Abnormal uterine bleeding during the COVID-19 pandemic among reproductive-age women with and without HIV

Background: Women have reported abnormal uterine bleeding (AUB) during the COVID-19 pandemic. Evaluating AUB among women living with HIV (WWH) and women without HIV (WWoH) during the COVID-19 pandemic is key to understanding reproductive health in the setting of viral co-infections. Methods: From 2021 to 2023, the Study of Treatment and Reproductive Outcomes (STAR) collected cross-sectional data from WWH and WWoH 18–45 years-of-age across the southern United States without conditions known to interfere with menses. Women completed surveys on COVID-19 testing, COVID-19 vaccination, AUB (spotting, missed periods, early/late periods), stress, and demographics. We tested plasma from participants at two study sites for COVID-19 antibodies. We defined “prior SARS-CoV-2 infection” as having detectable anti-nucleocapsid antibodies or a self-reported positive COVID-19 test. We examined AUB in association with COVID-19 vaccination and infection stratified by HIV status. Results: Among 188 eligible women, 61% were living with HIV, 49% had AUB, and 58% were vaccinated for COVID-19. When assessed via combined self-report and antibody tests (n = 86), 69% of women had prior SARS-CoV-2 infection. There were no differences in AUB, COVID-19 vaccination, or SARS-CoV-2 infection by HIV status. Among the entire sample of WWoH (n = 73), AUB was associated with lower age (32 vs. 35, p = 0.04) and higher perceived stress (17 vs. 13, p = 0.04), and AUB was more common in WWoH who self-reported a positive COVID-19 test versus WWoH without (70% vs. 43%, p = 0.03). AUB was not associated with COVID-19 vaccination, body mass index, race, or ethnicity. In WWoH with antibody testing (n = 42), AUB remained more common among WWoH with prior SARS-CoV-2 infection versus WWoH without (61% vs. 27%, p = 0.05). Among WWH, no variables were associated with AUB. Conclusions: In this hypothesis-generating, descriptive study, AUB was associated with SARS-CoV-2 infection, stress, and age among WWoH, but not among WWH. There was no association between AUB and COVID-19 vaccination.