International journal of molecular sciencesJul 28, 2026

How Long COVID May Affect the Female Reproductive System

Long Covid Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Aug 3, 2026

Abstract

Long COVID is associated with reported menstrual changes, including irregular cycles and amenorrhea.

Ovarian reserve findings are inconsistent, with some studies showing lower anti-Müllerian hormone levels and antral follicle count, while others report no significant changes.
Case reports indicate potential conditions such as premature ovarian insufficiency and autoimmune oophoritis, though causality is not established.
Proposed mechanisms for reproductive health issues include immune dysregulation, inflammation, oxidative stress, endothelial dysfunction, and hormonal axis disturbances.
Available evidence does not suggest that COVID-19 vaccination adversely affects ovarian reserve or fertility outcomes.
Most studies indicate that menstrual and ovarian changes may be transient, but direct evidence for sustained ovarian or endometrial injury remains limited.

Simplified

Long COVID affects multiple organ systems and disproportionately affects women, raising concerns about reproductive health. This updated narrative review summarizes evidence from PubMed, Scopus, and Web of Science through March 2026 and extends previous reviews by distinguishing Long COVID-specific findings from acute and early post-infection observations and integrating newer evidence on ovarian reserve, follicular-fluid biology, assisted reproduction, and endometrial function. Reported menstrual changes include irregular cycles, heavy or prolonged bleeding, intermenstrual bleeding, and amenorrhea. Evidence regarding ovarian reserve remains inconsistent: some studies reported lower anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC), whereas others found no significant changes. Case reports describe premature ovarian insufficiency (POI) and possible autoimmune oophoritis but do not establish causality. Proposed mechanisms include immune dysregulation, inflammation, oxidative stress, endothelial dysfunction, and hypothalamic-pituitary-ovarian axis disturbance. Available evidence does not indicate adverse effects of COVID-19 vaccination on ovarian reserve or fertility outcomes. Most studies suggest transient changes. Direct Long COVID-specific evidence for persistent ovarian or endometrial injury remains limited. However, short follow-up precludes conclusions regarding ovarian aging, menopausal timing, lifetime fertility, or long-term endometrial receptivity. Symptom-guided assessment may include menstrual tracking, AMH, early-follicular-phase follicle-stimulating and luteinizing hormones, and pelvic ultrasonography when clinically indicated.

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How Long COVID May Affect the Female Reproductive System

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