الفهرس 
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Abstract
The menstrual bleeding pattern is an important indicator of reproductive health. There has been public concern over the possibility that vaccination against COVID-19 leads to changes in menstrual cycles.
It is critical to perform menstrual health research in the context of the COVID‐19 pandemic considering the strong relationship between regular normal cycles and the general health of females. Therefore this study aimed to determine the incidence of menstrual cycle abnormalities after the administration of the COVID-19 vaccines.
This study was a clinical observational cohort study of menstrual cycle. Date were collected from 347 filled questionnaires by females who attended to receive Covid-19 vaccine at Menoufia University and Behera health directorate during the period of the study from January 2022 till February 2023. Data were collected prospectively from patients who came to receive the first dose then follow up for 3 months after the first dose then 3 more months after the second dose. Data were collected in two parts from patients who received any past doses; first part is past history about the previous doses, then prospective follow-up for 3 months after the current second or booster dose.
According to the prevalence of menstrual irregularities after COVID-19 vaccination in our research, 156 female out of included 347 cases (44.96%) developed at least one menstrual change.
As regard socio-demographic data, no statistically significant difference was detected between cases who developed menstrual changes post-COVID-19 vaccination and those who didn’t develop menstrual cycle changes according to age (P=0.285), BMI (P=0.791), residence (P=0.758) relationship status (P=0.785), with the mean age of our sample population was 29.67±6.27 years and the mean BMI was 23.63±3.39 kg/m2. Most respondents (47.3%) were married.
Regarding the menstrual cycle changes among the vaccinated women, menstrual cycle changes occurred in 156 women (45%) after Covid-19 vaccination; Pain was the most commonly reported symptom as it increased in 74 (21.3%) of participants. Almost 10.1% of the participants complained about the inter-menstrual bleeding and the same percentage of people (10.1%) experienced increase of menstrual amount and those changes not varied according to the vaccine type in our study. 9.8% of the whole cases were suffering from the menstruation frequency longer than 35 days (longer cycle than usual) while the amount of menstrual bleeding decreased in 31 (8.9%). 8.6% of them were suffering from the menstruation frequency shorter than 21 days (shorter cycle than usual).
The most commonly used vaccines in the present study were Sinopharm or Sinovac ’’ the killed vaccine’’ as 43.7% of the participants had taken Sinopharm or Sinovac (n=152,), followed by 27.6% who took Pfizer vaccine (n=96). Almost 14.4% of the participants were vaccinated by AstraZeneca (n=50) while 7.5% and 6.9% of the participants took Moderna, and Johnson and Johnson; respectively.
Regarding cases who received Sinopharm or Sinovac, the most frequent menstrual side effect was menstruation- associated pain that was reported by 23.68% of cases who received that vaccine. It was the same case in Pfizer Vaccine as pain was reported by 22.9% of cases who received that vaccine. In case of AstraZeneca vaccine, pain, increase of menstrual amount, intermenstrual bleeding were all the most frequently reported effects by 16%. Pain, decrease of menstrual length & intermenstrual bleeding were all the most repeatedly reported by 11.5% who received Moderna vaccine. In addition, the most frequent menstrual complaints after Johnson and Johnson vaccine were pain and intermenstrual bleeding that were equally reported by 20.8%of cases.