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Since the beginning of the COVID-19 pandemic, discussions on social media and blogs have indicated that women have experienced menstrual changes, including altered menstrual duration, frequency, regularity, and volume (heavier bleeding and clotting), increased dysmenorrhea, and worsened premenstrual syndrome. There have been a small number of scientific studies of variable quality reporting on menstrual cycle features during the pandemic, but it is still unclear whether apparent changes are due to COVID-19 infection/illness itself, or other pandemic-related factors like increased psychological stress and changes in health behaviours. It is also unclear to what degree current findings are explained by reporting bias, recall bias, selection bias and confounding factors. Further research is urgently needed. We provide a list of outstanding research questions and potential approaches to address them. Findings can inform policies to mitigate against gender inequalities in health and society, allowing us to build back better post-COVID.

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Background Maternal depression and anxiety may increase the risk of offspring incontinence; however, current evidence is unable to draw causal inferences. This study aimed to examine prospective associations between maternal psychopathology and offspring incontinence/constipation and examine evidence for causal intra-uterine effects. Methods The study used data from 6,489 children from the Avon Longitudinal Study of Parents and Children. Mothers provided data on depression and anxiety (antenatal and postnatal) and their childs incontinence (daytime wetting, bedwetting, soiling) and constipation at age 7. We used multivariable logistic regression to examine evidence for independent effects of maternal depression/anxiety on offspring incontinence/constipation and explore a critical/sensitive period of exposure. A negative control design was utilised to examine evidence causal intra-uterine effects. Results Postnatal maternal psychopathology was associated with an increased risk of offspring incontinence and constipation (e.g. postnatal anxiety and daytime wetting OR: 1.53; 95% CI: 1.21-1.94), and data were consistent with a critical period model. There was evidence for an independent effect of maternal anxiety. Antenatal maternal psychopathology was associated with constipation (e.g. antenatal anxiety OR: 1.57; 95% CI: 1.25-1.98), but there was no evidence for a causal intra-uterine effect. Limitations Attrition and maternal reports without use of established diagnostic criteria for incontinence/constipation are potential limitations. Conclusions Children exposed to maternal postnatal psychopathology had a greater risk of incontinence/constipation, and maternal anxiety had stronger associations than depression.