women using an online survey. The questionnaire includes basic demographic characteristics, the number of received vaccine doses, the type of vaccines, and the changes in menstrual cycles after receiving the COVID-19 vaccine. Results 700 reproductive age women met the inclusion criteria. After the first dose there was a significant change in menstrual cycle regularity P-value 0.009 (95% confidence interval 0.402-0.881) and odds ratio of (0.595). However, there was no significant change after the second and third dose p-value 0.065 and 0.055 respectively. The data also indicated a significant change in the menses flow; P-value (<0.001), with more women experiencing a reduction or increase in their period flow. Conclusion This study identifies a possible association between menstrual cycle abnormalities and COVID-19 vaccination. This was noted most after the first dose. Menstrual cycle abnormalities were in the form of changes in cycle length, duration of bleeding, premenstrual symptoms, and having missed periods. Menstrual changes are not uncommon but are transient and should not be alarming for women yet awareness about this experience is an instrumental factor to build trust in the COVID-19 vaccine. Menstrual cycles women reproductive health COVID-19 vaccine Figures Figure 1 Introduction During 2020 SARS-CoV-2 was declared by the WHO (World Health Organization) as a global pandemic, health care systems worldwide were struggling due to the virus high spread rate and the severity of the disease ( 1 ). A global consensus among the scientific and medical communities that a vaccine was urgently needed to limit the virus spread and reduce the impact of the disease on general population ( 2 ). Several vaccines were developed under these exceptional circumstances including BNT162b2 (Pfizer), AZD1222 (AstraZeneca), AD26.CoV2.S (Johnson & Johnson), and mRNA-1273 (Moderna), these vaccines were given emergency use authorization to protect the public from the SARS-CoV-2 and to reduce the global impact of the pandemic ( 3 ). While these vaccines are considered safe and offer great protection from the virus, they can have several side effects including fever, pain, tiredness, and swelling( 3 ). As these vaccines are not fully approved but in use under emergency authorization, the vaccines are under constant review for unexpected adverse events by several drug regulatory agencies such as CDC EMA and MHRA ( 4 ). Several vaccines related unexpected adverse events started to emerge such as the vaccine induced thrombotic thrombocytopenia, intravascular thrombosis, nephrotic syndrome, and acute kidney injury. This shows that there is a need for further review of vaccine adverse events to understand the full impact of these vaccines ( 3 ). Recently, a trend in the drug adverse events reporting systems showing increased number of female vaccine recipients having menstrual cycle changes post vaccination( 5 ). The British Medicines and Healthcare products Regulatory Agency have received 30000 reports through yellow card system of these events ( 5 ). Similarly, the European Medicines Agency reports approximately 16000 cases of menstrual cycle irregularity worldwide, 10% of these cases wore confirmed by healthcare professionals. The most common menstrual change reported is heavy menstrual bleeding post vaccination in 34% of cases ( 6 ). Additionally, there are 10556 adverse event cases related to menstrual cycle reported in the American CDC’s The Vaccine Adverse Event Reporting System( 7 ). The relationship between SARS-CoV-2 vaccines and menstrual cycle changes is unclear however, several direct and indirect factors related to the vaccines might play a role in inducing menstrual cycle changes. Sleep disturbance, anxiety, and fever can affect the hypothalamic pituitary gonadal axis ( 8 ), a recent survey by Almohaya et al found increased anxiety and sleep disturbance in vaccine recipients ( 9 ). The vaccine induced immune response might affect menstrual cycle hormonal regulation or affect the immune cells in the lining of the uterus which play important role in regulating uterine tissue proliferation and shedding ( 5 ). The vaccines are also associated with platelet dysfunction which can cause heavy menstrual bleeding ( 10 ). Few studies were conducted to assess the impact of COVID vaccine on the female reproductive health. Orvieto et al evaluated the impact of the Pfizer vaccine on ovarian stimulation, the study found no significant difference on ovarian stimulation before and after receiving the vaccine ( 11 ). However, the study is limited by the small sample size of 36 and short follow up duration. Additionally Alghamdi et al estimated the prevalence of post vaccination menstrual cycle dysregulation to be 0.69% in Pfizer vaccine recipients and 0.45% in AstraZeneca vaccine recipients ( 3 ). The study was not designed to specifically assess female reproductive health and it included women of post-menopausal age thus the study might be affected by misclassification error. Due to the lack of studies on this topic several organizations have issued statements encouraging research in this topic including the Royal College of Obstetricians and Gynecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG) and The North American Society for Pediatric and Adolescent Gynecology (NASPAG) ( 12 ), ( 13 ), and ( 14 ). In these statements these organization acknowledge that some females might suffer from short-lived menstrual cycle dysregulation post vaccination, however the prevalence of these side effects is unknown. Furthermore, the nature and the duration of the dysregulation is also unknown ( 12 ), ( 13 ) and ( 14 ). Thus, this study aims to determine the prevalence of menstrual cycle dysregulation post vaccination, compare the effect of different types of vaccines on menstrual cycle, and describe the nature and the duration of the dysregulation. Method This is a cross-sectional study based on online survey aimed towards females of reproductive age. The study was approved by King Abdullah International Medical Research Centre (KAIMRC) ethical committee. The survey was constructed on Google Forms and distributed through social media, convenience sampling was used to reach the largest sample size and data was collected by self-reporting. The study included all females aged between 18 and 50 years old, excluding those who are pregnant. The survey consisted of four parts, the first part was aimed to assess social status and general health of the individual focusing on reproductive health, the second part was to assess COVID infection and vaccination history, the third and fourth parts were to assess normal menstrual cycle pattern before vaccination and changes that occurred after vaccination. The parameters that were assessed included cycle length, number of bleeding days, degree of period flow, dysmenorrhea, intermenstrual bleeding, changes in premenstrual symptoms, and missed periods. Finally, the survey assessed medical interventions aimed to treat menstrual cycle irregularity post vaccination. Statistical Analysis Frequency and proportion (%) were used to summarize all the descriptive data in this project. The baseline characteristics of the menstrual cycle before receiving COVID-19 vaccine were compared to the changes in menstrual cycles after receiving the vaccine doses using the odds ratio. A p-value of 0.05 was considered statistically significant. The relationship between the type of vaccine and the changes in menstrual cycles had been conducted using Chi-square test. All data analyses were performed using the Statistical Packages for Software Sciences (SPSS) version 26 (Armonk, New York, IBM Corporation, USA). Results A total of 700 participants took the survey, the mean age was 34.7 (± 9.36 SD), approximately 60% of the sample were married woman (table 1) and around 30% were housewives or non-health care worker (table 1), about 20% were healthcare workers (table 1). 75% were medically free, the most common reported disease was thyroid disorders 9% and only 5% had polycystic ovarian syndrome. The most used medication was thyroid medication 29% followed by psychotropic drugs 15% (table 1). 13% used hypertension medication and 11% used diabetes medication. The majority of woman did not use any contraception (84%). For the ones using contraception, the most common method was copper intrauterine device followed by combined hormonal pills and progesterone only pills with 4% for each. Only 7% were breast feeding, and 60% had children. 70% reported using menstrual cycle recording method (table 1). Approximately 40% of participants had suffered from Covid infection (table 2). Almost all women had received the first vaccine dose, only one did not get vaccinated, 98% took the second dose and only 66% had received the third dose (table 2). The most common vaccine used by study participants was BNT162b2 (Pfizer) followed by AZD1222 (Astra Zeneca) and mRNA-1273 (Moderna) as the first and second dose. Ad26.COV2.S (Jonson & Johnson) was the least used vaccine in all doses. As for the third dose more women had mRNA-1273 than AZD1222. However BNT162b2 was still the most commonly used vaccine (table 2). Figure 1 shows the trend in menstrual cycle change after vaccination, the data indicate that before vaccination 17.4% of women had irregular menstrual cycle however after the first vaccination 40.3% reported irregular cycle, 34.6 after the second dese and 22.1 after the third dose. Chi-square test was used the asses the significance of the decrease. After the first dose there was a significant change in menstrual cycle regularity P-value 0.009 (95% confidence interval 0.40–0.88) and odds ratio of (0.59). However, there was no significant change after the second and third dose p-value 0.065 and 0.055 respectively. Table 3 compares the characteristics of menstrual cycle before and after each dose of vaccination. Several parameters were assessed including cycle length, number of bleeding days, amount of menstrual blood flow, pain with period, bleeding between periods, changes in premenstrual symptoms, and missed period. Fisher exact test was used to compare the cycle length and the duration of menses before and after each dose of vaccine. The result show significant change in period length and menses duration after each vaccination p-value (< 0.001) (Table 3 ). The data shows that women are deviating from the average cycle length (21–35 days) and reporting longer cycle length (more than 35 days) or shorter cycle length (less than 21 days) after vaccination (Table 3 ). Similar deviation is also seen in the data on menses duration where more women reported shorter menses (less than 5 days) or longer menses (more than 8 days). Additionally, chi-square test was used to compare period flow, period pain, premenstrual symptoms, missed period and bleeding between menses. The data indicate a significant change in the menses flow P-value (< 0.001), more women had decrease or increase in the amount of menstrual blood flow. Before vaccination only 11% reported light flow and 12% reported heavy flow however, after vaccination approximately 30% reported light flow and 30% reported heavy flow (Table 3 ). Interestingly the data suggest a significant decrease in mensural pain 10% more women reported no pain with their period. Furthermore, significantly more women reported intermenstrual bleeding and missed period p-value (< 0.001). No significant change was observed in premenstrual symptoms (Table 3 ) Table 4 shows that only 19.3% of women sought medical attention for menstrual cycle changes post vaccination. The majority visited Gynaecologists (79%) while the rest attended family physicians (21%). The most common management was conservative 36.8%, followed by hormonal treatment 29.8%, whereas 14% were managed by iron and vitamin supplements. The cycle changes lasted for more than 3 cycles in more than 50% of the affected women. Furthermore less than 4% were diagnosed with platelet disorder related to the vaccine. Discussion Our study examined the relationship between menstrual cycle abnormalities and the COVID-19 vaccines. The findings of this study suggest that there is a possible link between the changes in menstrual cycles before and after receiving the COVID-19 vaccine doses. Data in this study pointed out that before receiving the vaccine 17.4% experienced irregular menstrual cycle. However, this increased to 40.3% after receiving first dose of the vaccine, 34.6% after the second dose and 22.1% after the third dose. There was statistically significant change in the pattern of menstrual cycle after the first dose. Changes in menstrual cycles had also been reported in the USA ( 15 ), investigations uncovered that 42% of individuals with regular menstruation bled heavier than usual after receiving the SARS-CoV-2 vaccination while in the UK ( 16 ), findings indicated that the incidence of menstrual changes was 20% and the majority of the population (80%) did not report any changes in menstrual cycles up to 4 months after the first dose of vaccination. We also noted that there were significant change in the menstrual blood flow, with more women reporting reduced or increased in their period flow. Before vaccination only 11% reported light flow and 12% reported heavy flow. However, after vaccination approximately 30% reported light flow and 30% reported heavy periods. Nonetheless, our data suggest a significant decrease in mensural pain 10% where more women reported no pain with their periods. Significantly more women reported intermenstrual bleeding and missed periods. No significant change was observed in premenstrual symptoms. Consistent with our findings, Ozimek et al, discovered that since the start of the pandemic, the changes in menstrual cycles mostly occurred in the menstrual cycle length (50%), the duration of menses (34%), and changes in premenstrual symptoms ( 17 ). This has concurred in a study conducted among Irish people ( 18 ). The outcome of the study suggests that 53% of the sample population reported worsening pre-menstrual symptoms and there were incidences of menorrhagia and dysmenorrhea occurring among 18% and 30% of respondents, respectively. However, no change occurred in the median cycle length or days of bleeding but there was a wider variability of cycle length. In a study conducted by Edelman et al ( 19 ), they found an association between COVID-19 vaccine and cycle length, but only contributing to less than a day change in cycle length for the two vaccine-dose cycles concluding that COVID-19 vaccination is related to a small change in cycle length but it was not related to duration of menses. In this scenario, our study supported previous findings that there is a possible connection between the changes in menstrual cycles and the COVID-19 vaccination. We also observed that the specific type of vaccine taken does not significantly influence the changes in menstrual cycles, there was only a slightly statistically significant difference observed after the third vaccine dose, with a slight increase with the Pfizer vaccine (p = 0.019). These findings are in accordance with the paper of Muhaidat et al ( 20 ), according to their reports, the type of vaccines did not show a significant effect on the incidence of abnormalities. Almost all women in our study received the first vaccine dose, only one did not get vaccinated, 98% took the second dose and only 66% had received the third dose. The most common vaccine used by study participants was BNT162b2 (Pfizer) 73% followed by AZD1222 (Astra-Zeneca) 25% and mRNA-1273 (Moderna) 1.3% as the first dose. Whereas the uptake for the same vaccine was 82%, 13.5% and 4% respectively. For the third dose it was 84.4%, 1% and 14% respectively. A shift was seen towards mRNA-1273 (Moderna) as a booster (third) dose. It was noted that 19.3% of women sought medical attention for menstrual cycle changes post vaccination. Almost 80% visited the Gynaecologist and the rest seeing family physicians. Conservative management was most commonly deployed (36.8%) followed by hormonal management (29.8%) to regulate menstrual cycle. Almost 15% were managed by iron and vitamin supplements. In our population more than half of the women had their menstrual cycle returned back to baseline after more than three cycles post vaccination. These findings are similar to the paper published in Jordan ( 20 ). Researchers indicated that 66.3% of the women reported menstrual symptoms post-vaccination, of which 46.7% experienced them after their first dose. However, in 93.6% of participants, the symptoms resolved within 2 months. In our study, the cycle changes lasted for more than 3 cycles in more than 50% of the affected women. Other papers discovered a link between menstrual changes and psychological issues that occurred during the time of the pandemic such as the study conducted by ( 18 ) Phelan et al, as well as the study done by ( 21 ) Demir et al. The impact of the COVID-19 vaccine on the menstrual cycle is undeniably occurring. However, the long-term health effect of this is yet to be established. Up till now there is no evidence to suggest that COVID-19 vaccination has an adverse effect on the reproductive health of the woman ( 5 ). Conclusion This study identifies a possible association between menstrual cycle abnormalities and COVID-19 vaccination. This was noted most after the first dose. Menstrual cycle abnormalities were in the form of changes in cycle length, duration of bleeding, premenstrual symptoms, and having missed periods. Menstrual changes are not uncommon, but are transient and should not be alarming for women yet awareness about this experience is an instrumental factor to build trust in the COVID-19 vaccine. Further studies are required to determine the long-term effect of the COVID-19 vaccine on reproductive health. Declarations Ethical approval and consents: This study was approved by the IRB office at King Abdullah International Medical Research Centre (KAIMRC), the survey used in this study was also approved by the IRB office at King Abdullah International Medical Research Centre (KAIMRC). The study was carried in accordance with the relevant guidelines and regulation. Informed consents were taken from all study participants. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests Funding Not applicable. Authors contribution: A.K did the conceptualization, methodology, drafting, reviewing, and editing the manuscript. M.S did the methodology, data collection, and drafting the manuscript. A.R did the methodology, data analysis and visualization, drafting, and editing the manuscript. M.K did the statistical analysis, data visualization and reviewing the manuscript. All authors read and approved the final manuscript. Acknowledgements: Not applicable. References Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157–60. Dai L, Gao GF. Viral targets for vaccines against COVID-19. Nat Rev Immunol. 2021;21(2):73–82. Alghamdi AN, Alotaibi MI, Alqahtani AS, Al Aboud D, Abdel-Moneim AS. BNT162b2 and ChAdOx1 SARS-CoV-2 Post-vaccination Side-Effects Among Saudi Vaccinees. Front Med (Lausanne). 2021;8:760047. Lamptey E. Post-vaccination COVID-19 deaths: a review of available evidence and recommendations for the global population. Clin Exp Vaccine Res. 2021;10(3):264–75. Male V. Menstrual changes after covid-19 vaccination. BMJ. 2021;374:n2211. (PRAC) PRAC. 6. October 2021 COVID-19 vaccine safety update COMIRNATY BioNTech Manufacturing GmbH: European Medicines Agency; 2021 [Available from: https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-comirnaty-6-october-2021_en.pdf . CDC. Vaccine Adverse Event Reporting System: Centers for Disease Control and Prevention; 2021 [Available from: http://wonder.cdc.gov/vaers.html . Kurdoğlu Z. Do the COVID-19 vaccines cause menstrual irregularities. Inte J Women’s Health Reprod Sci. 2021;9(3):158–9. Almohaya AM, Qari F, Zubaidi GA, Alnajim N, Moustafa K, Alshabi MM, et al. Early solicited adverse events following the BNT162b2 mRNA vaccination, a population survey from Saudi Arabia. Prev Med Rep. 2021;24:101595. Hunter PR. Thrombosis after covid-19 vaccination. BMJ. 2021;373:n958. Orvieto R, Noach-Hirsh M, Segev-Zahav A, Haas J, Nahum R, Aizer A. Does mRNA SARS-CoV-2 vaccine influence patients' performance during IVF-ET cycle? Reproductive Biology and Endocrinology. 2021;19(1):69. Harrison M, Hoover K, Kaufman S, McCracken K, Robillard D, Romano M, et al. NASPAG Position Statement on COVID-19 Vaccines and Gynecologic Concerns in Adolescents and Young Adults. the American College of Obstetricians and Gynecologists’ Immunization ID, and Public Health Preparedness Expert Work Group. COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care: ACOG; 2021 [Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care . RCOG/FSRH. RCOG/FSRH respond to reports of 30,000 women’s periods affected after COVID-19 vaccin: RCOG; 2021 [Available from: https://www.rcog.org.uk/news/rcogfsrh-respond-to-reports-of-30-000-women-s-periods-affected-after-covid-19-vaccine/ . Lee KM, Junkins EJ, Fatima UA, Cox ML, Clancy KB. Characterizing menstrual bleeding changes occurring after SARS-CoV-2 vaccination. medRxiv. 2021:2021.10.11.21264863. Alvergne A, Kountourides G, Argentieri MA, Agyen L, Rogers N, Knight D, et al. COVID-19 vaccination and menstrual cycle changes: A United Kingdom (UK) retrospective case-control study. medRxiv. 2021:2021.11.23.21266709. Ozimek N, Velez K, Anvari H, Butler L, Goldman KN, Woitowich NC. Impact of Stress on Menstrual Cyclicity During the Coronavirus Disease 2019 Pandemic: A Survey Study. J Womens Health (Larchmt). 2022;31(1):84–90. Phelan N, Behan LA, Owens L. The Impact of the COVID-19 Pandemic on Women’s Reproductive Health. Frontiers in Endocrinology. 2021;12. Edelman A, Boniface ER, Benhar E, Han L, Matteson KA, Favaro C, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination: A U.S. Cohort. Obstet Gynecol. 2022;139(4):481–9. Muhaidat N, Alshrouf MA, Azzam MI, Karam AM, Al-Nazer MW, Al-Ani A. Menstrual Symptoms After COVID-19 Vaccine: A Cross-Sectional Investigation in the MENA Region. Int J Womens Health. 2022;14:395–404. Demir O, Sal H, Comba C. Triangle of COVID, anxiety and menstrual cycle. J Obstet Gynaecol. 2021;41(8):1257–61. Tables Table 1: Socio-demographic characteristics of the women (n=700) N % Marital status Married 416 59.4 Single 232 33.1 Divorced 44 6.3 Widowed 8 1.1 Occupation Health care worker 119 17.0 Non health care worker 199 28.4 Student 108 15.4 Housewife 205 29.3 Unemployed 69 9.9 Health status Thyroid disease 64 9.2 Polycystic ovary syndrome 36 5.2 Diabetes 13 1.9 Hypertension 23 3.3 Medically free 519 74.6 Others 41 5.9 Contraception use None 586 83.8 Combined contraception (pill, patch, ring) 27 3.9 Copper Intrauterine device 45 6.4 Progesterone only (pill, injection) 25 3.6 Hormonal Intrauterine device 8 1.1 Implant 5 .7 Others 3 .4 Use Menstruation recoding method 487 69.6 Currently Breastfeeding 51 7.3 Table 2: immunity and infection status (n=700) n % History of Covid infection 270 38.6 Received first dose of COVID vaccine 699 99.9 Type of first vaccine received Pfizer 512 73.1 AstraZeneca 176 25.1 Moderna 9 1.3 Johnson & Johnson 3 0.4 Received second dose of COVID vaccine 684 97.7 Type of second vaccine received Pfizer 561 82.1 AstraZeneca 92 13.5 Moderna 28 4.1 Johnson & Johnson 2 0.3 Received third dose of COVID vaccine 460 65.7 Type of the third vaccine Pfizer 395 84.4 AstraZeneca 5 1.1 Moderna 67 14.3 Johnson & Johnson 1 0.2 Table 3: Changes in Menstrual cycles before and after receiving COVID-19 vaccines Cycle length Less than 21 days N(%) 21-35 days N(%) More than 35 days N(%) I don't remember N(%) P-value Before 123 (17.6%) 491 (70.1%) 38 (5.4%) 48 (6.9%) First dose 90 (31.9%) 124 (44.0%) 63 (22.3%) 5 (1.8%) <0.001 Second dose 82 (33.9%) 106 (43.8%) 50 (20.7%) 4 (1.7%) <0.001 Third dose 58 (37.4%) 53 (34.2%) 40 (25.8%) 4 (2.6%) <0.001 Duration of menses in days Less than 5 days N(%) 5-7 days N(%) More than 8 days N(%) I don't remember N(%) P-value Before 75 (10.7%) 555 (79.3%) 68 (9.7%) 2 (0.3%) First dose 65 (23.0%) 160 (56.7%) 54 (19.1%) 3 (1.1%) <0.001 Second dose 57 (23.6%) 126 (52.1%) 55 (22.7%) 4 (1.7%) <0.001 Third dose 35 (22.6%) 78 (50.3%) 36 (23.2%) 6 (3.9%) <0.001 Amount of menstrual blood flow Light N(%) Normal N(%) Heavy N(%) P-value Before 77 (11.0%) 533 (76.1%) 90 (12.9%) First dose 75 (26.6%) 130 (46.1%) 77 (27.3%) <0.001 Second dose 73 (30.2%) 95 (39.3%) 74 (30.6%) <0.001 Third dose 47 (30.3%) 66 (42.6%) 42 (27.1%) <0.001 Period accompanied by pain Yes N(%) No N(%) P-value Before 463 (66.1%) 237 (33.9%) First dose 164 (58.2%) 118 (41.8%) <0.001 Second dose 136 (56.2%) 106 (43.8%) <0.001 Third dose 88 (56.8%) 67 (43.2%) 0.002 Experienced bleeding between periods Yes No P-value Before 83 (11.9%) 617 (88.1%) First dose 75 (26.6%) 207 (73.4%) <0.001 Second dose 55 (22.7%) 187 (77.3%) <0.001 Third dose 39 (25.2%) 116 (74.8%) <0.001 Experienced symptoms before menstruation Yes N(%) No N(%) P-value Before 603 (86.1%) 97 (13.9%) First dose 165 (58.5%) 117 (41.5%) 0.238 Second dose 141 (58.3%) 101 (41.7%) 0.769 Third dose 91 (58.7%) 64 (41.3%) 0.764 Having missed periods Yes N(%) No N(%) P-value Before 96 (13.7%) 604 (86.3%) First dose 92 (32.6%) 190 (67.4%) <0.001 Second dose 71 (29.3%) 171 (70.7%) <0.001 Third dose 48 (31%) 107 (69%) <0.001 ** Significant at p<0.05 level. Table 4 Medical intervention for post vaccination menstrual cycle changes N % Did you Seek medical help Yes 135 19.3 Family physician 33 21 Obs/Gynae 124 79 What was done by the doctor Reassurance/nothing 219 66.2 Investigation only 74 22.4 Investigation and treatment 38 11.5 Management prescribed by physician conservative 21 36.8 hormonal 17 29.8 antifibrinolytic/ tranexamic acid 1 1.8 metformin 1 1.8 pain killers 5 8.8 other 1 1.8 iron and vitamin 8 14 vasoprotectives/capillary stabilizing agents/bioflavonoids 3 5.3 diagnosed with low platelets Yes 16 3.6 Other vaccine side effects No bleeding problems 128 82.6 Gum bleeding 6 3.9 Petechial rash (small red dots) 7 4.5 Nosebleed 3 1.9 Easily bruises 11 7.1 Duration till cycle change resolve First dose Second dose Third dose 1 cycle 38 (14.2%) 42 (18.3%) 38 (26.4%) 2 cycles 54 (20.1%) 36 (15.7%) 25 (17.4%) 3 cycles 41 (15.3%) 25 (10.9%) 16 (11.1%) >3 cycles 135 (50.4%) 126 (55.0%) 65 (45.1%) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2330401","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":160057388,"identity":"7eac2e2b-3970-4523-8d28-812f61792872","order_by":0,"name":"Asma Khalil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYPACCQZ+EJVQQIoWyQaQFgNS7DE4ACaJUMnffzrxM0+Nhb3x+dWJHx4YMMjzix0g4KIbuZuleY5JJG678XazBNBhhjNnJxCw5gbvBukcNokEsxtnN4C0JBjcJqBF/vzZzb9z/knYG884u/kHUVoMDuRuk85tk2DcwN+7jThbDG/kbrP+2yeROOMG7zaLBAMJwn6RAzrs5oxvdfb8/UDGjwobeX5pAloQQAKsUoJY5SDAf4AU1aNgFIyCUTCSAAB1kUTGeNjNXQAAAABJRU5ErkJggg==","orcid":"","institution":"Ministry of National Guard - Health Affairs","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Asma","middleName":"","lastName":"Khalil","suffix":""},{"id":160057389,"identity":"05c4b211-bda6-411d-b7de-5cc6dc7e7eb8","order_by":1,"name":"Mada Sultan","email":"","orcid":"","institution":"Ministry of National Guard - Health Affairs","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mada","middleName":"","lastName":"Sultan","suffix":""},{"id":160057390,"identity":"3758fe1c-5179-4683-8059-925374993310","order_by":2,"name":"Albara Raggam","email":"","orcid":"","institution":"King Saud Bin Abdulaziz University for Health Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Albara","middleName":"","lastName":"Raggam","suffix":""},{"id":160057391,"identity":"b4120e5d-a6fa-404b-9d6e-9740293437f8","order_by":3,"name":"Mohammed Khan","email":"","orcid":"","institution":"King Saud Bin Abdulaziz University for Health Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Khan","suffix":""}],"badges":[],"createdAt":"2022-11-30 15:59:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2330401/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2330401/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":30444590,"identity":"ff18f380-2fdd-4c9b-9c7a-8d9e4d56727f","added_by":"auto","created_at":"2022-12-16 18:18:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12500,"visible":true,"origin":"","legend":"\u003cp\u003epercentage of women experiencing irregular menstrual cycle before and after COVID-19 vaccine\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2330401/v1/3ccd3bd2defbbec1f6607708.png"},{"id":41613030,"identity":"5d2aa40f-ea80-4ae8-ae48-e14318f77f8f","added_by":"auto","created_at":"2023-08-16 06:07:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":438403,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2330401/v1/fbba9483-d18d-41d8-8e3f-40ce1501be30.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The association between menstrual cycle abnormalities and the COVID-19 vaccine","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDuring 2020 SARS-CoV-2 was declared by the WHO (World Health Organization) as a global pandemic, health care systems worldwide were struggling due to the virus high spread rate and the severity of the disease (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A global consensus among the scientific and medical communities that a vaccine was urgently needed to limit the virus spread and reduce the impact of the disease on general population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Several vaccines were developed under these exceptional circumstances including BNT162b2 (Pfizer), AZD1222 (AstraZeneca), AD26.CoV2.S (Johnson \u0026amp; Johnson), and mRNA-1273 (Moderna), these vaccines were given emergency use authorization to protect the public from the SARS-CoV-2 and to reduce the global impact of the pandemic (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile these vaccines are considered safe and offer great protection from the virus, they can have several side effects including fever, pain, tiredness, and swelling(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As these vaccines are not fully approved but in use under emergency authorization, the vaccines are under constant review for unexpected adverse events by several drug regulatory agencies such as CDC EMA and MHRA (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Several vaccines related unexpected adverse events started to emerge such as the vaccine induced thrombotic thrombocytopenia, intravascular thrombosis, nephrotic syndrome, and acute kidney injury. This shows that there is a need for further review of vaccine adverse events to understand the full impact of these vaccines (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecently, a trend in the drug adverse events reporting systems showing increased number of female vaccine recipients having menstrual cycle changes post vaccination(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The British Medicines and Healthcare products Regulatory Agency have received 30000 reports through yellow card system of these events (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similarly, the European Medicines Agency reports approximately 16000 cases of menstrual cycle irregularity worldwide, 10% of these cases wore confirmed by healthcare professionals. The most common menstrual change reported is heavy menstrual bleeding post vaccination in 34% of cases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Additionally, there are 10556 adverse event cases related to menstrual cycle reported in the American CDC\u0026rsquo;s The Vaccine Adverse Event Reporting System(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relationship between SARS-CoV-2 vaccines and menstrual cycle changes is unclear however, several direct and indirect factors related to the vaccines might play a role in inducing menstrual cycle changes. Sleep disturbance, anxiety, and fever can affect the hypothalamic pituitary gonadal axis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), a recent survey by Almohaya et al found increased anxiety and sleep disturbance in vaccine recipients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The vaccine induced immune response might affect menstrual cycle hormonal regulation or affect the immune cells in the lining of the uterus which play important role in regulating uterine tissue proliferation and shedding (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The vaccines are also associated with platelet dysfunction which can cause heavy menstrual bleeding (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFew studies were conducted to assess the impact of COVID vaccine on the female reproductive health. Orvieto et al evaluated the impact of the Pfizer vaccine on ovarian stimulation, the study found no significant difference on ovarian stimulation before and after receiving the vaccine (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the study is limited by the small sample size of 36 and short follow up duration. Additionally Alghamdi et al estimated the prevalence of post vaccination menstrual cycle dysregulation to be 0.69% in Pfizer vaccine recipients and 0.45% in AstraZeneca vaccine recipients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The study was not designed to specifically assess female reproductive health and it included women of post-menopausal age thus the study might be affected by misclassification error.\u003c/p\u003e \u003cp\u003eDue to the lack of studies on this topic several organizations have issued statements encouraging research in this topic including the Royal College of Obstetricians and Gynecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG) and The North American Society for Pediatric and Adolescent Gynecology (NASPAG) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In these statements these organization acknowledge that some females might suffer from short-lived menstrual cycle dysregulation post vaccination, however the prevalence of these side effects is unknown. Furthermore, the nature and the duration of the dysregulation is also unknown (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Thus, this study aims to determine the prevalence of menstrual cycle dysregulation post vaccination, compare the effect of different types of vaccines on menstrual cycle, and describe the nature and the duration of the dysregulation.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis is a cross-sectional study based on online survey aimed towards females of reproductive age. The study was approved by King Abdullah International Medical Research Centre (KAIMRC) ethical committee. The survey was constructed on Google Forms and distributed through social media, convenience sampling was used to reach the largest sample size and data was collected by self-reporting. The study included all females aged between 18 and 50 years old, excluding those who are pregnant.\u003c/p\u003e \u003cp\u003eThe survey consisted of four parts, the first part was aimed to assess social status and general health of the individual focusing on reproductive health, the second part was to assess COVID infection and vaccination history, the third and fourth parts were to assess normal menstrual cycle pattern before vaccination and changes that occurred after vaccination. The parameters that were assessed included cycle length, number of bleeding days, degree of period flow, dysmenorrhea, intermenstrual bleeding, changes in premenstrual symptoms, and missed periods. Finally, the survey assessed medical interventions aimed to treat menstrual cycle irregularity post vaccination.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFrequency and proportion (%) were used to summarize all the descriptive data in this project. The baseline characteristics of the menstrual cycle before receiving COVID-19 vaccine were compared to the changes in menstrual cycles after receiving the vaccine doses using the odds ratio. A p-value of 0.05 was considered statistically significant. The relationship between the type of vaccine and the changes in menstrual cycles had been conducted using Chi-square test. All data analyses were performed using the Statistical Packages for Software Sciences (SPSS) version 26 (Armonk, New York, IBM Corporation, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 700 participants took the survey, the mean age was 34.7 (\u0026plusmn;\u0026thinsp;9.36 SD), approximately 60% of the sample were married woman (table 1) and around 30% were housewives or non-health care worker (table 1), about 20% were healthcare workers (table 1). 75% were medically free, the most common reported disease was thyroid disorders 9% and only 5% had polycystic ovarian syndrome.\u003c/p\u003e\n\u003cp\u003eThe most used medication was thyroid medication 29% followed by psychotropic drugs 15% (table 1). 13% used hypertension medication and 11% used diabetes medication. The majority of woman did not use any contraception (84%). For the ones using contraception, the most common method was copper intrauterine device followed by combined hormonal pills and progesterone only pills with 4% for each. Only 7% were breast feeding, and 60% had children. 70% reported using menstrual cycle recording method (table 1).\u003c/p\u003e\n\u003cp\u003eApproximately 40% of participants had suffered from Covid infection (table 2). Almost all women had received the first vaccine dose, only one did not get vaccinated, 98% took the second dose and only 66% had received the third dose (table 2). The most common vaccine used by study participants was BNT162b2 (Pfizer) followed by AZD1222 (Astra Zeneca) and mRNA-1273 (Moderna) as the first and second dose. Ad26.COV2.S (Jonson \u0026amp; Johnson) was the least used vaccine in all doses. As for the third dose more women had mRNA-1273 than AZD1222. However BNT162b2 was still the most commonly used vaccine (table 2).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan\u003e1\u003c/span\u003e shows the trend in menstrual cycle change after vaccination, the data indicate that before vaccination 17.4% of women had irregular menstrual cycle however after the first vaccination 40.3% reported irregular cycle, 34.6 after the second dese and 22.1 after the third dose. Chi-square test was used the asses the significance of the decrease. After the first dose there was a significant change in menstrual cycle regularity P-value 0.009 (95% confidence interval 0.40\u0026ndash;0.88) and odds ratio of (0.59). However, there was no significant change after the second and third dose p-value 0.065 and 0.055 respectively.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan\u003e3\u003c/span\u003e compares the characteristics of menstrual cycle before and after each dose of vaccination. Several parameters were assessed including cycle length, number of bleeding days, amount of menstrual blood flow, pain with period, bleeding between periods, changes in premenstrual symptoms, and missed period. Fisher exact test was used to compare the cycle length and the duration of menses before and after each dose of vaccine. The result show significant change in period length and menses duration after each vaccination p-value (\u0026lt;\u0026thinsp;0.001) (Table\u003cspan\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe data shows that women are deviating from the average cycle length (21\u0026ndash;35 days) and reporting longer cycle length (more than 35 days) or shorter cycle length (less than 21 days) after vaccination (Table \u003cspan\u003e3\u003c/span\u003e). Similar deviation is also seen in the data on menses duration where more women reported shorter menses (less than 5 days) or longer menses (more than 8 days). Additionally, chi-square test was used to compare period flow, period pain, premenstrual symptoms, missed period and bleeding between menses. The data indicate a significant change in the menses flow P-value (\u0026lt;\u0026thinsp;0.001), more women had decrease or increase in the amount of menstrual blood flow.\u003c/p\u003e\n\u003cp\u003eBefore vaccination only 11% reported light flow and 12% reported heavy flow however, after vaccination approximately 30% reported light flow and 30% reported heavy flow (Table\u003cspan\u003e3\u003c/span\u003e). Interestingly the data suggest a significant decrease in mensural pain 10% more women reported no pain with their period. Furthermore, significantly more women reported intermenstrual bleeding and missed period p-value (\u0026lt;\u0026thinsp;0.001). No significant change was observed in premenstrual symptoms (Table \u003cspan\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eTable \u003cspan\u003e4\u003c/span\u003e shows that only 19.3% of women sought medical attention for menstrual cycle changes post vaccination. The majority visited Gynaecologists (79%) while the rest attended family physicians (21%). The most common management was conservative 36.8%, followed by hormonal treatment 29.8%, whereas 14% were managed by iron and vitamin supplements. The cycle changes lasted for more than 3 cycles in more than 50% of the affected women. Furthermore less than 4% were diagnosed with platelet disorder related to the vaccine.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study examined the relationship between menstrual cycle abnormalities and the COVID-19 vaccines. The findings of this study suggest that there is a possible link between the changes in menstrual cycles before and after receiving the COVID-19 vaccine doses. Data in this study pointed out that before receiving the vaccine 17.4% experienced irregular menstrual cycle. However, this increased to 40.3% after receiving first dose of the vaccine, 34.6% after the second dose and 22.1% after the third dose. There was statistically significant change in the pattern of menstrual cycle after the first dose.\u003c/p\u003e \u003cp\u003eChanges in menstrual cycles had also been reported in the USA (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), investigations uncovered that 42% of individuals with regular menstruation bled heavier than usual after receiving the SARS-CoV-2 vaccination while in the UK (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), findings indicated that the incidence of menstrual changes was 20% and the majority of the population (80%) did not report any changes in menstrual cycles up to 4 months after the first dose of vaccination.\u003c/p\u003e \u003cp\u003eWe also noted that there were significant change in the menstrual blood flow, with more women reporting reduced or increased in their period flow. Before vaccination only 11% reported light flow and 12% reported heavy flow. However, after vaccination approximately 30% reported light flow and 30% reported heavy periods. Nonetheless, our data suggest a significant decrease in mensural pain 10% where more women reported no pain with their periods. Significantly more women reported intermenstrual bleeding and missed periods. No significant change was observed in premenstrual symptoms.\u003c/p\u003e \u003cp\u003eConsistent with our findings, Ozimek et al, discovered that since the start of the pandemic, the changes in menstrual cycles mostly occurred in the menstrual cycle length (50%), the duration of menses (34%), and changes in premenstrual symptoms (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This has concurred in a study conducted among Irish people (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The outcome of the study suggests that 53% of the sample population reported worsening pre-menstrual symptoms and there were incidences of menorrhagia and dysmenorrhea occurring among 18% and 30% of respondents, respectively. However, no change occurred in the median cycle length or days of bleeding but there was a wider variability of cycle length.\u003c/p\u003e \u003cp\u003eIn a study conducted by Edelman et al (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), they found an association between COVID-19 vaccine and cycle length, but only contributing to less than a day change in cycle length for the two vaccine-dose cycles concluding that COVID-19 vaccination is related to a small change in cycle length but it was not related to duration of menses. In this scenario, our study supported previous findings that there is a possible connection between the changes in menstrual cycles and the COVID-19 vaccination.\u003c/p\u003e \u003cp\u003eWe also observed that the specific type of vaccine taken does not significantly influence the changes in menstrual cycles, there was only a slightly statistically significant difference observed after the third vaccine dose, with a slight increase with the Pfizer vaccine (p\u0026thinsp;=\u0026thinsp;0.019). These findings are in accordance with the paper of Muhaidat et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), according to their reports, the type of vaccines did not show a significant effect on the incidence of abnormalities.\u003c/p\u003e \u003cp\u003eAlmost all women in our study received the first vaccine dose, only one did not get vaccinated, 98% took the second dose and only 66% had received the third dose. The most common vaccine used by study participants was BNT162b2 (Pfizer) 73% followed by AZD1222 (Astra-Zeneca) 25% and mRNA-1273 (Moderna) 1.3% as the first dose. Whereas the uptake for the same vaccine was 82%, 13.5% and 4% respectively. For the third dose it was 84.4%, 1% and 14% respectively. A shift was seen towards mRNA-1273 (Moderna) as a booster (third) dose.\u003c/p\u003e \u003cp\u003eIt was noted that 19.3% of women sought medical attention for menstrual cycle changes post vaccination. Almost 80% visited the Gynaecologist and the rest seeing family physicians. Conservative management was most commonly deployed (36.8%) followed by hormonal management (29.8%) to regulate menstrual cycle. Almost 15% were managed by iron and vitamin supplements.\u003c/p\u003e \u003cp\u003eIn our population more than half of the women had their menstrual cycle returned back to baseline after more than three cycles post vaccination. These findings are similar to the paper published in Jordan (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Researchers indicated that 66.3% of the women reported menstrual symptoms post-vaccination, of which 46.7% experienced them after their first dose. However, in 93.6% of participants, the symptoms resolved within 2 months. In our study, the cycle changes lasted for more than 3 cycles in more than 50% of the affected women.\u003c/p\u003e \u003cp\u003eOther papers discovered a link between menstrual changes and psychological issues that occurred during the time of the pandemic such as the study conducted by (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Phelan et al, as well as the study done by (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) Demir et al. The impact of the COVID-19 vaccine on the menstrual cycle is undeniably occurring. However, the long-term health effect of this is yet to be established. Up till now there is no evidence to suggest that COVID-19 vaccination has an adverse effect on the reproductive health of the woman (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identifies a possible association between menstrual cycle abnormalities and COVID-19 vaccination. This was noted most after the first dose. Menstrual cycle abnormalities were in the form of changes in cycle length, duration of bleeding, premenstrual symptoms, and having missed periods. Menstrual changes are not uncommon, but are transient and should not be alarming for women yet awareness about this experience is an instrumental factor to build trust in the COVID-19 vaccine. Further studies are required to determine the long-term effect of the COVID-19 vaccine on reproductive health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consents:\u003c/p\u003e\n\u003cp\u003eThis study was\u0026nbsp;approved by the IRB office at King Abdullah International Medical Research Centre (KAIMRC), the survey used in this study was also approved by the IRB office at King Abdullah International Medical Research Centre (KAIMRC). The study was carried in accordance with the relevant guidelines and regulation. Informed consents were taken from all study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors contribution:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.K did the conceptualization, methodology, drafting, reviewing, and editing the manuscript. M.S did the methodology, data collection, and drafting the manuscript. A.R did the methodology, data analysis and visualization, drafting, and editing the manuscript. M.K did the statistical analysis, data visualization and reviewing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDai L, Gao GF. Viral targets for vaccines against COVID-19. Nat Rev Immunol. 2021;21(2):73\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlghamdi AN, Alotaibi MI, Alqahtani AS, Al Aboud D, Abdel-Moneim AS. BNT162b2 and ChAdOx1 SARS-CoV-2 Post-vaccination Side-Effects Among Saudi Vaccinees. Front Med (Lausanne). 2021;8:760047.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLamptey E. Post-vaccination COVID-19 deaths: a review of available evidence and recommendations for the global population. Clin Exp Vaccine Res. 2021;10(3):264\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMale V. Menstrual changes after covid-19 vaccination. BMJ. 2021;374:n2211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e(PRAC) PRAC. 6. October 2021 COVID-19 vaccine safety update COMIRNATY BioNTech Manufacturing GmbH: European Medicines Agency; 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-comirnaty-6-october-2021_en.pdf\u003c/span\u003e\u003cspan address=\"https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-comirnaty-6-october-2021_en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCDC. Vaccine Adverse Event Reporting System: Centers for Disease Control and Prevention; 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://wonder.cdc.gov/vaers.html\u003c/span\u003e\u003cspan address=\"http://wonder.cdc.gov/vaers.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurdoğlu Z. Do the COVID-19 vaccines cause menstrual irregularities. Inte J Women\u0026rsquo;s Health Reprod Sci. 2021;9(3):158\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmohaya AM, Qari F, Zubaidi GA, Alnajim N, Moustafa K, Alshabi MM, et al. Early solicited adverse events following the BNT162b2 mRNA vaccination, a population survey from Saudi Arabia. Prev Med Rep. 2021;24:101595.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunter PR. Thrombosis after covid-19 vaccination. BMJ. 2021;373:n958.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrvieto R, Noach-Hirsh M, Segev-Zahav A, Haas J, Nahum R, Aizer A. Does mRNA SARS-CoV-2 vaccine influence patients' performance during IVF-ET cycle? Reproductive Biology and Endocrinology. 2021;19(1):69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarrison M, Hoover K, Kaufman S, McCracken K, Robillard D, Romano M, et al. NASPAG Position Statement on COVID-19 Vaccines and Gynecologic Concerns in Adolescents and Young Adults.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ethe American College of Obstetricians and Gynecologists\u0026rsquo; Immunization ID, and Public Health Preparedness Expert Work Group. COVID-19 Vaccination Considerations for Obstetric\u0026ndash;Gynecologic Care: ACOG; 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care\u003c/span\u003e\u003cspan address=\"https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRCOG/FSRH. RCOG/FSRH respond to reports of 30,000 women\u0026rsquo;s periods affected after COVID-19 vaccin: RCOG; 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rcog.org.uk/news/rcogfsrh-respond-to-reports-of-30-000-women-s-periods-affected-after-covid-19-vaccine/\u003c/span\u003e\u003cspan address=\"https://www.rcog.org.uk/news/rcogfsrh-respond-to-reports-of-30-000-women-s-periods-affected-after-covid-19-vaccine/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee KM, Junkins EJ, Fatima UA, Cox ML, Clancy KB. Characterizing menstrual bleeding changes occurring after SARS-CoV-2 vaccination. medRxiv. 2021:2021.10.11.21264863.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvergne A, Kountourides G, Argentieri MA, Agyen L, Rogers N, Knight D, et al. COVID-19 vaccination and menstrual cycle changes: A United Kingdom (UK) retrospective case-control study. medRxiv. 2021:2021.11.23.21266709.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzimek N, Velez K, Anvari H, Butler L, Goldman KN, Woitowich NC. Impact of Stress on Menstrual Cyclicity During the Coronavirus Disease 2019 Pandemic: A Survey Study. J Womens Health (Larchmt). 2022;31(1):84\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhelan N, Behan LA, Owens L. The Impact of the COVID-19 Pandemic on Women\u0026rsquo;s Reproductive Health. Frontiers in Endocrinology. 2021;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdelman A, Boniface ER, Benhar E, Han L, Matteson KA, Favaro C, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination: A U.S. Cohort. Obstet Gynecol. 2022;139(4):481\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuhaidat N, Alshrouf MA, Azzam MI, Karam AM, Al-Nazer MW, Al-Ani A. Menstrual Symptoms After COVID-19 Vaccine: A Cross-Sectional Investigation in the MENA Region. Int J Womens Health. 2022;14:395\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemir O, Sal H, Comba C. Triangle of COVID, anxiety and menstrual cycle. J Obstet Gynaecol. 2021;41(8):1257\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"63.04347826086956%\"\u003e\n \u003cp\u003eTable 1: Socio-demographic characteristics of the women (n=700)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e59.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003eHealth care worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eNon health care worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHealth status\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003eThyroid disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003ePolycystic ovary syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eMedically free\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e74.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eContraception use\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e83.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eCombined contraception (pill, patch, ring)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eCopper Intrauterine device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eProgesterone only (pill, injection)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eHormonal Intrauterine device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eImplant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.03174603174603%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.984126984126984%\"\u003e\n \u003cp\u003e.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse Menstruation recoding method\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.52173913043478%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.47826086956522%\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"49.91304347826087%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTable 2: immunity and infection status (n=700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"49.91304347826087%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Covid infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"49.91304347826087%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived\u003c/strong\u003e \u003cstrong\u003efirst dose of COVID vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e99.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eType of first vaccine received\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePfizer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e73.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eAstraZeneca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eModerna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eJohnson \u0026amp; Johnson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"49.91304347826087%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived\u003c/strong\u003e \u003cstrong\u003esecond dose of COVID vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eType of second vaccine received\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePfizer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e82.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eAstraZeneca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eModerna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eJohnson \u0026amp; Johnson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"49.91304347826087%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived\u003c/strong\u003e \u003cstrong\u003ethird dose of COVID vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.043478260869566%\"\u003e\n \u003cp\u003e65.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eType of the third vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePfizer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eAstraZeneca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eModerna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eJohnson \u0026amp; Johnson\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"110%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Changes in Menstrual cycles before and after receiving COVID-19 vaccines\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCycle length\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eLess than 21 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e21-35 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eMore than 35 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eI don\u0026apos;t remember N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e123 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e491 (70.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e38 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e48 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e90 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e124 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e63 (22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e5 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e82 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e106 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e50 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e4 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e58 (37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e53 (34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e40 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e4 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of menses in days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eLess than 5 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e5-7 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eMore than 8 days N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eI don\u0026apos;t remember N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e75 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e555 (79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e68 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e2 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e65 (23.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e160 (56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e54 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e3 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e57 (23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e126 (52.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e55 (22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e4 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e35 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e78 (50.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e36 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e6 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"35.714285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of menstrual blood flow\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eLight N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eNormal N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eHeavy N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e77 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e533 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e90 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e75 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e130 (46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e77 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e73 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e95 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e74 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e47 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e66 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e42 (27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"35.714285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriod accompanied by pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eYes\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eNo\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e463 (66.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e237 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e164 (58.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e118 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e136 (56.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e106 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e88 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e67 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"35.714285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced bleeding between periods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e83 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e617 (88.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e75 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e207 (73.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e55 (22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e187 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e39 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e116 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"35.714285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced symptoms before menstruation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eYes\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eNo\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e603 (86.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e97 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e165 (58.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e117 (41.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.238\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e141 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e101 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.769\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e91 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e64 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.764\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"35.714285714285715%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving missed periods\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eYes\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eNo\u0026nbsp;N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e96 (13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e604 (86.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e92 (32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e190 (67.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e71 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e171 (70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e48 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e107 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e** Significant at p\u0026lt;0.05 level.\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4 Medical intervention for post vaccination menstrual cycle changes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" width=\"93.93939393939394%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDid you Seek medical help\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.0606060606060606%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eFamily physician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eObs/Gynae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat was done by the doctor\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eReassurance/nothing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eInvestigation only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eInvestigation and treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"93.93939393939394%\"\u003e\n \u003cp\u003e\u003cstrong\u003eManagement prescribed by physician\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.0606060606060606%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003econservative \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003ehormonal \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eantifibrinolytic/ tranexamic acid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003emetformin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003epain killers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eiron and vitamin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003evasoprotectives/capillary stabilizing agents/bioflavonoids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"93.93939393939394%\"\u003e\n \u003cp\u003e\u003cstrong\u003ediagnosed with low platelets\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.0606060606060606%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther vaccine side effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eNo bleeding problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eGum bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003ePetechial rash (small red dots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eNosebleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"64.28571428571429%\"\u003e\n \u003cp\u003eEasily bruises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"6.122448979591836%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDuration till cycle change resolve \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.608247422680414%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003eFirst dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003eSecond dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eThird dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.0309278350515463%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.608247422680414%\"\u003e\n \u003cp\u003e1 cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e38 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e42 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e38 (26.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.0309278350515463%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.608247422680414%\"\u003e\n \u003cp\u003e2 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e54 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e36 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e25 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.0309278350515463%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.608247422680414%\"\u003e\n \u003cp\u003e3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e41 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e25 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e16 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.0309278350515463%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.608247422680414%\"\u003e\n \u003cp\u003e\u0026gt;3 cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e135 (50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e126 (55.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e65 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.0309278350515463%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Menstrual cycles, women, reproductive health, COVID-19 vaccine","lastPublishedDoi":"10.21203/rs.3.rs-2330401/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2330401/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\n\u003cp\u003eCOVID-19 vaccines are considered safe and offer great protection from the virus. However, they can have several side effects including fever, fatigue, and local pain and swelling. Recently a trend in the drug adverse events reporting systems showed an increased number of female vaccine recipients having menstrual cycle abnormalities post-vaccination.\u003c/p\u003e\n\u003cp\u003eAim\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the association between menstrual cycle abnormalities and the COVID vaccines.\u003c/p\u003e\n\u003cp\u003eSubjects and methods\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional study conducted among reproductive-age women aged between 18 and 50 years old. A self-administered questionnaire was distributed among women using an online survey. The questionnaire includes basic demographic characteristics, the number of received vaccine doses, the type of vaccines, and the changes in menstrual cycles after receiving the COVID-19 vaccine.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003e700 reproductive age women met the inclusion criteria. After the first dose there was a significant change in menstrual cycle regularity P-value 0.009 (95% confidence interval 0.402-0.881) and odds ratio of (0.595). However, there was no significant change after the second and third dose p-value 0.065 and 0.055 respectively. The data also indicated a significant change in the menses flow; P-value (\u0026lt;0.001), with more women experiencing a reduction or increase in their period flow.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eThis study identifies a possible association between menstrual cycle abnormalities and COVID-19 vaccination. This was noted most after the first dose. Menstrual cycle abnormalities were in the form of changes in cycle length, duration of bleeding, premenstrual symptoms, and having missed periods. Menstrual changes are not uncommon but are transient and should not be alarming for women yet awareness about this experience is an instrumental factor to build trust in the COVID-19 vaccine.\u003c/p\u003e","manuscriptTitle":"The association between menstrual cycle abnormalities and the COVID-19 vaccine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-12-16 18:18:50","doi":"10.21203/rs.3.rs-2330401/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d38000d2-f15c-4fdf-b7d7-da5eb19c9ad4","owner":[],"postedDate":"December 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-16T05:59:15+00:00","versionOfRecord":[],"versionCreatedAt":"2022-12-16 18:18:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2330401","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2330401","identity":"rs-2330401","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}