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What Women Need to Know About the Covid Vaccine

Can it affect mammograms or the timing of fertility treatments? What side effects should you look out for? Experts weigh in.

  Credit...James Estrin/The New York Times

News that a small number of women had developed a rare blood clotting disorder after receiving Johnson & Johnson’s Covid-19 vaccine prompted questions about whether vaccines affect women differently than men, and whether there are special considerations that women should take into account when getting vaccinated.

We spoke with a few experts to learn what women should know before getting their shots.

In April, federal health agencies recommended that practitioners pause administering the Johnson & Johnson vaccine after a half-dozen women developed a rare blood clotting disorder about two weeks after vaccination. There have been more cases since then, and nearly all of them have been in adult women younger than 50 years old.

The blood clotting disorder has been found to be so rare, however, that the Centers for Disease Control and Prevention recommended on April 23 that use of the Johnson & Johnson vaccine resume because the agency said the benefits outweighed the risks.

If you do receive the Johnson & Johnson vaccine, you should be on the lookout for possible symptoms of a serious condition called thrombosis with thrombocytopenia syndrome during the three weeks following vaccination:

  • Severe or persistent headaches or blurred vision

  • Shortness of breath

  • Chest pain

  • Leg swelling

  • Persistent abdominal pain

  • Easy bruising or tiny blood spots under the skin

Coronavirus vaccinations can cause enlarged lymph nodes in the armpit that will show up as white blobs on mammograms. This type of swelling is a normal reaction to the vaccine and will typically occur on the same side as the arm where the shot was given, said Dr. Geeta Swamy, a maternal-fetal medicine specialist and a member of the American College of Obstetricians and Gynecologists’s Covid vaccine group. It usually lasts for only a few weeks.

But the vaccine’s effect on mammograms can be concerning to radiologists, she added, because “if someone had breast cancer we might see enlarged lymph nodes as well.”

Because this type of swelling could be mistaken for a sign of cancer, the Society of Breast Imaging recommends trying to schedule your routine mammogram before your first Covid-19 vaccine dose or at least one month after your second vaccine dose.

“I am particularly eager to get the word out to all the patients undergoing surveillance after successful prior treatment of cancer,” Dr. Constance D. Lehman, who has written about the problem and is the chief of breast imaging at Massachusetts General Hospital, told The New York Times in March. “I can’t imagine the anxiety of getting the scan and hearing, ‘We found a node that is large. We don’t think it’s cancer but can’t tell.’ Or worse, ‘We think it might be cancer.’”

But say you are getting a diagnostic mammogram because of a suspicious lump or other symptoms of breast cancer disease or you are someone who had been treated for breast cancer and needs to get regular exams; in those cases, “do not delay,” Dr. Swamy said. You should keep your current mammogram appointment as well as your vaccination appointment, and tell your radiologist the date that you received the vaccine.

Another option is to get the vaccine in your thigh instead of your arm. Dr. Lehman recommends a thigh injection for patients who are being treated for breast cancer or who have a history of breast cancer.

“Injection in thigh would be extremely unlikely to lead to armpit nodes swelling,” she said in an email.

Based on all of the reassuring evidence to date, when it comes to fertility or pregnancy, “there are no known safety concerns with the vaccine,” said Dr. Sigal Klipstein, a reproductive endocrinologist in Chicago who is a member of the American Society for Reproductive Medicine Covid-19 Task Force.

Going unvaccinated, however, could be dangerous, she added.

“Women who contract Covid during pregnancy are at increased risk for more severe disease compared to women who get Covid when they’re not pregnant,” she added.

According to the C.D.C., pregnant women can receive any of the three available Covid-19 vaccines, but all women younger than 50 years old — regardless of whether they are pregnant — should be aware of the rare but increased risk for blood clots with the Johnson & Johnson vaccine.

Fertility patients who are scheduled for procedures like egg retrieval, embryo transfer or intrauterine insemination are advised to avoid getting a Covid vaccine within three days before and three days after the procedure, according to the American Society for Reproductive Medicine.

That’s because patients undergoing surgical procedures could develop vaccine-related side effects like fever or chills that might make it difficult for doctors to know if a post-surgical infection is brewing. In addition, many medical providers may not allow a patient who is experiencing Covid-like symptoms into their facility, even if it’s likely that the symptoms are from a vaccine and their Covid-19 test is negative.

If you manage to get a vaccine appointment and you are scheduled to undergo a fertility procedure, tell your fertility doctor right away so that you can plan any surgical procedures, testing or treatment.

If you are trying to get pregnant and one of your vaccine shots is scheduled during the two-week wait — the period of time between ovulation and your expected period when the embryo would implant in the uterus — don’t worry, even if you develop side effects from the vaccine.

“Fever should not interfere with implantation,” Dr. Klipstein said.

Try not to take any painkillers ahead of time in anticipation of vaccine-related symptoms like fever or headache, because it is believed to dampen your body’s immune response. After the vaccine, it is OK to take acetaminophen, which is considered safe during pregnancy. Women who are pregnant or potentially pregnant should avoid ibuprofen, Dr. Klipstein said.

Some women say they have observed changes in the flow or timing of their period after getting vaccinated.

But so far this is purely anecdotal.

“It’s unlikely that the Covid vaccine would affect menstrual cycles, and there’s no plausible biological mechanism by which this would occur. However, there is little data on this topic,” Dr. Klipstein said. “Menstrual cycles are often understudied.”

Even if the vaccine were to affect a woman’s period, Dr. Klipstein added, that effect should be seen only during the menstrual cycle in which the vaccine was given. “We would not expect long-term effects.”

And, in general, one disrupted cycle is not a cause for concern, she added. Getting any kind of severe illness, like Covid, can temporarily affect your menstrual cycle, so the best way to protect your reproductive health is to get vaccinated, she said.

Kathryn Clancy, an associate professor of anthropology at the University of Illinois, generated hundreds of responses on Twitter after saying that her period was heavier than usual after her first dose of the Moderna vaccine. She is now collaborating with Katharine Lee, a postdoctoral research scholar at Washington University in St. Louis, to survey women on short-term vaccine side effects related to the menstrual cycle.

Periods can be influenced by a multitude of factors, including stress, thyroid dysfunction, endometriosis or fibroids. If you have questions about your menstrual cycle, be sure to speak with your doctor.

A study by the C.D.C., published in February, examined the Pfizer-BioNTech and Moderna vaccines and found that 79 percent of the reports to the agency of side effects came from women, even though only 61 percent of the vaccines had been administered to women.

It could be that women are more likely to report side effects than men, said Dr. Sabra L. Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. Or, she added, women might be experiencing side effects to a greater degree. “We’re not sure which it is,” she said.

If women are in fact having more side effects than men, there might be a biological explanation: Women and girls can produce up to twice as many antibodies after receiving flu shots and vaccines for measles, mumps and rubella (M.M.R.) and hepatitis A and B, probably because of a mix of factors, including reproductive hormones and genetic differences. The size of the vaccine dose may also be important because women metabolize drugs differently than men do. More research is needed to know if women ought to receive a different dose than men.

A study found that over nearly three decades, women accounted for 80 percent of all adult allergic reactions to vaccines. Similarly, the C.D.C. reported that most of the anaphylactic reactions to Covid-19 vaccines, while rare, have occurred among women.

And in a letter published in the New England Journal of Medicine describing the experiences of people who had redness, itching and swelling that began four to 11 days after the first shot of the Moderna vaccine, 10 of the 12 patients were women. A more recent study examined skin reactions to the Moderna or Pfizer Covid-19 vaccines among 414 health care workers, of which 90 percent were women. But the study authors said it was difficult to know whether women are more prone to the problem because the health care work force is already mostly female.

If you have mild side effects like headache or a low fever after getting the Covid vaccine, it’s actually a good thing, Dr. Klein said, because it means your immune system is ramping up. A lack of side effects, however, does not mean the vaccine isn’t working.

You can share your symptoms or concerns via the C.D.C.’s V-safe app, which records symptoms and provides health check-ins after vaccinations. Medically significant reports sent using V-safe will be followed up by a call from a representative.

Christina Caron is a reporter for the Well section, covering mental health and the intersection of culture and health care. Previously, she was a parenting reporter, general assignment reporter and copy editor at The Times. More about Christina Caron

A version of this article appears in print on  , Section D, Page 3 of the New York edition with the headline: Vaccines May Affect Women Differently. Learn More.. Order Reprints | Today’s Paper | Subscribe

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