METHODS
This cross-sectional study was based on retrospective and prospective inquiries. An online questionnaire prepared using Google Forms application was sent to 196 women between May 18 and 31, 2021. We included all volunteers who answered the questionnaire, were aged 18–45 years, had been diagnosed with COVID-19 (based on a confirmed positive polymerase chain reaction test result that was emailed to us), were fluent in Turkish, and were in the menstrual phase at the time of inclusion. Individuals who were in the premenopausal–postmenopausal period, unable to email their PCR results, or unable to answer the questionnaire adequately were excluded. The study protocol was approved by the Non-Interventional Ethics Committee of Biruni University (No: 2021/47-45) and registered at the ClinicalTrials.gov (NCT04806815). The study was conducted according to the principles of the Declaration of Helsinki, and all participants provided informed consent at the beginning of the study.
Data on sociodemographic characteristics, the history of COVID-19, and prolonged symptoms were recorded. Menstrual symptoms, menstrual pain severity, fatigue severity, and anxiety levels were assessed using the Menstrual Symptom Questionnaire (MSQ), Visual Analogue Scale (VAS), Fatigue Severity Scale (FSS), and Coronavirus Anxiety Scale (CAS), respectively.
Participants were asked to answer all questions included in the MSQ, taking into account their menstrual periods before and after their COVID-19 diagnosis. The MSQ consists of 22 items divided into three subgroups (Factor 1-negative effects/somatic complaints [1-13], Factor 2-pain symptoms [14-19], and Factor 3-coping methods [20-22]), with each item scored from 1 and 5, designed to assess menstrual pain and symptoms. The total MSQ score is calculated by adding the mean scores of the items included in the subgroups and ranges from 22 to 110. Higher scores indicate increased menstrual symptom severity.13,14
VAS was used to score patients’ menstrual pain severity, with scores ranging from 0 (no pain) to 10 (most severe pain).15
The FSS questionnaire consists of nine Likert-type questions, with each question scored from 1 to 7, and scores ≥4 indicating severe fatigue. The participants were asked to answer all questions, while considering what they experienced before and after their COVID-19 diagnosis. The total score ranges from 9 to 63, with higher scores indicating greater severity.16,17
The CAS is used to assess dysfunctional anxiety. Participants were asked to rate their frequency of anxiety episodes when exposed to thoughts or information about COVID-19 on a five-point scale, ranging from 0 (not at all) to 4 (almost every day). A total score of ≥9 indicated coronavirus-related anxiety.18,19