Postmenopausal bleeding after COVID-19 vaccination.

Postmenopausal bleeding after COVID-19 vaccination.

Publication date: Sep 17, 2023

There is a growing literature base regarding menstrual changes following COVID-19 vaccination among premenopausal people. However, relatively little is known about uterine bleeding in postmenopausal people following COVID-19 vaccination. To examine trends in incident postmenopausal bleeding diagnoses over time before and after COVID-19 vaccine introduction and describe cases of new-onset postmenopausal bleeding after COVID-19 vaccination. For PMB incidence calculations, monthly population-level cohorts consisted of female Kaiser Permanente Northwest members ages 45 and older. Those diagnosed with incident postmenopausal bleeding in the electronic medical record were included in monthly numerators. Members with pre-existing postmenopausal bleeding or abnormal uterine bleeding, or who were at increased risk of bleeding due to other health conditions, were excluded from monthly calculations. We used segmented regression analysis to estimate changes in the incidence of postmenopausal bleeding diagnoses from 2018 through 2021 in Kaiser Permanente Northwest members meeting inclusion criteria, stratified by COVID-19 vaccination status in 2021. Additionally, we identified all members with ≥1 COVID-19 vaccination between December 14, 2020, through August 14, 2021, who had an incident postmenopausal bleeding diagnosis within 60 days of vaccination. COVID-19 vaccination, diagnostic procedures, and presumed bleeding etiology were assessed through chart review and described. A temporal scan statistic was run on all cases without clear bleeding etiology. In a population of 75,530 to 82,693 individuals per month there was no statistically significant difference in the rate of incident postmenopausal bleeding diagnoses before and after COVID-19 vaccine introduction (p=0. 59). One hundred four individuals had incident postmenopausal bleeding diagnosed within 60 days following COVID-19 vaccination; 76% of cases (79/104) were confirmed as post-vaccination postmenopausal bleeding after chart review. Median time from vaccination to bleeding onset was 21 days (range: 2-54 days). Among the 56 postmenopausal bleeding cases with a provider-attributed etiology, the common causes of bleeding were uterine or cervical lesions (50% [28/56]), hormone replacement therapy (13% [7/56]), and proliferative endometrium (13% [7/56]). Among the 23 cases without a clear etiology, there was no statistically significant clustering of postmenopausal bleeding onset following vaccination. Within this integrated health system, introduction of COVID-19 vaccines was not associated with an increase in incident postmenopausal bleeding diagnoses. Diagnosis of postmenopausal bleeding in the 60 days following receipt of a COVID-19 vaccination was rare.

Concepts Keywords
August COVID-19 vaccination
Bleeding incidence rates
Vaccination postmenopausal bleeding
segmented regression
temporal scan statistic
uterine bleeding
vaccine adverse events


Type Source Name
disease MESH bleeding
disease MESH COVID-19
disease VO vaccination
disease MESH uterine bleeding
disease VO time
disease VO COVID-19 vaccine
disease VO monthly
disease VO population
disease MESH etiology
drug DRUGBANK Methylergometrine
disease VO Hormone
disease VO vaccine

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