Gynaecologists, Obstetrics & women that have recovered from COVID-19 By Dr Sumaiya Shaikh

TW & thread: COVID-19, menstruation & depression Gynaecologists, Obstetrics & women that have recovered from COVID-19: (Or keen beaners of Covid-19) Women, How were your menstrual cycles post COVID-19 recovery? Want to know what may have happened?

So we know that SARS-COV2 affects a lot of organs in the body apart from the respiratory system. They infection is systemic after a point and the virus is found in many areas of the body including the brain, liver, gut, & the reproductive organs. But once the recovery is over.

What do we know about the after effects? A lot of people have reported generalised fatigue several weeks (6-7 or more) post recovery. Not just physical but mental fatigue. And that conversation about depression I had with @dhruv_rathee was never so timely. Everything hurts.

And there is no motivation to do the most important things to survive. Feeling worthless, loss of appetite, unable to work, focus, exercise & much more. For someone who had a previous mental health condition (or predisposition) this is way too relatable. So I started reading.

We know that soluble ACE-2 binds to the SARS-COV2 protein to attach to the cell membrane ACE-2 receptor on the epithelium of the respiratory tract. Once the virus is attached, it releases anti ACE-2 antibodies

 

Ofcourse we add the effect of ACE2 depletion & G protein coupled receptor & MAS pathway. Later we see, lung injury, cardiovascular injury, metabolic processes, respiratory distress, & possible mortality (in other words the detrimental effects renin-angiotensin system)

These effects of RN system were also seen in many years ago with mice models of ACE2 gene deficiency. But ACE2 depletion also leads to the depletion of brain serotonin - major neurotransmitter in depression (SSRI- antidepressants are selective serotonin reuptaje inhibitors)

How? ACE2 depletion known time deplete tryptophan in blood. Since tryptophan is a precursor to making serotonin, it reduces the its production in blood & brain. Low serotonin leading to low serotonin transporter activity leading to depression.

Link-1

Cases have been known where Covid19 has triggered depression for those previously recovered, & increased who were already depressed (although not for everyone & severity varied).

However for menstruating women, the arrival of PMS related symptoms, pain, & hormonal imbalances gave another jolt to the already depleting serotonin. Ask around menstruating women with post covid recovery period. It is known but not discussed as a typical women problem.

Not only did the onset of mentruation trigger a longer low, motivation less, energy less phase (severe depression), when I really started to notice was the length + amount of the menstruation. And the occurrence of blood clots that lasted for days.

Link 2

Not only the virus had triggered this confusing cognitive,memory and behavioural problems, but to see physical manifestations as clots made it very real. PS: Also, shows how physical health is seen and focused on, and mental health is not quickly acted upon.

The virus, like flu but in more people, causes these clotting of blood everywhere. In the periphery or internally. Also causes deaths. Anti thrombotics are known to be given as a part of supportive treatment to Covid-19 patients.

But it didn’t end there! In the garb of a menstral period, my body flushed chunks of blood, in clumps, some purple, some attached to a membrane. For days. It was confusing, painful, traumatic. Worried, I read endlessly to find many blogs, FB group with same experiences.

Exhibit A on why it is so underreported: mental health and women’s period related problems are hushed because we should suck it & move on. Unspoken, it lacked efficient female support & clinical support. At the start, I couldn’t even link it to Covid-19.

The first thing I found was this on a psych blog, as scientist, I needed more than a blog to validate my experiences. After weeks of speaking to specialists, friends who are clinicians, & other women who had COVID-19, I realised it was indeed that Link 3 So in the middle of a personal mental health crisis, a physical crisis happened after what I thought I had my share of crisis in 2020 during those two days of breathlessness. And worse, the lack of emotional support and validation by someone experienced.

Also worse was to realise, that someone with my kind of exposure didn’t pay attention to a mental health problem, until it became a physical problem. NB: blood clots may be seen under the skin, before the onset of periods.

I wanted to list an interview I had read about blood clotting not just in the lungs but blood vessels and other organs during the infection. It’s from the director’s blog of NIH. Link 4

So I created this thread to document the many unspoken Covid-19 problems that are manifesting in not everyone, but in enough number of people. So when someone like me looks for documentation & possible explanation, it’s here! I hope this reaches to those who need to hear.