Menstrual changes & (very) early miscarriages

How would we even know?

If you have read my first post on the sudden drop in births in Germany in 2022 you will have noticed how I tried to systematically approach the relationship-conception-pregnancy-birth timeline with a view to exploring possible causal dynamics for the drop in births we are currently witnessing (my focus remains on births in Germany).

As mentioned in Update: Significant drop in German births, I continue to struggle with the sudden onset of the significant fall in births starting in January 2022. It is quite simply unprecedented. Recall, December births figures are now official and they were in the normal pre-pandemic range - even recording a slight increase on the pre-pandemic average. Instintictively everyone thinks something must have taken effect suddenly - nine months previously - in April 2021 and that this effect or causal event must continue through May, June, July in order to explain the crash in births we see nine months later in Janauar-April 2022.

In my first post I tended to disclude a vaccine effect on conceptions in April 2021 because the numbers of women aged 18-42 who were vaccinated in April were reputedly so limited. Unfortunately the German data on the vaccination rollout is not very granular and so it is very difficult to accurately assess exact numbers. However, as a result of writing my last post I discovered the detailed French data for their vaccine rollout and so I was albe to use this as a rough guide when regarding the German data.

At first glance, the vaccination campaign certainly seems a prime suspect overlapping the problematic time 9 months prior to the fall in births, but as the experts in the “fact-check” featured in my last post counter (my paraphrasing):

Because predominantly only elderly people and vulnerable groups were vaccinated prior to elegibility restrictions being dropped on June 7th, this makes a connection between births and vaccinations very unlikely.

What the above argument fails to mention, is by this date almost half of the population had already received at least one dose and there had been many categorical exceptions during the prioritised vaccine rollout such as healthcare professionals, teachers, other “essential workers”, etc.

Then came fresh news of a new report (preprint here) linking temporary menstrual changes with the vaccines - full article at Science.org here.

I recommend reading the article but if you didn’t catch the news, it can be summed up thus: some researchers think it’s time to add another common side effect of the Covid-19 vaccines to the list: temporary menstrual changes. A word of caution - this preprint is of a survey without a control group, so make of that what you will. This is from the article at Science.org:

…the percentage affected is likely not representative of the general population—and indeed, a whopping 42% of about 16,000 people in the survey who had a regular menstrual cycle said they bled more heavily than usual after vaccination, a number far higher than others have reported.

Particularly noteworthy was that some groups of women who thought they would never menstruate again experienced breakthrough bleeding, i.e. vaccination induced bleeding:

Still, the researchers captured a broad swath of people and their stories, including populations often neglected in menstrual research and breakthrough bleeding, which occurs when it is not expected, such as transgender and postmenopausal people.

Interestingly, another researcher in Norway did a survey with a control group and she found a smaller but still significant effect:

The survey results, even with the authors’ caveats, could lead to concern that the chance of menstrual irregularities after vaccination is much higher than it actually is, worries Lill Trogstad, an obstetrician-gynecologist and epidemiologist at the Norwegian Institute of Public Health who wasn’t involved with the study.

…

Her own survey, done via smartphones and published as a preprint, found that just over 13% of young women in Norway said their periods were heavier after COVID-19 vaccination; that compared with 7% of the same group who said their period prior to vaccination was heavier than normal.

Umm that’s seems pretty significant. Although other studies have also been completed and have not reported significant differences, I think these 2 surveys combined with the abundance of online anecdotal evidence make this a path of enquiry worth pursuing some more. And for me it leads to early miscarriages.

A disruption to menstruation or fertilisation is not quite adequate to explain the drop in births at the start of 2022 because, again, it seems unlikely enough young women were vaccinated so early on in 2021. However, if the disruption in menstruation also led to a small increased likelihood in very early miscarriages this widens the timeframe of a possible “vaccine effect” and allows a mechanism for May vaccination doses to affect conceptions from April.

Definitions of miscarriage vary slightly but, generally speaking, it is the premature loss of an embryo or foetus most often in the first trimester of a pregnancy and less frequently in the 2nd trimester (more precisely, until viability around week 20). The overwhelming majority of miscarriages occur in the first trimester. Rates vary based on age, stress, and other health factors but there is agreement that risk is greatest early on and reduces to very low (~1%) by the end of the first trimester. Then consider the following, taken from MedPageToday (lightly edited):

Implantation usually occurs around 3 weeks after a woman’s last period and about a week after ovulation. By week 4, they may be able to get a positive result on a home pregnancy test.

As many as 50–75% of pregnancies end before getting a positive result on a pregnancy test. Most women will never even know that they were pregnant.

Previously I had assumed that much higher incidences of miscarriages would be needed to explain the “missing births” from 2022 and that somehow this would show up in official data during Q2-Q4 2021. But how exactly?

For example, a woman whose last menstrual period was the start of April might become pregnant in the middle of April. Her missing period would be at the end of April/start of May. What if she got vaccinated in the middle of May and it caused irregular menstrual bleeding. Would she even notice that it was an early miscarriage? If she did, would she mention/report it?

Starting in week 5 by week 8 at the latest most women will notice they may be pregnant when their period is late. Late periods are not uncommon but recognition of the possibility of pregnancy and a pregnancy test generally occur in weeks 5-6. If there was any increase in miscarriages at this stage there would likely also be no registered record of this.

Weeks 6-10 is when most women have a first appointment with a medical professional, with a second follow-up appointment around weeks 10-12. If a woman miscarried at any point after initial contact with their healthcare professional (Doctor, Gynaecologist, Nurse, etc.) it would be recorded in their medical records. In Germany - the focus of my discussion - the federal statistics agency records live births, still births, and abortions but do not record miscarriages.

I now suspect an increase in early miscarriages (weeks 1~6 of pregnancy) may not show up in any official data.

Let’s take a quick look at the vaccination rollout data to see if this fixes the timing of the correlation. As substacker CM27874 (who also posts on German data) has pointed out, the vaccine data in Germany is not good. The authorities only release the broad adult age-bands 60+ and 18-59 years-old. In addition, the graphic below from the Robert Koch Institute’s weekly reports only shows what percentage (slightly less than 40%) of 18-59 year-olds had received 2 doses by the end of the 2nd quarter 2021.

I used the graph from the interactive graphic from the German vaccine dashboard website to quickly find a breakdown of the monthy figures for doses administered (I have excluded 3rd doses):

What follows are back of the envelope calculations using the values from the above table combined with the % vaccine uptake from the previous graph:

By the end of June ~70% of the 60+ cohort had already received their second dose so I estimated ~70% of 60+ had received one dose by end of April. On this basis I estimated monthly 1st doses for the 60+ groups and the 18-59 cohort while trying to ensure my figures fitted to the above graph.

Using population data I found the proportion of the 18-59 cohort which is between 18-42 is about 55% . I estimated monthly values for the 18-42 subgroup assuming the following percentages (before restrictions were lifted in June): Feb 20%, Mar 30%, Apr 40%, May 50% - these may be too low/high? From June onward I just used 55%).

Yes, I know this is very messy and these are only rough figures, but they seem to match other data and what can I do when the German authorities use ridiculously wide age-bands. This is what I came up with:

As you can see, my estimated figures show, contrary to the hand-waving claims of the experts, there was already substantial vaccine uptake among the child bearing ages 18-42 prior to June when elegibiltiy restrictions were lifted (and a surprising 2.5 million doses in April).

New theory of explanation:

If vaccine doses administered in one month could have not just affected pregnancies conceived/planned in the same month but also have affected those conceived one month prior, can this explain the “missing births” nine months later in 2022?

The question remains: how many women of child-bearing age may have gotten vaccinated in Q2 2021 who were unwittingly in the very early stages of pregnancy, AND how may women may have had their subsequent menstrual cycle disrupted preventing/ending a very early stage pregnancy subsequent to their vaccination?

Problems with the hypothesis:

(i) The number of “missing births” in early 2022 has remained quite uniform, but my graph suggests doses climbed through April and May, peaked in June before declining thereafter, i.e. should we not have expected a similar trend in the drops in 2022 monthly birth figures?

(ii) Would women planning a pregnancy have risked vaccination?

Note, I suspect the number of knowingly pregnant women who got vaccinated in Q2 2021 was vanishingly small. STIKO (Federal Vaccine Commision) did not recommend vaccination around pregnancy until September 2021, and when they did, it was only during pregnancy in the 2nd or 3rd trimester, after birth for breast-feeding mothers, and pre-birth for all women of child-bearing age. It has NEVER been recommended in the 1st trimester.

(iii) What about France??? Highly vaccinated, detailed vaccination data, monthly births data - no drop in 2022 births! See my reference to this in my previous post German Births in the News

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Sidenote: How big is noticeable?

With regard to the German births data, 2022 seasonal births are now down ~10%. That is a very big deviation in comparison to the pre-pandemic 5 year average. However, for most people 10% means 9 instead of 10, or 90 instead of 100, or 900 instead of 1000, etc. For most people not recording events methodically this is not a very noticeable deviation. We might hear anecdotal reports (I have, from a midwife, and I initially discounted it as inadequate to explain the high number of “missing births"). Would busy doctors notice?

Similarly, I initially discounted the increase in stillbirths reported over at Jackanapes substack because it (an extra ~300 stillbirths in 2021) could not adequately explain over 20,000 fist quarter “missing births" in 2022. Stillbirths have thankfully become rare (only ~3,000 for all of Germany).

Remember, very early miscarriages are NOT rare! Very early misscariages are in fact very common (some claims are around 50%). In which case, a 10% increase in very early miscarriages could easily explain a 10% drop in births.

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Disclaimer: I am not a doctor nor any kind of medical professional. I consider my posts a type of citizen journalism and I welcome any feedback/criticism that might further my understanding of this topic.

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