Coughing fits that send shockwaves down to your toes. Breathlessness that feels as though you’re drowning. Haunted by a cloud of constant, paralysing exhaustion.
All symptoms that crept up on 46-year-old Dawn Knight in March, after she returned from a family holiday in Thailand. She had no doubt: it was a classic case of Covid.
But a few weeks into her illness came another symptom, one which she had not yet heard of in the flurry of news reports. She missed her period. There was no chance that she could be pregnant, but by April, there was still no sign of it.
‘My Covid symptoms were so terrible and continued for months and months, leaving me barely able to move from the sofa, so my lack of periods was the least of my problems,’ says the mental health nurse from Somerset.
‘But it was very strange because I’ve been as regular as clockwork for as long as I can remember.’
The phenomenon of long Covid is now well documented. It is thought to affect as many as one in 20 people, and especially women, although researchers are not entirely sure why
As the months went on, it became clear that Dawn had developed so-called long Covid – where individuals are no longer infectious, but symptoms such as crushing fatigue, breathlessness and brain fog continue.
‘The breathlessness still feels at times like I’m being strangled,’ she says. ‘I started having to use the mobility scooter my husband, who is disabled, relies on, just to get to the shops.’
The phenomenon of long Covid is now well documented. It is thought to affect as many as one in 20 people, and especially women, although researchers are not entirely sure why.
In June, Dawn visited her doctor when even more symptoms emerged – a racing pulse and a burning sensation in her hands and feet.
Blood test results proved startling: her level of the reproductive hormones oestrogen, progesterone and follicle-stimulating hormone (FSH) were at ‘post-menopausal’ levels.
‘The doctor diagnosed me as being post-menopausal,’ says the mother of two, who recently received a formal long Covid diagnosis.
‘I was really surprised. Even though I don’t want more children, I didn’t expect it quite yet and I didn’t have any of the signs.
‘This didn’t happen to my mother until she was in her mid-50s.’
‘We didn’t have any of the signs’: Mental health nurse Dawn Knight, 46 (pictured above). As the months went on, it became clear that Dawn had developed so-called long Covid
At 46, Dawn is a little young to be past the menopause – the average age in the UK is 51.
It is not uncommon for a woman to be peri-menopausal in her mid-40s – that is when levels of the sex hormones (oestrogen and progesterone) begin to fluctuate unevenly throughout the cycle, causing low mood and night sweats, and making periods lighter and irregular.
But this can last for years as progesterone and oestrogen gradually fall before periods eventually stop completely. It is more unusual to happen suddenly, without any symptoms
Yet Dawn is far from the only Covid sufferer to be struck by this phenomenon. Hundreds of women have taken to social media to report similar experiences.
On Facebook, a global support group for long Covid sufferers, with more than 22,000 female members, is host to scores of discussions about a sudden lack of periods, and concerns about fertility.
With no monthly bleed, it’s unlikely a woman will be regularly ovulating, and no eggs will be released for fertilisation.
One poll of more than 100 members found 80 per cent reported their periods had changed since being infected with Covid.
Claire Hastie, who founded the Facebook group, reveals that members from around the world have reported strange menstrual fluctuations.
Claire, from Birmingham, who is still struggling to walk after contracting coronavirus in March, says: ‘Women have said their periods have stopped, while for others they’re less frequent.
‘For some, like me, their long Covid symptoms get worse around the time of their period. Something very odd is happening.’
While many women like Dawn are not mourning the end of their fertile years, others are heartbroken at a change they did not feel ready for.
Anna Marie Grieve, 47, from Shotts, in North Lanarkshire, contracted the virus in March after her daughter, Rebecca, 20, returned from college with a cough. Within days, Anna Marie had developed her own hacking cough and breathlessness, and also lost her sense of taste and smell.
Like most people who had Covid in the spring, the pair weren’t tested but their symptoms clearly aligned with the virus.
Then, in April, she didn’t get her period – a particular shock, given that she’d been pregnant just a year previously.
Anna Marie Grieve (above, with her son Romeo), 47, from North Lanarkshire, contracted the virus in March after her daughter, Rebecca, 20, returned from college with a cough
‘I had a miscarriage last year, so I knew I was still able to conceive. I’ve been regular since I was 15, so my first thought was that I could be pregnant again.
‘I took numerous pregnancy tests but they were all negative.’ Nine months on, Anna Marie’s periods have not returned. ‘There’s been nothing since March.
‘No signs, no changes beforehand,’ she says. ‘I guess this is it. I have no choice but to accept the end of my fertility. But I haven’t had time to prepare.
‘I just wish that I had known it was coming because it feels like I’ve been robbed of my final fertile years.’
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Curiously, just like Dawn, Anna Marie is suffering long Covid and still battles shortness of breath and extreme exhaustion daily. So what is going on?
Currently, there is little research in this area other than the mounting anecdotal evidence.
But now doctors are embarking on new studies to tackle the question, too.
Dr Louise Newson, a GP and menopause specialist who runs a private clinic in Stratford-upon-Avon, is working with experts from the University of Edinburgh and University College London to investigate whether the virus could be triggering early menopause.
Dr Newson says that although some common long Covid symptoms – such as dizziness, fatigue and brain fog – are also symptoms of the menopause, mounting reports mean the links between the two ‘feel more than just coincidence’.
‘I’ve been engaging with the support groups online and it’s astonishing just how many have had their periods change or stop,’ says Dr Newson.
‘It is true that the most common group of people to suffer from long Covid are in their 50s – so menopause, or peri-menopause, may be a factor in their symptoms.
‘Their hormones are depleted. But we need to research whether this is normal menopause that just happens to coincide with coronavirus, or if coronavirus itself is causing problems for the ovaries, where the hormones are produced.’
It is already known that other infections, such as sepsis or a bad bout of flu, can disrupt periods or cause them to stop temporarily.
The problem is thought to lie with the control centre in the middle of the brain, called the hypothalamus, which is responsible for regulating a host of bodily functions. When the hypothalamus detects signs of stress, be it mental or physical, it signals for the release of chemicals that safeguard basic survival functions, and stops other less important ones – for instance, those connected with reproduction.
It is already known that other infections, such as sepsis or a bad bout of flu, can disrupt periods or cause them to stop temporarily (file photo)
As Mary Jane Minkin, a gynaecologist at the Yale School of Medicine in the US, explains: ‘It’s a really intricate set-up, and any stressor can whack the whole thing up.’
Consultant gynaecologist Dr Jackie Maybin, a senior research fellow at the University of Edinburgh, who is collaborating on the new research with Dr Newson, adds: ‘Shutting down processes like menstruation, which isn’t needed, is a natural way of conserving energy and prioritising the immune system.’
And perhaps for those women whose hormones are already depleting as a natural by-product of age, their hormones don’t recover – and periods stop for good.
There’s another even more concerning theory. According to some experts, coronavirus could be directly attacking the ovaries, reducing the production of crucial progesterone, oestrogen and testosterone.
If this is actually happening, it’s not clear but the answer could lie with receptors, called ACE2, through which Covid enters the body’s cells to cause infection – a bit like a key in a lock.
There are lots of these receptors in the heart and lungs, which is thought to be why they are so badly affected.
The virus could be attacking the ovaries, reducing production of vital hormones
But they are also in the ovaries, the womb lining and, in men, the testes. It means the virus could, in theory, spread to the cells in the ovaries through the bloodstream, having entered the body through the nose, eyes or mouth.
What happens in practice isn’t clear and hasn’t yet been studied. But Chinese research has shown that men’s fertility is also affected by the virus.
There is evidence too that having already dwindling hormones can make coronavirus far more disruptive for some.
Studies show that while women are 50 per cent more likely to be affected by longer-term Covid than men, it’s post-menopausal women who are even more at risk. After the menopause, women are increasingly likely to both get Covid and experience more severe symptoms, experts say.
On the flip side, having higher levels of oestrogen and progesterone has a protective effect against Covid, so women with the highest levels experience milder symptoms.
According to a Chinese study, among those treated in hospital with the virus, the women with the highest hormone levels had symptoms which were least severe.
This finding is further reflected in reports from women with long Covid whose symptoms worsen in the 48 hours before their period begins. This is when levels of progesterone and oestrogen drop from very high to quite low.
Professor Zuzanna Olszewska, from Oxford University, is about to launch a study with colleagues into whether women’s reproductive health has been affected by the pandemic – having first noticed the pattern after her own suspected Covid infection.
Studies show that while women are 50 per cent more likely to be affected by longer-term Covid than men, it’s post-menopausal women who are even more at risk (file photo)
‘I’d recovered a few months after being infected, but noticed I would get a few typical symptoms of long Covid – shortness of breath, a racing heart and extreme fatigue – which always coincided with the first day of my period,’ she says.
‘I joined an online support group and found dozens of women reporting the same thing and other changes to their period. But women going to long Covid clinics tell us that doctors haven’t heard of this as a symptom.
‘There’s a silence around it – so we’re hoping to fill in that part of the conversation.’
If hormones, or a lack of them, are partly culpable for long Covid symptoms, there are treatments which could help.
GP Louise Newson says menopausal women who came to her clinic – and who happened to also have long Covid – saw a ‘huge improvement’ in symptoms after being prescribed hormone replacement therapy (HRT).
The treatment, prescribed on the National Health Service to alleviate symptoms of the menopause, is a combination of oestrogen, progesterone and sometimes testosterone.
Dawn Knight, who was prescribed oestrogen patches and capsules of progesterone three months ago, saw some limited benefits.
‘It’s eased some of my symptoms like the tingling sensation in my hands and my husband says I’m less stressed,’ she says.
‘But sadly it hasn’t helped with the chest pains, breathlessness or the fatigue.’
Even so, Dr Newson believes that for the majority, who currently have no other options to relieve their life-changing symptoms, it’s worth a try.
‘I’m not saying that hormones are the complete answer for long Covid,’ she says.
‘But for some women, if it improves their symptoms by a quarter, if means they could get their job back, or look after their kids again, which is really important. We need to get these women feeling better.’
Has YOUR period been affected by coronavirus or lockdown?
Take part in Dr Louise Newson’s study here.
Take part in the University of Oxford study here.
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