Study links long COVID to higher risk of heavy menstrual bleeding

News brief

Woman lying on couch — *m-gucci / iStock*

Women who have long COVID are at higher risk for heavy menstrual bleeding (HMB), perhaps from an outsized inflammatory response, British and French researchers report in Nature Communications.

The team used data from a study involving 12,187 British women, the care of 54 women with long COVID for 3 months, and analysis of blood and endometrial (uterine lining) samples. The goals were to identify any relationship between COVID-19 and abnormal uterine bleeding, determine if long-COVID symptoms vary with the menstrual cycle, and explore potential underlying mechanisms.

In total, 40% of participants had received one or two doses of COVID-19 vaccine.

"These menstrual symptoms can have a profoundly negative impact on quality of life, interfering with physical, social, mental and material wellbeing," the team wrote. "HMB is a leading cause of iron deficiency anemia in developed countries, and, when extreme, can necessitate blood transfusion."

Higher levels of male hormone

Of all participants, 57% reported at least one abnormal menstrual symptom, such as irregular cycles, heavy bleeding, abnormal cycle length, and prolonged menstrual periods at baseline, and 20% had a condition affecting reproductive function (eg, endometriosis, polycystic ovary syndrome, HIV/AIDS, underactive/overactive thyroid, uterine polyps or fibroids, eating disorders, interstitial cystitis [bladder pain]).

Differences in peripheral and endometrial inflammation may contribute to AUB and long COVID symptom severity.

Compared with 9,423 uninfected women, 1,048 participants with long COVID reported heavier menstrual bleeding, longer periods, and bleeding between periods, while 1,716 who recovered from acute COVID reported mild menstrual disruption.

Among the 54 women provided follow-up care across the menstrual cycle, heavy bleeding was greatest during the perimenstrual and proliferative (uterine lining–thickening) phases.

Higher levels of the male hormone 5α-dihydrotestosterone and lower levels of endometrial androgen (male hormone) receptors were observed in long-COVID patients than in uninfected women. Greater menstrual inflammation was noted in long-COVID patients, and immune-cell clusters were seen in menstrual endometria.

"In conclusion, long COVID was associated with AUB [abnormal uterine bleeding] but not impaired ovarian function," the study authors wrote. "Differences in peripheral and endometrial inflammation may contribute to AUB and long COVID symptom severity."

CDC: Most enteric disease outbreaks linked to fruit, backyard poultry

News brief

Stephanie Soucheray, MA

backyard birds — sierravalleygirl / Flickr cc

A new report on 2023 outbreaks of enteric, or intestinal, diseases in the United States from the Centers for Disease Control and Prevention (CDC) shows that fruits were the source of most foodborne outbreaks, and backyard poultry was the most common source of animal-contact cases and outbreaks.

Overall, there were 181 possible multistate outbreaks reported in 2023 with two or more people with similar illnesses living in two or more states. Of those, 50 outbreaks were solved, meaning a source was identified. Of the 50 solved, 32 were food-borne and 18 were linked to animal contact.

In total, the outbreaks were linked to 12 deaths, 942 hospitalizations, and 3,153 illnesses.

Salmonella most common

“More multistate outbreaks were investigated by CDC in 2023 than any year since 2016. Compared to 2022. the number of multistate outbreaks investigated in 2023 increased for all pathogens except Listeria, which caused the same number of outbreaks in 2022 and 2023,” the authors wrote.

More multistate outbreaks were investigated by CDC in 2023 than any year since 2016

Of the multistate outbreaks caused by Salmonella, Shiga toxin-producing Escherichia coli (STEC), Listeria monocytogenes, or Campylobacter during 2023. Salmonella was the most common, making up 64% of the multistate outbreaks investigated and most of (90%) of the illnesses.

Backyard poultry was the most common animal exposure to Salmonella, followed by small turtles.

Illinois announces first Powassan virus case

News brief

Lisa Schnirring

The Illinois Department of Public Health (IDPH) yesterday reported a Powassan virus infection in a state resident, who became seriously ill, for the first time.

tick close up — Cornell Integrated Pest Management/Flickr cc

In a statement, the IDPH said investigators are still trying to determine if the patient was exposed to a tick bite in Illinois or another state. Officials will conduct tick surveillance, including dragging and testing ticks for Powassan and other viruses, in parts of Illinois where the patient spent time before symptoms began.

Health officials urged Illinois residents to take precautions against ticks, which are known to spread the virus.

Sameer Vohra, MD, IDPH director, said, “With warm weather still prevalent, tick-borne diseases remain a potential threat here in Illinois.” He also urged people who live in wooded or grassy areas where ticks are present and who experience fever, headache, or fatigue to immediately contact a health provider.

CDC update notes 36 cases from 9 states

Powassan virus is spread by infected ticks, most commonly the black-legged type. The virus can cause severe disease, including meningitis and encephalitis, and can sometimes be fatal.

US Centers for Disease Control and Prevention (CDC) ArboNet data show that as of September 16, 36 Powassan virus cases from 9 states have been reported this year, 33 of them involving neuroinvasive disease. Most were reported from Wisconsin and Minnesota, with several Northeastern states also reporting cases.