{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:16:04Z","timestamp":1783595764147,"version":"3.55.0"},"reference-count":87,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>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-M\u00fcllerian 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\u2013pituitary\u2013ovarian 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.<\/jats:p>","DOI":"10.3390\/ijms27146127","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"6127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Long COVID on the Female Reproductive System: A Narrative Review"],"prefix":"10.3390","volume":"27","author":[{"given":"Ernest","family":"Starek","sequence":"first","affiliation":[{"name":"Doctoral School, Medical University of Lublin, 20-059 Lublin, Poland"},{"name":"1st Chair and Department of Gynecologic Oncology and Gynecology, Medical University of Lublin, 20-081 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudia","family":"\u017bak","sequence":"additional","affiliation":[{"name":"Doctoral School, Medical University of Lublin, 20-059 Lublin, Poland"},{"name":"Department of Medical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ostrowska-Le\u015bko","sequence":"additional","affiliation":[{"name":"Independent Laboratory of Translational Medicine, Chair of Genetics, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Bobi\u0144ski","sequence":"additional","affiliation":[{"name":"Independent Laboratory of Translational Medicine, Chair of Genetics, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","first-page":"101026","article-title":"Differences in Long COVID Severity by Duration of Illness, Symptom Evolution, and Vaccination: A Longitudinal Cohort Study from the INSPIRE Group","volume":"44","author":"Gottlieb","year":"2025","journal-title":"Lancet Reg. 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