COVID vaccine: Social, menstrual and psychological aftermath

Abstract

Objective

Beginning from the end of year 2019 till end of year 2021 the whole world has witnessed a calamity that shook every aspect of human life. Globally, countries were engrossed in developing the vaccine at the earliest. Several vaccines having Emergency Use Authorization (EUA) were distributed and administered, after assuring no severe adverse impact. However, certain side effects persist. These unforeseen outcomes led to vaccine hesitant behavior and even refusal to take a jab. In this context, the present study attempts to investigate the social, psychological and menstrual changes perceived after inoculation.

Material and methods

Cross-sectional observational study following the CHERRIES publication guidelines for the description of research results from web based surveys and questionnaires.

Results

The study reveals that almost 40 % of the respondents have received some information relating to the impact that vaccine has on menstrual health and out of which almost 65% have received negative information. Moreover, 32% of the respondents were not very sure about the side effects or after effects of the vaccine. The inferential findings of this study suggest that COVID vaccine has affected the menstrual cycle, particularly cycle length and volume. Majorly, the impact of vaccine was reported by those who have already suffered from past menstrual illnesses. However, age, geographical demography and the type of vaccine injected does not significantly impact the menstrual homeostasis.

Conclusion

Geographical demography of respondents have significant impact on their perceived psychological stress after the vaccination. This study shows the significance of gender-based trials of vaccines in the coming future so that these unforeseen physiological and psychological ailments can be evaded.

Resumen

Objetivo

Desde finales del año 2019 hasta finales del año 2021, el mundo entero ha sido testigo de un evento que sacudió todos los aspectos de la vida humana. A nivel mundial, los países estaban absortos en desarrollar la vacuna lo antes posible. Se distribuyeron y administraron varias vacunas con Autorización de Uso de Emergencia (EUA), tras ser verificada su seguridad y ausencia de efectos adversos significativos. Sin embargo, ciertos efectos secundarios persisten. Estos resultados imprevistos llevaron a una reticencia frente a la vacuna e incluso a la negativa a vacunarse. En este contexto, el presente estudio intenta investigar los cambios sociales, psicológicos y menstruales percibidos después de la immunización.

Material y métodos

Estudio observacional transversal siguiendo las directrices de publicación CHERRIES para la descripción de resultados de investigación procedentes de encuestas y cuestionarios de entornos web.

Resultados

El estudio revela que casi el cuarenta por ciento de los encuestados ha recibido alguna información relacionada con el impacto que tiene la vacuna sobre la salud menstrual, de los cuales casi el 65 por ciento habían recibido información negativa. Además, el 32 por ciento de los encuestados no estaba muy seguro acerca de los efectos secundarios de la vacuna. Los hallazgos inferenciales de este estudio sugieren que la vacuna frente a la COVID-19 ha producido afectación del ciclo menstrual, particularmente en la duración del ciclo y el volumen de sangrado. Principalmente, informaron del impacto de la vacuna quienes habían sufrido enfermedades menstruales en el pasado. Sin embargo, la edad, la demografía geográfica y el tipo de vacuna inyectada no afectaron significativamente la homeostasis menstrual.

Conclusión

La demografía geográfica de los encuestados tuvo un impacto significativo en el estrés psicológico percibido después de la vacunación. Este estudio muestra la importancia de los ensayos de vacunas basados en el género para, en el futuro próximo, se puedan evitar dolencias fisiológicas y psicológicas imprevistas.

Introduction

Beginning from the end of year 2019 till end of year 2021 the whole world has witnessed a calamity that shook every aspect of human life. Enforcement of lockdown, maintaining social distancing, using mask and hand sanitisers were practised in order to put a check on spread of the coronavirus. Despite the strict implementation of the guidelines provided by the government in India from early January, 2020 till early August, 2022 there were almost 4,41,07,600 confirmed cases of COVID-19, while reportedly 5,26,600 people have succumbed to death.¹ During such situation of heightened crisis vaccines were the only possibility as a preventive measure against this fatal flu. Vaccines were formulated in limited span of time to curb the menace of coronavirus. Several vaccines having Emergency Use Authorization (EUA) were distributed and administered after assuring no severe adverse impact.² In India also first indigenous COVID-19 vaccine (COVAXIN) was developed by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR) - National Institute of Virology (NIV). After administration of vaccine some expected side effects crop up such as- fatigue, mild fever, headache, and arm pain; along with-it unexpected changes in menstrual cycle also surfaced and that led to vaccine mistrust and consequently, vaccine hesitant behavior or even refusal to take vaccine.^3,4

Regular menstrual cycle is a vital sign of women health and well-being. Heavy bleeding/ clotting, irregular/ disrupted cycle, excessive pain during periods are some of the commonly experienced side effects of vaccine as reported by women.^5,6 Even before the launch of vaccination drive in India, social media was flooded with rumors and uncertainties pertaining to the impact of COVID vaccine on menstrual cycle.¹⁹ But very few research studies attempted to dig deeper in this area. The present study intends to explore the perception and experience of Indian women towards the COVID vaccine with regard to menstrual health; along with its psychological impact. As per the author knowledge, this is the only study that endeavored to look into its psychological impacts. Disturbances in menstrual cycle cannot be solely attributed to COVID vaccines. In this study other factors such as age, previous history of menstrual illness, post-partum cases, use of hormonal contraceptives etc. have also been taken into consideration. The study was planned and executed based on the following objectives:

• 1.

  To find out the nature of information received regarding the impact of COVID vaccine on menstruation.

• 2.

  To explore the physiological changes (pertaining to menstruation) experienced after taking the jab of COVID vaccine.

• 3.

  To explore the psychological changes related to menstruation after taking the vaccine.

• 4.

  To see the relationship between age of participants and probable after effects of COVID vaccine on their menstruation.

• 5.

  To investigate the relationship between past or existing menstrual illnesses and COVID vaccine.

COVID-19 vaccines have been prepared and went through clinical trials in a very short period of time. Although there is a limited literature available that comprises of relationship between COVID vaccine and menstrual health; yet almost most of the study has reported that surveillance systems of respective COVID vaccines does not collect data regarding its impact on menstrual health.^7,8 Summary of Yellow Card Reporting released by U.K. government has also suggested that there are possible suspected association between COVID-19 Vaccines (Pfizer and Moderna) and menstrual health and unexpected vaginal bleeding (post menopause). The report further states that there are evidences of delayed periods, heavy bleeding and unusual bleeding but these are temporary and the Medicines and Healthcare products Regulatory Agency (MHRA) will continue review the suspected side-effects.⁹

Nazir et al. (2022) in their thorough review of the existing literature showed that out of 14 studies conducted in different parts of the world namely Saudi, U.K., U.S., China, Italy, Africa and Norway; merely 3 studies concluded that there is no significant difference was found in the menstrual patterns pre and post vaccination.¹⁰ Studies have also suggested that the most commonly stated disruptions were concerning the length of menstrual cycle and the volume of menstrual discharge. Considering the above literature void and to contribute to the existing body of literature the following study is undertaken.

The present study contributes to the existing literature in the following aspects:

• 
  ▪

  There is no such study has been conducted in India, restraining us from gathering adequate data related to post-effects of COVID vaccine, that has been developed and tested in India, on menstrual health of Indian women in reproductive age.

• 
  ▪

  Unlike other studies available online, this study predominantly explores social and psychological perspective of the issue instead of medical viewpoint.

Based on the objectives mentioned in the introduction section and the accessible literature the researcher has formulated and tested the following hypotheses-.

H₀ 1- Age of respondents will not significantly affect menstrual homeostasis and psychological health post vaccination.

H₀ 2- Geographical demography will not significantly affect menstrual homeostasis and psychological health post vaccination.

H₀ 3- History of menstrual illness will not significantly affect menstrual homeostasis post vaccination.

H₀ 4- Type of vaccine injected will not significantly affect menstrual homeostasis post vaccination.

Methodology

In this exploratory study, data collection has been conducted using cross-sectional online survey, to know the perception and experience of menstruating women towards COVID-19 vaccine based on their experience.)

Method

The questionnaire utilized for data collection is adapted from the Vaccine Hesitation Survey Questions developed by SAGE working group on vaccination hesitancy (WHO).¹¹ The questions were adapted to conform the objectives of current study. The questions were translated into Hindi language for better comprehension. Experts have checked the objectivity and language precision by reverse translation into English. The questions were related to information received regarding menstrual changes post- vaccination, source of information, credibility of information received, doubt regarding taking a jab, and attitude towards COVID vaccine (majorly based on respondents' experience). Pilot testing was conducted on the data received initially from thirty participants and in reliability analysis the value of Cronbach α was found to be 0.68 and 0.61 for information regarding COVID vaccine (6-items) and attitude towards COVID vaccine (9-items) respectively.

For the purpose of data collection Google form based questionnaire was utilized. The survey questionnaire has four sections. The first section of the questionnaire contains brief introduction of the study, instruction for filling out the questionnaire and informed consent for voluntary participation. The second section encompasses demographic details of the participants such as- age, level of education, marital status, geographical demography and it also includes questions regarding status of COVID vaccination, gap between vaccines, infected or tested positive for corona virus and history of menstrual problems. The third section of the questionnaire includes questions about the information wandering on social media such as-source of information, nature of information, participants' viewpoint and attitude towards vaccination. The fourth section of the questionnaire comprises of items related to experiences of physical and psychological changes post vaccination relating to menstrual health along with the likelihood of taking the booster dose. Questionnaire is bilingual (English and Hindi) for avoiding misinterpretation of questions or items. Questions/ items in this questionnaire are of varied kinds, e.g. it has 5-point rating scale, 3 point rating scale, dichotomous questions and multiple answers questions. Furthermore, to substantiate the quantitative responses, some qualitative, open-ended questions were also given in the questionnaire.

The sample size for the study was determined using G* Power 3.1.9.7 (HHU, Germany). The minimum required sample size calculated was 122 in order to detect medium effect size (0.6), with a power of 0.95 and alpha value 0.05.¹² Snowball sampling technique was utilized to collect data as this technique is commonly used in various other studies during the pandemic.¹³

Procedure

The survey questionnaire has been circulated through e-mails and other social networks like- LinkedIn, ResearchGate, WhatsApp and Facebook to randomized menstruating women population. The online survey was conducted between December 19, 2021 and March 27, 2022. In India vaccination drive began on January 16, 2021, therefore by the time of responding to the survey majority of the women were inoculated with both the doses of either of the two prominent vaccines (Covaxin and Covishield). Questionnaire was sent to more than 250 potential respondents, but merely 183 responses were received; out of which 177 responses were found suitable for further analysis. Responses were excluded as either they were inconsistent or straight lined.

Ethical approval

In the very first section of the questionnaire, the objective of the study was clearly stated and it was also mentioned that the participation is completely voluntary. Informed consent was taken from each respondent before their participation in the study. Respondents were also assured that their data will be kept confidential and will be used only for research purpose. Norms for anonymity of the respondents has also been followed by the researcher. This study has been conducted and reported, adhering to the ethics of Helsinki declaration 1964 and Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines as far as human participation was concerned.¹⁴

Sample profile

In this study, menstruating women who have taken at least one jab of COVID vaccine, have participated. Women of age ranging from 16 years to 45 years have participated in this study and 83.6% of respondents belong to the age group of 21–35 years. Data collection was done using online survey which has widened the geographical coverage area of the study. In this study, women from 19 states/ union territories (such as- Bihar, Delhi, Gujarat, Haryana, Jharkhand, Odisha, West Bengal, Jammu & Kashmir, Telangana, Karnataka, Maharashtra, Uttar Pradesh) have responded, out of which from 11 states 3 or more responses have been obtained. The Table 1 is depicting demographic details of the respondents.

Table 1.

Depicting demographic details.

Demography	Categories	Frequency	Percent
Level of Education	Intermediate	8	4.5
	Graduate	56	31.6
	Post Graduate	78	44.1
	MPhil/ PhD/ Post Doc.	35	19.8
Occupation	Student	89	50.3
	Homemaker	13	7.3
	Government sector employee	21	11.8
	Private sector employee	44	24.8
	Self-employed	10	5.6
Geographical demography	Rural	12	6.8
	Semi- urban	27	15.3
	Urban	138	78
Status of Vaccination	Fully vaccinated	172	97.2
	Single Dose	05	2.8
Place of vaccination	Government Hospital	94	53.1
	COVID Vaccination center (temporary setup)	49	27.7
	Private Hospital	34	19.2
Name of Vaccine Taken	Covaxin	27	15.3
	Covishield	145	81.9
	Pfizer	5	2.8
Infected with Coronavirus	Yes, RT-PCR test confirm	32	18.1
	Might be, suspected with similar symptoms (not tested)	35	19.8
	No	110	62.1
History of menstrual problems	Yes	40	22.6
	No	137	77.4

Author's calculation based on the sample profile.

Data analysis techniques

The survey questionnaire contains dichotomous questions, multiple choice questions with multiple correct options, open ended questions and two reflective five-point rating scales. For various kinds of quantitative responses frequency distribution, independent t-test and one-way ANOVA has been used accordingly.

Results

This section has been broadly categorized into two parts based on type of analysis used. The first part includes results based on descriptive analysis, majorly frequency distribution; while the second part contains inferential statistics to test the formulated hypotheses.

Analysis based on frequency distribution and qualitative responses

Table 2 shows that almost 40 % of the respondents have received some piece of information related to effect of COVID vaccine on menstrual cycle.

Table 2.

Depicting frequency and percentage of respondents who have received encountered information related to COVID vaccine and Menstrual periods.

Question	Response categories	Frequency	Percent
Have you ever received information related to the effect of COVID vaccine on Menstrual periods?	Yes	70	39.5
	No	107	60.5

As depicted in Table 3 majority of the respondents have received information about COVID vaccine and menstrual periods from social media, mostly by WhatsApp. Merely 7 of the 70 respondents have got the information from relatively scientific sources (e.g. Doctor/ Nurses or research articles).

Table 3.

Showing the varied sources of information related to COVID vaccine and Menstrual periods.

Question	Response categories	Frequency	Percent
Source of information	Family/ relatives	2	2.8
	Colleagues/ Friends	9	12.8
	Social Media	35	50
	Doctor/ Nurse	4	5.7
	Research Article	3	4.2
	Multiple sources	17	24.3
	Total	70	100

Table 4 depicts that out of 54 respondents, who have described the nature of information received along with the gist of received information, 35 respondents have appraised the information to be negative as it signifies ill-effect of COVID vaccine on menstrual cycle/ health. Moreover, 17 respondents have labeled the received information to be positive as it does not imply any relation between COVID vaccine and menstrual cycle and 2 respondents got information that has both positive and negative components and such information has been categorized as mixed information. A few responses to the open-ended question- What information did you receive regarding COVID-19 Vaccine and menstruation? has been mentioned as follows:

• 
  ▪

  Negative information:

  • o

    “That you shouldn't take vaccinations when you're on your periods.”

  • o

    “That after vaccination u get blood clots, periods are irregular (mostly they get delay for 10 to 15 days)”

  • o

    “While menstruating, vaccination is not a good idea as it may affect the cycle.”

  • o

    “No information before vaccination. After the first shot, I read some threads on twitter that shared that people were having irregular periods after that. Funny thing is my maid also suspected herself to have had a pregnancy even though she had her tubes tied after her third kid due to delay in period.”

• 
  ▪

  Positive information:

  • o

    “That there is no harm getting vaccinated during menstruation.”

  • o

    “Vaccine has no relation with mensuration cycle”

  • o

    “That it's absolutely safe to take the vaccine during periods”

• 
  ▪

  Mixed information:

  • o

    “One set of studies claim that vaccination will have adverse impact on menstrual cycle while others deny on the same.”

Table 4.

Depicting the nature of received information.

Question	Response categories	Frequency	Percent
Nature of Information	Positive	17	31.5
	Negative	35	64.8
	Mixed	2	3.7
	Total	54	100

The Table 5 represents that almost 32% of the total respondents were suspicious about the impact COVID vaccine will have on their menstrual cycle. Further, nearly 68% of the respondents perceive the vaccine to be completely safe as far as their menstrual cycle is concerned.

Table 5.

Depicting the perception regarding effect of COVID vaccination on menstrual periods.

Question	Response categories	Frequency	Percent
Before getting vaccinated did you have any doubts in your mind regarding its impact on menstrual periods?	Little	42	23.7
	Somewhat	14	7.9
	Not at all	121	68.4
	Total	177	100

The Table 6 denotes that approximately half of the total respondents have not encountered any change in their menstrual cycle post vaccination, although the other half has experienced evident changes in their menstrual cycle. Delayed menstrual cycle has been the most commonly observed change. Thirty percent of the respondents have reported more than one change pertaining to length of menstrual cycle, flow or duration of menstruation, while 20% of the respondents have stated at least one change that they have undergone.

Table 6.

Illustrating the changes perceived in their menstrual cycle by the respondents after vaccination.

Statement	Response categories	Frequency	Percent
After COVID Vaccination my menstrual cycle/ periods were (more than one options can be selected)	Few days short	3	1.7
	Few days long	1	0.6
	Started few days early	13	7.3
	Delayed by few days	16	9
	Comparatively light flow	1	0.6
	Comparatively heavy flow	3	1.7
	More than one changes	53	29.9
	No change	87	49.2
	Total	177	100

Analysis based on mean differences (independent t-test, one-way ANOVA)

The Table 7a and 7b illustrates that there is significant difference among the mean scores obtained across different age groups. Higher mean score is indicative of perception of comparatively more menstrual changes. It is evident from the Table 7a that younger respondents belonging to the age group of 16 to 20 years have perceived significantly more changes in their menstrual cycle after getting a shot of COVID vaccine than respondents of any older age groups. The difference among mean scores obtained on the scale of perceived psychological changes have also been computed and compared across age groups but no significant difference have been found. Therefore, the H₀ 1 has been partially rejected as significant difference among mean scores based on age of respondents has been found for perceived physiological changes pertaining to menstrual homeostasis; however no significant difference was found in terms of perceived psychological changes.

Table 7a.

Table showing age-wise mean scores and standard deviation obtained by the respondents on the scale of perceived menstrual changes.

Age group	N	Mean	S.D.
16–20 years	15	2.74	0.67
21–25 years	55	2.05	0.55
26–30 years	57	2.17	0.74
31–35 years	36	2.41	0.81
36–40 years	9	1.84	0.48
41–45 years	5	2.23	0.69
Total	177	2.21	0.71

Table 7b.

Showing one-way ANOVA computation for age-wise difference in the mean scores obtained on the scale of perceived menstrual changes.

	Sum of squares	df	Mean Square	F	Sig.
Between groups	8.313	5	1.66	3.25	0.005**
Within Groups	80.75	171	0.47
Total	89.06	176

The Table 8a and 8b depicts that respondents residing in urban areas have perceived comparatively less psychological stress caused majorly due to changes in menstrual cycle after vaccination as compare to those residing in semi-urban and rural areas. On the other hand, no significant difference was found in terms of physical changes in menstrual cycle after vaccination on the basis of geographical demography of respondents. The findings suggest that the H₀ 2 has been partially rejected as statistical significance was found only for mean scores of psychological changes not for menstrual changes.

Table 8a.

Showing mean scores and standard deviation obtained on the scale of perceived psychological stress based on respondents' geographical demography.

Geographical demography	N	Mean	S.D.
Urban	138	2.13	0.66
Semi-urban	27	2.55	0.79
Rural	12	2.51	0.44

Levene's test- F (2,174) = 1.81, p = 0.16.

Table 8b.

Showing one-way ANOVA computation for difference in the mean scores obtained on the scale of perceived psychological stress based on respondents' geographical demography.

	Sum of squares	df	Mean Square	F	Sig.
Between Groups	5.16	2	2.58	5.66	0.004**
Within Groups	79.38	174	0.45
Total	84.55	176

The Table 9 denotes that respondents who have a history of menstrual illness have perceived significantly higher extent of changes in their menstrual cycle post-vaccination as compared to those respondents who did not have any history of disrupted menstrual cycle.

Table 9.

Showing the mean difference of perceived physical changes (particularly in menstrual cycle) after vaccination between categories of respondents based on their history of menstrual illnesses using independent-t test.

History of menstrual problems	N	Mean	S.D.	t	df	Sig.
Yes	40	2.49	0.83	2.71	175	0.004⁎⁎
No	137	2.14	0.65

⁎⁎

Significant at 0.01 level.

The researcher has also computed the differences between the mean scores of perceived psychological changes post vaccination between the groups based on history of menstrual illness but no significant difference was found. It is evident from the findings that H₀ 3 has been partially rejected as the respondents with medical history of menstrual illnesses have perceived significantly more changes in their menstrual homeostasis than those who have not experienced any disturbance in their menstrual cycle. Although, its impact on psychological health does not differ significantly for both the categories.

The researcher has further analyzed the obtained data to inspect whether the type of vaccine injected to the respondents has significant impact on their menstrual cycle or on their psychological well-being; the results showed no significant difference between the mean scores of the two groups. The computation is as given below:

Independent t (170) = 0.46, p = 0.32 (perceived changes in menstrual cycle).

Independent t (170) = 0.68, p = 0.24 (perceived psychological stress).

The statistical analysis clearly implies that H₀ 4 has been retained. Perceived changes in menstrual cycle and its impact on psychological equilibrium does not get affected by the type of vaccine taken. Both, Covishield and Covaxin has similar effect on menstrual cycle and subsequently on psychological health.

Discussion

This survey study aimed at exploring the type of information were roaming around regarding the impact of COVID vaccines on menstrual cycle and also to investigate the impact of COVID vaccines on menstrual and psychological health. The findings revealed that majority of the respondents received the information from social media and it was indicative of negative impact of COVID vaccines on menstrual cycle. It led to vaccine hesitancy in nearly 30% of the total respondents. A study on healthcare workers in Egypt regarding vaccine perception and attitude² also supports the researcher's findings as the respondents have shown high level of concern for safety after inoculation. In Table 6 it can be markedly seen that almost 50 % of the respondents have undergone changes in their menstrual cycle post- inoculation. Length of menstrual cycle has been impacted the most, further 30 % of the respondents have experienced multiple variations in terms of flow and duration of bleeding and length of menstrual cycle. Muhaidat and his colleagues¹⁶ have found in their study that women have reported menstrual abnormalities in terms of length of menstrual cycle and duration of menstruation. Nazir et al.¹⁰ have also mentioned in their review article that 52.05% of women have experienced menstrual abnormalities post vaccination. Similar results have also been found by Lebar et al.,¹⁷ Kurdoglu³ Baena-Garcia et al.,⁵ Rodriguez Quejada et al.⁶ [18]Farhan et al., 2021 in their research.

Table 7a in result section shows that respondents belonging to different age groups have perceived post-vaccination changes in their menstrual cycle differently. Moreover, Table 7b affirms that the difference in among age groups regarding perception of menstrual changes is significant and respondents belonging to age group of 16 to 20 years have perceived significantly more changes in their menstrual cycle after vaccination than respondents of any other age groups. Supporting the results, Nazir et al.¹⁰ in their systematic review article reported that age was one of the predictors of menstrual abnormalities post vaccination. Respondents of these age groups do not differ significantly in terms of their perception of psychological changes after vaccine shot.

The results of this study also signifies that women perceived menstrual changes irrespective of their geographical locations (urban, semi-urban and rural); although women residing in urban areas perceived less psychological stress in comparison to those residing in semi-urban and rural areas. It is perhaps due to the reason that women residing in urban areas have comparatively more awareness about menstruation and they also have better means (accessibility and availability of doctors and material resources) to manage the changes. Another finding of this research denotes that those respondents who reportedly have history of menstrual illnesses have experienced significantly more anomalies in their menstrual cycle after taking the jab as compared to those who have normal menstrual history. In consistence with this finding, a study by Wang et al.⁸ reported menstrual irregularities post inoculation is more common among women who have related problems before vaccination. Perceived psychological stress is not significantly different in both the groups. The researcher has also analyzed the effect of type of vaccine taken on menstrual cycle and psychological stress and no significant difference was found. Muhaidat et al.¹⁶ in their study have compared the effect of Pfizer-BioNTech, Sinopharm, and AstraZeneca and they found that incidence of menstrual abnormalities cannot be attributed to types of vaccines.

Conclusion

COVID- 19 pandemic has impacted every aspect of human life such as work, lifestyle, health, economy and the list continues. From past two years research realm has been flooded by the scientific work done in order to explore and comprehend the new normal. In the present study the researcher has attempted to delve into the arena less explored. The study revealed that almost 40 % of the respondents have received some information relating to the impact that vaccine has on menstrual cycle/ health. Moreover, 32% of the respondents were not very sure about the side effects or after effects of the vaccine. The inferential findings of this study suggest that COVID vaccine has affected the menstrual cycle but the degree of change perceived differs person to person. Almost 50 % of the respondents have perceived changes in their menstrual cycle post inoculation and majority of them have mentioned that their length of cycle has been affected. Majorly, the impact of vaccine has been noticed by those who have already been suffered from menstrual illnesses in the past. Geographical demography and the type of vaccine injected does not significantly impact the menstrual homeostasis. Interestingly, respondents residing in urban areas have found the menstrual changes post vaccination less troublesome as compared to those residing in semi-urban or rural areas.

This study ascertains the significance of monitoring menstrual health in clinical trials of vaccines; further, gender-based differences in these trials should also be taken into consideration so that these turbulences can be avoided. Vaccine alters bodily functions in various dimensions and degrees, and it is crucial to monitor its impact on major bio-chemicals such as- hormones and neurotransmitters for evading physical and psychological ill-effects. As mentioned in the beginning of this article, healthy menstrual cycle plays pivotal role in women's life therefore these alterations in medical procedures are essential for improving overall quality of life of women.

This research can be taken further by addressing the questions like- how long-lasting the menstrual irregularities were? What are the factors that aided in coping with the menstrual irregularities? What are the techniques (exercises/ Yoga) to attain and maintain menstrual and psychological homeostasis post-vaccination?

Funding acknowledgement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.