the importance of female reproductive changes in covid-19 and vaccine administration: a narrative review

The covid-19 pandemic has disrupted people’s lives all over the world, and vaccination is one of the best ways to eradicate this pandemic and save people’s lives. despite this, vaccines have many known and unknown side effects like fever, fatigue, headache, etc. fertility is an important aspect of human life, but there are too many concerns about its relationship with covid-19 and its vaccines. women are complaining of menstrual irregularities like postmenopausal bleeding, heavy menstrual bleeding, polymenorrhea and fertility concerns after receiving the second dose of the covid-19 vaccine. the immunologic reactions between vaccine ingredients and the immune system of the body seem to be responsible for this global issue. angiotensin-converting enzyme 2 (ace2) and basigin (bsg) are the receptors for sars-cov-2. ace2 is expressed in the human respiratory system, kidney, vagina, uterus and particularly widely in the ovaries, and bsg is expressed in the uterus, ovary stroma and granulosa cells. therefore, sars-cov-2 can invade the target cells by attachment to ace2 and bsg and modulate their expression, and through these probable mechanisms, it can disturb female reproduction and menstruation. according to this accumulated evidence, in this study we aimed at summarizing the recent studies with a focus on probable mechanisms by which sars-cov-2 and covid-19 vaccines affect menstruation irregularities and reproduction complications.