116. When Illness Delays Ovulation: Infections, Long COVID & Your Cycle

Illness can throw off your hormones—and it’s not “just stress.” In this episode, Dr. Monica Minjeur explains how acute infections and Long COVID can delay ovulation, shorten the luteal phase, trigger heavier or brown bleeding, and decrease your energy. You’ll learn what typically self-corrects within a couple of cycles, when 3+ irregular cycles signal deeper hormone or immune issues, and the exact steps of a restorative, cycle-informed workup (charting, timed progesterone/estradiol, thyroid, prolactin, iron/ferritin, and evaluation of inflammation). Practical strategies help you rebuild energy, protect ovulation, and restore regular cycles.

If your cycles haven’t bounced back after illness—or you’re seeing heavier bleeding, short luteal phases, or no clear ovulation—you’re not broken, and you’re not alone. At Radiant Clinic, we use cycle charting and timed labs to pinpoint what your body needs and create a personalized plan.

Schedule your free discovery call at radiantclinic.com to start restoring your cycle and your energy.

Transcript

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Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Menger, and I'm so glad you're listening today. What if that late period. Sudden heavy bleeding or a skipped ovulation wasn't just stress, but a real inflammatory response that your body is still working through after a illness like COVID or other respiratory infections. Since we're entering into that time of year when respiratory illnesses are more common, today we're going to be talking about how those infections, especially COVID or long COVID, I can impact menstrual cycles. Ovulation, bleeding patterns and your energy levels. We're going to take a look at what tends to self-correct and what is a sign that you deserve a deeper hormone and immune status evaluation. Research has shown that both acute COVID I and long COVID I are associated with menstrual cycle changes. Things like delayed cycles, missed cycles, heavier bleeding, and temporarily blocking ovulation have all been noted in the literature. These changes are largely driven by a mix of inflammation, signaling, and stress on the impact between your brain and your ovaries. So let's get started today with a story about a patient who will call Sophia. Now Sophia came to see me a couple of months after having a COVID infection. Prior to having COVID, her cycles were very reliable, roughly 30 days apart. She had a clear mucus pattern and clear ovulation signs. She and her husband had been talking about trying for a baby, so they had been charting their cycles. However, after she had COVID, her first period came about 10 days late and was noticeably much heavier. The cycle after that, she had almost no cervical mucus and she felt really exhausted around the time of ovulation, and then she didn't have a period at all. Now. At first she was excited because she thought maybe she was pregnant, but after she had multiple negative pregnancy tests, she started to panic thinking, did I go into early menopause? Did COVID break me? She had heard from many coworkers that had had COVID or had received the vaccines in the past that they had delayed their cycles or thrown things off, and she was worried that this was a more permanent situation. Prior to coming to our clinic, she had been seen at urgent care and they told her, this is normal. It's just stress. We see this happen often. But Sophia didn't feel stressed. She felt tired and in fact a bit dizzy when she stood up. But she also was noticing headaches and brain fog and didn't know if that played a role in what she was experiencing with her hormones. So she came to see me. I had her restart her charting again so we could see what her body was doing in real time. We had her map her symptoms like fatigue, temperature shift, any signs of cervical mucus changes, and not just the days that she was actually bleeding. Her first cycle after COVID revealed that she indeed had a very delayed ovulation and her luteal phase after that timeframe was short and very inconsistent. Her next cycle, the one where she never started a period again. Showed that she actually didn't have a clear ovulation at all. Eventually when she did bleed, it was very heavy and about 10 days, and she felt lightheaded by the time she got to about day three or four of the bleeding. So we started with running some targeted labs to her cycle. I evaluated her ferritin levels, which is a marker of iron stores as well as a complete blood count, and found she was tending towards some iron deficiency, likely from the heavier bleeding she'd been experiencing. We did look for a luteal phase, progesterone level. The next time she did ovulate and it showed that it was lower than what we would expect for previously trying to conceive. And we also checked out her thyroid levels, prolactin and adrenal hormones, and most of these were fairly normal, which helped us to rule out some other causes. Over the next two to three cycles, we helped to support Sophia's Iron Stores recovery towards sleep and her food intake because she had not been eating as much because she actually had lost her sense of taste during this time and over the next few cycles, we saw that her ovulation pattern returned and her periods normalized. Her initial fear that something was broken was replaced with education and empowerment, that her body was still healing from infection. We helped her not only learn to monitor the difference in real time from a short term status, but also long term, gave her the education she needed in order to be able to tell in the future what's just a one-time bump in the road, and when is there a more important pattern that is worth additional evaluation. So let's take a step back and talk a little bit about how an illness can actually disrupt your cycle. Now, there's lots of different things that we think about with this, and many of these infections that we can see, especially respiratory illnesses, have a lot of overlap. So one of the most common things we see is, is that during an acute illness, meaning when you are. In the throes of feeling really miserable, we have inflammation that happens and your brain is constantly deciding, is it safe to ovulate this month when your body is fighting off a significant infection, your body says, Nope, not a good month to get pregnant. And your body can actually temporarily shut down or delay ovulation in order to conserve energy that you need to help heal from that infection. Now if that ovulation is delayed or doesn't happen at all, it can actually show up as a really late period. You can miss a period altogether, or you might have a bleeding pattern after you have actually not even ovulated, which can sometimes be much heavier than usual. Now, there have been lots of studies that were done during the pandemic times with COVID that described many women experiencing delayed cycles, missed cycles, and even shortened luteal phases after both getting COI infection and vaccinations. In most cases, this was a short-term blip on the radar, but in some cases it did progress and cause longer term issues. So in those people that have long COVID or the longer symptoms, there's evidence that they report heavier bleeding, irregular cycles, and bleeding between periods. Now, this is felt to be caused from ongoing inflammation, specifically inflammation that's impacting the uterus and the ovaries, which can delay or impact that hormone signaling that happens between our brain and our ovaries on a regular basis. Other people with long COVID have been shown to have an increased risk of iron deficiency because they have that chronically heavier or prolonged bleeding, which then feeds into some other symptoms like fatigue, lightheadedness, dizziness, and iron deficiency. The other piece that we pay attention to is that the stress of illness is a real thing. It's not just something that's in your head. So even if you didn't have the fighting off of the illness that your body was going through, the stress load from that illness. Disrupted sleep, appetite changes, fever, pain, anxiety. All of these things can also throw off the messaging that happens between our brain and the ovaries, which can then lead to impairment on those hormones as well. Chronic stress that occurs can increase your cortisol levels, which then decreases your body's ability to have that luteinizing hormone surge and can delay or stop ovulation. Again, it goes back to this mentality that your brain is always trying to make sure that it's focusing on the most important thing, which is getting you feeling better. Managing stress, keeping you upright so that you can function on a regular basis. And in some cases it will say, Hey, this is not a good month to get pregnant. And so it pushes off ovulation altogether. Most importantly, many of these changes are not always permanent. Most women notice that after a couple of cycles, after either a COVID infection or other respiratory illnesses that their cycles tend to resolve, and many women don't even notice a change unless they're charting their ovulation patterns. However, if you're somebody who has persistent changes with your cycle, especially months after an infection. This can actually signal ongoing inflammation, a disruption in the hormones or inadequate ovulation. And this is where we would want to step in and say, Hey, this is beyond just normal recovery and how can we help support you? So in our practice, we are never just looking at when are you having a bleeding pattern happen? We want to see are you actually ovulating? And is your body able to support implantation? So even if you're not trying to get pregnant, that ovulation event is a really good marker that we look at to see that your hormone health is in a good place. Because if your body is able to ovulate on a regular basis, you are going to have a regular cycle. And it tells us that all of the hormones are working in concert to do what they're supposed to be doing. So step one is always going to be starting with that cycle tracking, not just guessing. So we ask you to chart your cervical mucus. We ask you to chart any symptoms that you're having, especially around the time of ovulation. And in some cases we may ask you to chart your luteinizing hormone surge from urinary monitoring or a temperature spikes. So what we're looking for is to see is ovulation happening? Is it delayed? And also what is that luteal phase? So again, the time from when you ovulate until your next cycle, and if it is less than 10 days, that is a suboptimal ovulation pattern, and we want to make sure that we're doing everything we can to support that luteal phase, which should be somewhere closer to 12 days. We also wanna pay attention to see if you're having any bleeding at times that are not appropriate. So whether that's spotting between your cycles, spotting that's happening, perhaps around the time of ovulation, or just an increased number of days of bleeding. All of these things help give us some additional information as to where we need to start targeting lab work. So again, rather than just checking a random cycle, day 21, progesterone, we want to check your progesterone levels approximately seven days after your confirmed ovulation. We also are checking estradiol levels to assess whether your luteal phase is strong enough to support implantation. And one of the most common findings we see on labs is that your estrogen levels can be normal, but your progesterone levels are decreased. And we see this because we can have impaired ovulation function and impaired follicular development earlier on in your cycle, depending on your symptoms, we may also check other things like we did in Sophia's case, like your iron stores. Your blood counts, thyroid and prolactin levels, because in some cases your irregular cycles or heavy bleeding may be due to something else. So we always are looking to see what else might be causing those changes in your cycle that you're noticing. And again, if you're having any problems with irregular spotting or brown bleeding at the beginning or the end of your menstrual cycle, we wanna think about other inflammatory markers, things like chronic endometritis. And so again, if you wanna hear more about chronic endometritis, I just talked about this a couple weeks ago in episode 113. So go back and check out that episode for more info. If you are noticing brown bleeding or spotting. So beyond just helping to support the hormone levels, we also want to be assessing for what are your energy stores. So again, if your body is interpreting that you're not getting enough fuel in your tank, whether that is caloric intake or whether that is dealing with all of the other GI symptoms you might be having, your body interprets that as a sign of saying, this is also not a good time to get pregnant. And ovulation is the first thing that sacrifices. So we talk about how to build in appropriate protein intake, iron intake, if you're on the low sides, and making sure that you're not overdoing it with exercise. Typically starting with just gentle walking or light resistance training. And then we also always are prioritizing, restoring. Sleep. Many people after they're dealing with illness have gone through irregular sleep patterns, and so trying to get your sleep back on track and allowing your body to have extra sleep when needed to recover from that fatigue can be especially crucial. If it seems like you're ovulating, but maybe having a weak gluteal phase, we can always support that phase with hormone medications. If needed, and again, this is not typically needing to be a lifelong medication, but is targeted to help with healing your hormone levels and giving you the support you need while your connection between your brain and your ovaries continues to recover from inflammation. And then finally, if you're actively trying to conceive after having a viral illness, this is really important to track your ovulation because a shortened luteal phase or chronic inflammation can make implantation less likely and can increase your risk for miscarriage. So in those cases, we correct what we can and help to educate you as to when is the best time to try and conceive again after your body has had some more time to heal. So if you've had just one late period after a COVID infection or after another viral illness, that is pretty common. In fact, in some studies it showed that there was a delay of ovulation and irregular cycles in up to 35% of women after a viral illness. Now many people experience just a delay in their cycle, a slightly longer cycle, or maybe one heavier period after infection, but it typically will correct within one to two cycles. Now, if you've had three or more cycles that have also been really irregular, no clear ovulation or heavier bleeding, and you're previously somebody who was pretty normal, it's time to get checked out and not just give it more time. Ongoing heavy bleeding has been associated with long COVID ID, and can also lend to low iron, which can worsen fatigue, dizziness, and brain fog, and actually make it more difficult for you to heal if your body is chronically running on empty. Again, we're always wanting to make sure that you're tracking more than just your bleeding days and evaluating when are your other symptoms getting worse. So if you are still dealing with fatigue, headaches, brain fog, we wanna track that along with your cycles. And again, as always, timing your labs for the correct time during your cycle. This is not just your body being dramatic or something that you just have to tough it out and deal with. This is time to get medical evaluation if you're still having struggles. So imagine if you didn't have to choose between just figuring out, is this just stress or something is permanently wrong with me. Instead, we can look at your post illness cycles with real data timing of your ovulation charting, luteal phase strength and bleeding patterns, and make determinations early on whether we have to escalate treatment more quickly, or whether we can just let things phase out in the next couple of cycles. Over time, we can continue to work together to see the inflammation decrease, see your energy levels improve, and get back to that regular and reliable ovulation again in order to improve your health and promote fertility.

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