Stress and menstrual cycle characteristics among adolescents during the COVID-19 pandemic: An observational study using longitudinal app-tracking data
Christiane K. Helmer, Amanda A. Shea, Virginia J. Vitzthum, Annalisa Watson, Brenda Eskenazi, Kim G. HarleyBackground
Stress is linked to irregular menstrual cycles in adults, but little research has examined this relationship in adolescents. Adolescents may be particularly vulnerable because their menstrual cycles are still developing and more variable.
Objectives
To investigate the association of stress and irregular menstrual cycle characteristics in adolescents during the COVID-19 pandemic using data from the Clue menstrual cycle tracking app.
Design
We surveyed 13–18-year-old Clue app users (N = 6,486) in the United States about their perceived stress and linked responses to app-recorded menstrual cycle data.
Methods
Using mixed-effects models, we analyzed the association of overall stress and changes in stress during the pandemic with cycle and period length, dysmenorrhea, heavy flow, and three aspects of irregularity: short, long, and variable cycles.
Results
Adolescents reporting high perceived stress had higher odds of reporting dysmenorrhea (adjusted odds ratio [aOR] = 1.1, 95% confidence interval [CI]: 1.1–1.2, p = 0.001), and short cycles (<21 days) (aOR = 1.4, 95% CI: 1.1–1.8, p = 0.003), and had slightly longer periods (β = 0.1 days, 95% CI: 0.0–0.3, p=0.007) compared to those reporting low stress. Adolescents reporting that their stress levels had become much worse during the COVID-19 pandemic also had higher odds of reporting dysmenorrhea (aOR = 1.1, 95% CI: 1.1–1.2, p<0.001), and heavy flow (aOR = 1.2, 95% CI: 1.1–1.3, p<0.001) compared to those whose stress levels had not increased. Stronger associations between COVID-19 stress and report of dysmenorrhea were observed in users menstruating for <4 years (interaction p-value = 0.008).
Conclusion
Increases in COVID-19 pandemic-related stress may have impacted adolescents’ cycle characteristics, particularly among adolescents menstruating for <4 years.