The Impact of Long COVID on the Female Reproductive System: A Narrative Review.

Long COVID affects multiple organ systems and disproportionately affects women, raising concerns about reproductive health. This updated narrative review summarizes evidence from PubMed, Scopus, and Web of Science through March 2026 and extends previous reviews by distinguishing Long COVID-specific findings from acute and early post-infection observations and integrating newer evidence on ovarian reserve, follicular-fluid biology, assisted reproduction, and endometrial function. Reported menstrual changes include irregular cycles, heavy or prolonged bleeding, intermenstrual bleeding, and amenorrhea. Evidence regarding ovarian reserve remains inconsistent: some studies reported lower anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC), whereas others found no significant changes. Case reports describe premature ovarian insufficiency (POI) and possible autoimmune oophoritis but do not establish causality. Proposed mechanisms include immune dysregulation, inflammation, oxidative stress, endothelial dysfunction, and hypothalamic-pituitary-ovarian axis disturbance. Available evidence does not indicate adverse effects of COVID-19 vaccination on ovarian reserve or fertility outcomes. Most studies suggest transient changes. Direct Long COVID-specific evidence for persistent ovarian or endometrial injury remains limited. However, short follow-up precludes conclusions regarding ovarian aging, menopausal timing, lifetime fertility, or long-term endometrial receptivity. Symptom-guided assessment may include menstrual tracking, AMH, early-follicular-phase follicle-stimulating and luteinizing hormones, and pelvic ultrasonography when clinically indicated.