Menstrual experiences after COVID‐19 vaccination in a non‐menstruating gender diverse sample
Authors: Lee Katharine M. , Junkins Eleanor J. , Clancy Kathryn B. 
Published: May 2022

After COVID‐19 vaccination a number of currently and formerly menstruating people reported changes in menstrual bleeding and menstrual symptoms. Media highlighted these experiences, but much of the focus was on changes in regularly menstruating cis‐gendered women and unnecessary concerns about fertility. This was despite ample evidence of vaccine safety for people who were currently pregnant or conceived after vaccination. An overlooked phenomenon was reports of periods, spotting, or other unexpected vaginal bleeding in people who usually do not menstruate, including people assigned female at birth who are transmasculine, trans men, agender, non‐binary, and other gender diverse identities. We present preliminary descriptions of post‐vaccine menstrual experiences of a vaccinated, non‐menstruating, gender diverse sample.

Methods

We conducted an online survey to characterize the menstrual experiences of a diverse group of currently and formerly menstruating people from April 7, 2021 through Oct 7, 2021. From over 160,000 responses, we identified 552 people between the ages of 18 and 45 who 1) reported they usually do not menstruate; 2) reported using testosterone and/or gender‐affirming hormones (some did not specify testosterone); and 3) were not cis women. In addition to demographic characteristics (e.g., age, gender), we asked multiple‐choice and open‐ended questions about current menstrual status (including why they do not menstruate), hormone medications, contraceptive use, and menstrual symptoms after being vaccinated. Here, we combine experiences for both doses of the vaccine for analysis and group period, spotting, and other menstrual bleeding into one category called “breakthrough bleeding”.

Results

In this sample (n=552, age=25.6 +/‐ 5.7 (mean +/‐SD)), most respondents (84%, 463/552) selected more than one gender, with the most common for this subsample being transgender (n=460), man or man identified (n=373), non‐binary (n=241), and genderqueer/gender non‐conforming (n=124). 33% of respondents (180/552) reported breakthrough bleeding after vaccination, 9% (52/552) reported chest or breast soreness, and 46% (254/552) reported having other symptoms they would usually associate with a period. In response to the open‐ended question about other period related symptoms, respondents reported common symptoms such as cramping and bloating. A number of respondents also used the open‐ended text boxes to report negative mental health in response to their period symptoms, including anxiety, depression, gender dysphoria, panic attacks, and suicidal ideation.

Conclusions

Many gender diverse people who received vaccines for COVID‐19 experienced symptoms that are usually associated with menstruation, including unexpected bleeding. Because menstruation is usually considered in relation to fertility, other important aspects of this physiology are overlooked and this impacts people beyond fertile women. Attentiveness to menstruation beyond fertility and more inclusive use of gender in clinical trials is important to prepare people for potential side effects, address medically underserved populations, and reduce vaccine hesitancy.