MNHQ here: COVID vaccines and Women's Health Q&A - ask your question here

[JuliaMumsnet]

Hello

We're very pleased to say we've managed to secure some time with experts to answer all your questions about the COVID vaccines and women’s health - whether that’s pregnancy and breastfeeding, menstruation and fertility, the menopause or much more.

We’ve seen lots of confusion and dilemmas on site by pregnant women especially, under pressure to make big decisions but not empowered with all the information they need.

We also know that women are tired of being patronised so these experts will try and present as full a picture about the current research as possible, as well as their personal medical opinions and suggestions. Our aim is to get you evidence-based answers without judgement or pressure.

This is a non-live Q&A: we’ll be collecting your questions from now until 2pm on Friday 27th August, and the answers will be posted up on this thread on Friday 3rd September.

So if you have any questions at all about the vaccines, now's your chance to ask 'em. Whether you want to know which vaccine is best for the third trimester, if you can still breastfeed, how it will affect your flow or your menopause, or anything else to do with your health as a woman, no question is too stupid.

The experts answering your questions will be:

Dr Nikki Kanani, a GP in south-east London and Medical Director of Primary Care for NHS England and NHS Improvement. Nikki has held a range of positions within healthcare and with her sister she co-founded STEMMsisters, a social enterprise supporting young people to study science, technology, engineering, maths and medicine.

Dr Kate Wiles, Consultant Obstetric Physician and Nephrologist at the Royal London Hospital, Barts Health NHS Trust. She is also the medical lead for the East London and Essex maternal medicine network, managing all aspects of medical disease in pregnancy.

Dr Oge Ilozue, a GP and Senior Clinical Advisor for the London NHS COVID Vaccination Programme.

So please do add all your questions here by Friday 27th August 2pm and we look forward to posting up the answers next week.

As always, please remember our guidelines - please keep it civil, and if one topic is dominating a thread, we might request that people don't continue to post what's effectively the same question or point. Rest assured we will ALWAYS let the guest know that it's an area of concern to multiple users and will encourage them to engage with those questions.

And with that it’s over to you for your questions.

Thanks
MNHQ

EDIT: Friday 3rd September - Dr Kate Wiles and Dr Oge Ilozue have answered some of your questions this afternoon. If your question hasn't been answered, Dr Nikki Kanani is planning to answer any remaining questions on Monday. Thank you

To be honest it feels like all the questions I was interested in have been dismissed. I feel like I'm being told I'm a silly little woman for having concerns.

Women are worried about fertility and the correlation between the vaccine and menstrual changes. These worries have been dismissed without explanation or acknowledgement, this does not inspire confidence or settle worries.

I'm pregnant and am scared to get the vaccine, I don't know what the potential consequences for my baby are. I've not taken lots of medication because of the potential but unknown risk of harm during this time. Why is tge vaccine different? Quite frankly now I'm less inclined to get it after reading these 'answers' which don't give details, merely tell us we are wrong to be concerned.

Sorry to hear that @Magenta82 - we've got some more answers coming today so hopefully they will help to inform/reassure.

NHS England/NHS London have asked us to pass on their apologies for the lateness of some of the answers. As you can imagine the doctors concerned all have clinical commitments and have a lot of demands on their time, so it took them a little longer than anticipated to answer all your questions.

However with a bit of luck the rest of them should be posted today. (Please don't add any new questions though as we won't be able to get answers for them - at least not this time around!)

Thanks
MNHQ

@kelcys2175

I am 43 yrs old and was diagnosed with breast cancer in January. I am now on Tamoxifen for the next 5/10 years. In the Tamoxifen booklet, the Breast Cancer Nurse gives you, a large section is dedicated to blood clots however after speaking to my doctor she states the only medication they would be concerned about is Warfarin. After having cancer and now being on Tamoxifen the last thing I want to worry about is Astra Zenica blood clots. My question is can I voice my concerns at the covid drop in centre and would they give me the Pzifer vaccine if requested?

Hi @kelcys2175

You will be asked about your medical history, including any medications you’re currently taking by clinically trained staff at the vaccination centre, regardless of whether you have booked through the National Booking Service or if you just turn up at a drop-in clinic. Details of vaccination sites near you, and information about the vaccinations they are offering, are available here.

Remember, all vaccines are thoroughly reviewed by the independent regulator, MHRA.

@Calendula00

Hello!

I am in a similar position to posters above (although not pregnant!). I had my first AZ vaccine at the end of March. I had various neurological symptoms (including severe headaches and double vision). Following that I developed lots of black eye floaters that obscure my vision. This happened within 4-5 weeks of the vaccine. This may or may not be connected but I have since put off having my second dose, as clearly risking my vision is not something I'd like to do. So I am in the one-dose only club. Should I just book another AZ, try for a Pfizer for the second dose, or hope for the best. I believe I had the original Cover last spring. Thanks for your help.

Hi @Calendula00

In order to have maximum protection from Covid-19, everyone should have their second dose of the vaccine. Just with any other situation, if you are concerned about any symptoms, I would advise you to contact 119 or your GP practice team to discuss this at the earliest opportunity.

@Tealightsandd

Women seem to be at higher risk of Long Covid. Is there yet any information/studies/data on whether vaccines help protect against Long Covid? If so, is the protection equal regardless of which vaccine (AZ, Pfizer, Moderna, Johnson and Johnson)?

Hi @Tealightsandd

Early research is showing that Long Covid – where COVID-19 can cause symptoms that last weeks or months after the infection has gone – affects both younger and older people. The chances of having long-term symptoms does not seem to be linked to how ill you are when you first get COVID-19.

The fact remains that vaccinated people are far less likely to get COVID-19 with symptoms and pass it onto others and are even more unlikely to get serious COVID-19, to be admitted to hospital, or to die from it.

@CorrBlimeyGG

I developed headaches after my first AZ vaccine, initially very severe, now manageable but frequent. I would like to have my second vaccine, but only if it is an alternative. I know I'm not the only woman in this position. Who can authorise this?

Please don't suggest my GP, they refuse to deal with anything vaccine related. The local chemist offer the Pfizer, and whilst they were understanding they're not able to give it to me.

Hi @CorrBlimeyGG

In order to have maximum protection from Covid-19, everyone should have their second dose of the vaccine. You mention that your GP refuses to deal with anything vaccine related, but your GP team will want to speak to you about any concerning symptoms - just with any other situation. I would advise you to contact your practice to discuss this.

Details of bookable and walk-in vaccination sites near you, and information about the vaccinations they are offering, are available here.

@AllSinging

Hello! I’m currently 17 weeks pregnant and I have received 1x dose of AZ back in January. I declined the 2nd dose in April on advice from the vaccination centre clinical lead as at the time we were TTC and the info was changing re. Blood clots and under 30’s (I’m now 29). I have a few queries that I don’t seem to be getting any help with regarding my current vaccine status and having another dose:

• how protected am I (and my baby) currently after 1x dose of AZ (am I classed as unvaccinated in regards to all the data coming through on pregnant women & covid)
• if I was to have my 2nd dose, would I need to “restart” my course due to the time lapse. Would this be AZ (If 2nd dose or if restarting course) that I’d be offered even though pregnant & what are the risks of having a different vaccine (Pfizer/Moderna) if already had AZ
• risk of AZ in pregnancy (blood clots but also any data on AZ in pregnancy)
• what’s the difference between covid vaccine and whooping cough that is also offered in pregnancy

Thank you so much

Hi @AllSinging

If you are under 40 and had the AstraZeneca vaccine for your first dose, it’s safe to have AstraZeneca for your second dose when pregnant, unless you had very serious side effects after your 1st dose.

The AstraZeneca vaccine efficacy is around 73% after one dose, but it’s important that you have the second dose to provide longer lasting protection. It is recommended that there should be a gap of 8 weeks between the first and second dose, but you will not need to have another first dose if this time period has passed. Our recommendation is to proceed with your 2nd dose of AZ vaccine for maximum protection at this time.

The whooping cough vaccine and the COVID vaccine aren’t live vaccines, so they can’t infect the developing baby or cause harm. While the whooping cough vaccine will protect your baby from developing whooping cough in the first few weeks of their life, the COVID vaccine is the best way to protect yourself against coronavirus as we know pregnant women are at increased risk of severe Covid-19, especially in the 3rd trimester.

@DoctorBambino

I had my first dose of pfizer at 14 weeks pregnant, I'll have my second at 22 weeks. When my husband had his second dose he had an awful fever and high temperature which didn't reduce much with paracetamol. I'm worried about the impact this would have on my baby, I know fever is bad in the first trimester what is the impact in the second?

Also I have heard that there is a link between covid vaccines and iugr is this something you have seen?

Thank you

Hi @DoctorBambino

Most side effects of the COVID-19 vaccine are mild and should not last longer than a few days, such as:

• a sore arm where the needle went in
• feeling tired
• a headache
• feeling achy
• feeling or being sick

You can take painkillers, such as paracetamol, if you need to. How the vaccine affects one person doesn’t mean it will affect someone else in the same way.

COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccine causes harm to the pregnancy or to fertility. You can read more about this here.

Covid-19 infection itself in the mother has been linked with an increased risk of stillbirth and increased incidence of small for gestational age (SGA) babies. The preterm birth rate in women with Covid-19 is also higher.

@DrOgeIlozue thank you so much, I really appreciate the information

@VickyS202

Thanks so much to the experts for doing this! I have a few questions: I have friends who are pregnant who were advised by their midwife not to get the vaccine (sometimes they received a very vaccine sceptic response from their healthcare professional) earlier this year. Are you considering calling pregnant people so you can make sure they're aware that the guidance now is very clear and give them a chance to talk through any questions they have with a midwife or GP or nurse? Otherwise what is being done to ensure all midwives give out the same information (some continue to either express personal opinion about the vaccine and pregnancy, telling pregnant people not to get it, or advise the pregnant person to check the internet)?

If someone had a dose of AstraZeneca then became pregnant what should they do now and what data do we have on AstraZeneca in pregnancy? There seems to be a huge amount of data on Pfizer and Moderna but not much on AZ. If pregnant people feel concerned about having AZ as a second dose, can they opt to have Pfizer instead?

If someone had a first dose then becomes pregnant, but hesitated about getting the second dose until they got out of the first trimester, can they still come forward for a second dose if more than 12 weeks have passed since the first dose? Do we have any data on whether this would mean they are not as well protected?

Will pregnant people be prioritised for boosters with other clinically at risk groups?

What would you say to someone who is concerned about long-term effects on their baby, say two or more years after they get the vaccine?

Thank you!

Hi @VickyS202

We are working with the Royal College of Midwives and maternity services to make sure that all health professionals who work with pregnant women are given up to date information and guidance to share with the pregnant women they care for.

If you got a first dose of AstraZeneca, it’s advised you complete with the same vaccine and attend your second dose appointment as planned, unless you experienced very serious side effects from the 1st dose.

2 doses offer maximum protection and as long as at least 8 weeks has passed since your 1st dose, you can proceed and book your 2nd dose. There is no data to suggest there will be less protection if the gap between doses is greater than the currently suggested 8 weeks. It’s recommended to book your second appointment as soon as possible. Details of vaccination sites near you, and information about the vaccinations they are offering, are available here.

Plans for booster vaccines are still under development. Interim guidance is that booster vaccine will start with those most at risk from serious disease. This includes care home residents, people aged over 70, frontline health and social care workers, clinically extremely vulnerable adults and those who are immunosuppressed. More information can be found here.

The Royal College of Obstetricians and Gynaecologists cites studies that have shown that protective antibodies from vaccination cross the placenta, helping with the baby’s immunity to COVID-19. The vaccine itself cannot cross the placenta. They also clarify that catching COVID-19 during pregnancy can cause severe illness in a pregnant woman, especially in the third trimester – that’s why RCOG recommend the COVID-19 vaccine in pregnancy.

We have vaccinated against infectious disease in pregnant women for many years – influenza and whooping cough currently. There is no known biological way that the vaccines can affect the baby in the long term and the observational studies so far have shown no increased risk of severe side effects in baby and mother after vaccination. We know that Covid-19 infection itself may have long term consequences in people who had the infection and we are learning more about every day.

@AlphaJura

As a PP mentioned, any data about effects of covid the disease's effect on periods, blood clots, fertility to compare to? Also general prevalence of these things in the population en masse pre covid. I have read some information on blood clots and effects on sperm because of covid . Also, does it have anything to do with the blood clots associated with the contraceptive pill. Does covid have effects on unborn babies? They've said flu can before. How Many women have got pregnant after receiving the vaccines? Is it more or less or the same. If there are effects are they detrimental, permanent or temporarily. Any research into psychological effects on periods (stress can affect them we've been told) Any information on period changes b/c covid or vaccine in women with mirena coil?

Hi @AlphaJura

In your first or second trimester of pregnancy, there's no evidence you're more likely to get seriously ill from coronavirus. However, in your third trimester (after 28 weeks), pregnant women are more likely to be seriously unwell and have a higher risk of their baby being born prematurely if they develop COVID-19. It may be possible for you to pass coronavirus to your baby before they are born, however, there's no evidence coronavirus causes miscarriage or affects how your baby develops in pregnancy. Your baby cannot get coronavirus from you having the vaccine.

There is no evidence to suggest that COVID-19 vaccines will affect fertility. There is no biologically plausible mechanism by which current vaccines would cause any impact on women's fertility.

The decision to offer the vaccine to pregnant women was based on real-world data from the United States which shows that around 130,000 pregnant women have been vaccinated, mainly with mRNA vaccines including Pfizer-BioNTech and Moderna, without any safety concerns being raised.

You can read more about an American study here, which is tracking women who self-report they were pregnant at the time they received their covid vaccination and are enrolling eligible women in observational studies. The American v-safe safety monitoring system showed that 4,800 people had a positive pregnancy test after receiving the 1st dose of an MRNA vaccine. Some of these women were involved in the initial Covid-19 vaccine trials and subsequently discovered their pregnancies.

In the UK, Public Health England are also tracking data for pregnant women who received a dose of the AstraZeneca vaccine before knowing they were pregnant.

@AlphaJura

As a PP mentioned, any data about effects of covid the disease's effect on periods, blood clots, fertility to compare to? Also general prevalence of these things in the population en masse pre covid. I have read some information on blood clots and effects on sperm because of covid . Also, does it have anything to do with the blood clots associated with the contraceptive pill. Does covid have effects on unborn babies? They've said flu can before. How Many women have got pregnant after receiving the vaccines? Is it more or less or the same. If there are effects are they detrimental, permanent or temporarily. Any research into psychological effects on periods (stress can affect them we've been told) Any information on period changes b/c covid or vaccine in women with mirena coil?

In regards to your final question, previous research has shown that viral infections can impact the menstrual cycle. Studies looking into menstrual cycle change during the pandemic have also noted increased frequency of menstrual disturbance compared to pre-pandemic. The study linked to included women who were using hormonal contraception.

@MyCatDribbles

I have two questions:

1. how can you be sure that there are no long term side effects on a baby after the birth

2. when there’s no explanation given as to why periods are affected after the vaccine, how can we be sure there are no hidden unwanted side effects of the vaccine that aren’t evident yet

Hi @MyCatDribbles

As these are new vaccines, there are no studies yet on the long-term effects on babies born to women who had a COVID-19 vaccine in pregnancy, but as COVID-19 vaccines are not ‘live’ vaccines they cannot cause infection, and other non-live vaccines have been given to women in pregnancy for many years without any safety concerns.

I had bad stomach cramps and pain in opposite arm to vaccine and also pain in left leg after first Astrazeneca. Should I have a second jab or can I have Pfizer. I am 22 weeks pregnant

@CorrBlimeyGG

I developed headaches after my first AZ vaccine, initially very severe, now manageable but frequent. I would like to have my second vaccine, but only if it is an alternative. I know I'm not the only woman in this position. Who can authorise this?

Please don't suggest my GP, they refuse to deal with anything vaccine related. The local chemist offer the Pfizer, and whilst they were understanding they're not able to give it to me.

Hi @CorrBlimeyGG,

Just to add to this – The safety of mixing different vaccines is being investigated in an ongoing trial (the ComCov trial). Initial data, published on 12 May 2021, showed that mixing vaccines appeared to be safe overall. However, there was an increase in short-lasting side effects such as fever for individuals who were given two different vaccines compared to individuals who had two doses of the same vaccine.

Therefore, the current advice from the JCVI is to proceed with the same vaccine for your 2nd dose, unless you had severe side effects from the 1st. It won’t be possible for any clinician to currently authorise a deviation from this official advice as this will be against the current guidelines.

Headaches have many causes and these may not be related to the vaccine. If they are persisting, it's important to speak to your GP about the symptoms. If you continue to experience difficulties accessing care from your current GP practice, you can check NHS choices for other practices in your area.

@Shanda5

Thank you for doing this Q&A.

I am 38 and TTC. I has my first dose of AZ in March under the zero waste scheme. My next period was 10 days early and really heavy and painful. My next 3 cycles were also 10 days shorter than usual.

They have now returned to normal. I have put off the second dose for this reason.

I was contacted by the NHS as someone who had not taken up the second dose. The lady I spoke to said she understood my reason not to have it and said I had done the right thing.

I did called the GP when my first period was early and was advised that the vaccine was the likely cause.

I spoke to a different GP this week and asked whether I could have the Pfizer vaccine. This GP kept asking me if I would accept that there could be a cause other than the vaccine for the change to my cycle.

Of course this is possible.but I would find it extremely coincidental. I have been tracking my periods for years and have a very regular cycle, it never differs.by more than a day either way. I was asked if I had moved, if anyone in my family had been ill or if I was under any other stress at all as these factors could have caused the change. Non of these things were the case.

In the end the GP said he would speak to 'the administration ' to see if I could be offered the Pfizer vaccine but he could not promise.

If I was younger or not TTC I would not be worried however I am concerned I have ruined my chance of conceiving.

I was like to be fully vaccinated and would feel more comfortable having Pfizer.

Do you have any advice for me please?

Hi @Shanda5

There is no evidence at all that the Covid-19 vaccination affects fertility and that you have ruined your chance of conceiving. There have been reports of disrupted or more irregular bleeding after vaccination that return to normal as you have described.

The current guidance is to proceed with the same vaccine you had for your 1st dose. Any reported side effects from the 1st dose of vaccination are usually minimised after the 2nd dose.

The TTC journey can be an anxious and difficult one for many, so we hope you are getting the support you need from healthcare professionals as required.

@Florence08

I know 3 people who have come down with shingles following their vaccination. I have been very ill with shingles in the past and am concerned about getting it again - I continue to suffer from post herpetic neuralgia. I see from the yellow card reports that there have been a significant number of cases of shingles reported. This is making me hesitant in getting the vaccine as I am aware that I am at increased risk of getting shingles again. What would you advise?

Hi @Florence08

All vaccinations stimulate an immune response and this may cause some side effects. With everything you have to balance the risk of covid-19 infection and complications from that with the potential risk of side effects from the vaccine.

From the evidence we have gathered so far from the millions of people vaccinated in the UK and globally, the benefits of vaccination far outweigh any potential risks and we would recommend you proceeding to get vaccinated.

Hi @Bellagonna

In response to your question about PCOS, there are no specific studies on the Covid-19 vaccination and PCOS as far as we are aware, however we know that people have been concerned and are reporting disrupted menstrual cycles after vaccination that do return to normal.

The overall benefits of vaccination to protect against Covid-19 infection outweigh the potential risks of severe side effects and there is no known reason why someone diagnosed with PCOS cannot proceed with vaccination.

Thanks so much to Drs Ilozue, Wiles and Kanani for their answers and to all of you who asked questions - we're going to close this thread now but there's obviously an ongoing demand for info on this topic so we'll keep our eyes peeled for anything more we can do.

Thanks
MNHQ

@Magenta82

To be honest it feels like all the questions I was interested in have been dismissed. I feel like I'm being told I'm a silly little woman for having concerns.

Women are worried about fertility and the correlation between the vaccine and menstrual changes. These worries have been dismissed without explanation or acknowledgement, this does not inspire confidence or settle worries.

I'm pregnant and am scared to get the vaccine, I don't know what the potential consequences for my baby are. I've not taken lots of medication because of the potential but unknown risk of harm during this time. Why is tge vaccine different? Quite frankly now I'm less inclined to get it after reading these 'answers' which don't give details, merely tell us we are wrong to be concerned.

Hi @Magenta82

We completely understand your concerns and want to provide the most up to date and credible information available, so that you can make an informed decision about getting the vaccine.

Covid vaccination is about protecting you from severe illness from coronavirus infection. With any medication or vaccine there is always a risk / benefit balance and discussion to be had. Nothing is without any risk, even for example when taking paracetamol, and as you mentioned you have reduced taking medication to reduce the chance of any potential harm to your baby.

Right now, the medical advice is to be vaccinated in pregnancy to protect you from Covid-19 infection (and we also offer the whooping cough vaccine to protect babies and the influenza vaccination in pregnancy). The reason for this advice is that the risk of potential severe illness from Covid-19 is more than the potential risk of severe side effects from the vaccine. Not everyone who gets Covid-19 in pregnancy will be severely unwell, but there is an increased risk of this in the 3rd trimester especially.

The trials have been done and we have now vaccinated enough people, including pregnant women before, during and after pregnancy, to show the vaccine is safe and effective and any potential risks of vaccination are far far outweighed by the benefits of the protection it offers. Public Health England has reported that more than 62,000 pregnant women in England have received at least one dose of COVID vaccine, with no serious side effects.

It is a scary time and we are acknowledging the concerns women, and men too, are expressing about fertility, menstrual cycle changes and the concern about possible long-term harm to the baby. This is why forums and conversations like this are so needed.

We continue to learn more and more with each passing month about this virus and we can only present you with the facts as we know it currently – Covid-19 infection itself can be a very scary illness that has potentially significant long-term consequences for some people who get the infection. Currently there are unvaccinated pregnant women in hospital very unwell with covid-19 infection. There is an increased rate of preterm birth, stillbirth and other complications that can cause harm to baby as a consequence of Covid-19 infection in the mother. Vaccination data collected since 1 February 2021 found that more than 99% of pregnant women admitted to hospital with symptomatic Covid-19 were unvaccinated.

The increased scrutiny and awareness of the vaccine has meant that more women have been coming forward and reporting observed menstrual changes. We are acknowledging that a range of menstrual disorders have been reported after vaccination, including heavier than usual periods, delayed periods, unexpected vaginal bleeding.

However, the number of reports of menstrual disorders is low in relation to both the number of females who have received COVID-19 vaccines to date and compared to expected levels of common menstrual disorders. We also have evidence from past vaccine surveillance reports of previous vaccines (e.g. HPV) that they can temporarily affect the menstrual cycle. Even with these reports, the vast majority go back to normal after a few cycles and there is no evidence that this disruption (that does not affect everyone) affects fertility. In fact, The British Fertility Society has reported that there is nothing in the vaccine that can affect the fertility of women or men.

The COVID vaccines aren’t live vaccines, so they can’t infect the developing baby or cause harm. Other non-live vaccines have been given to women in pregnancy for many years without any safety concerns.

– Dr Oge Ilozue