L, 40, had Covid 6 months ago. She was admitted to the hospital for a week for the treatment of her respiratory symptoms. After discharge, she still felt tired and listless with occasional headaches. She also had difficulty thinking clearly and likened it to a brain fog. Before the infection, she was always on the go, balancing a busy career as a banker and looking after her family with two children, aged ten and eight.

“Normally I am a very energetic and analytical person,” she said. “But now, I have problems doing simple tasks and basic logic problems. I would normally do this easily.”

Her menstruation was also getting irregular with scanty prolonged periods. Occasionally, her menses were heavy with clots.

What is Long Covid?

Most people infected with the recent strain of Covid recover quickly. But in some, the effects of the virus can last for much longer and new symptoms can also develop.

The World Health Organization (WHO) defines long Covid as symptoms that start usually within three months of having Covid, last for at least two months, and cannot be explained by another condition. Symptoms can fluctuate or relapse over time.

What Are the Symptoms of Long COVID?

According to the American Medical Association, there are over 200 symptoms that have been associated with long Covid. Common symptoms are:

• Feeling extremely tired

• Feeling lethargic after exertion

• Brain fog characterized by forgetfulness, and a lack of focus and mental clarity.

• Palpitation when heart beats over 100 times a minute

What are the effects of Long covid on ovarian functions?

Although most studies have shown that Covid did not infect the female reproductive system, patients with long Covid have reported an upsurge of menstrual abnormalities such as prolonged cycles and decreased volume of menstruation. A few patients also experienced shortened or disordered menstrual cycles as well as increased volume of menses. Disruption in ovarian hormone concentrations is hypothesized to be the cause. As hormone production by the ovary is controlled by the brain centers such as hypothalamus and pituitary gland, researchers thought that these hormonal changes are due to the chronic inflammatory changes of the brain tissues brought about by the virus.

Fortunately, the ovarian reserve as measured by the blood levels of AMH (anti-Mullerian Hormone) does not seem to be affected by the infection.

How long the virus will suppress ovarian functions remains unclear.

Recent studies have found that middle-aged women and those who are near menopause or already menopausal appear to experience more serious complications from the virus. They seem to get specific, and severe symptoms such as brain fog, fatigue, new-onset dizziness, and insomnia. These symptoms are probably related to the reduced levels of female hormone, oestrogen.

L’s irregular menses were monitored and managed with oral oestrogen therapy. She was advised to have adequate rest with at least 7 hours of sleep. Regular exercise, reducing stress, and avoiding excess alcohol help normalize her ovarian function. L felt much better after treatment. Frequency of other symptoms had been reduced. She hoped to recover soon.