Long Covid and Menopausal Women: The Protective Role of Estrogen
As I sit at home coughing up a lung for the tenth day in a row feeling this enormous weight on my chest, I have to wonder if COVID-19 has a more profound health impact on menopausal women than any other demographic due to estrogen egress. I will admit, this strain of the virus has hit me harder than during the lockdown era. Coupled with fact that I am nearing 12 months without a menses (official menopause), indicates to me there is a distinct correlation between the Covid and estrogen levels. What exactly that is, I don’t know, so I researched it to learn more. The findings are compelling.
No question, the pandemic has significantly affected global health, with varying impacts across different demographics. But, according to recent research, among the groups at heightened risk, older women, particularly those who are postmenopausal, have raised significant interest.
Key findings from several studies highlight the crucial role of estrogen in mitigating Covid symptoms and outcomes in this demographic. Additionally, emerging evidence suggests that hormone replacement therapy (HRT) may play a role in managing long Covid symptoms.
Menopause and Increased COVID-19 Severity
Multiple studies indicate that postmenopausal women experience more severe COVID-19 symptoms compared to their premenopausal counterparts and age-matched men. For instance, a study by Frigo (2020) found that postmenopausal women had longer hospitalization times and more severe disease courses. This increased severity is attributed to the decline in estrogen levels, which plays a significant role in the immune response. And just why is that?
Estrogen's Protective Effects
Estrogen is known to have immunomodulatory properties, which means it can enhance the body's immune response to infections. Premenopausal women and those undergoing hormone replacement therapy (HRT) showed lower rates of severe COVID-19 symptoms (Costeira et al. 2020). The hormone helps in mounting a stronger immune response, which is crucial in fighting viral infections like Covid.
I’ve been on HRT for a little over 5 months and by the third month, I started to experience improved sleep and cognitive function. The brain fog has dissipated and forgetfulness is less frequent. But when Covid hit, these symptoms came back along with others that are very similar to menopause. Memory loss, extreme fatique, headaches, and a general sensation of being spaced out. However, this was far different in intensity, so I began to wonder if HRT was more of a hinderance than a help.
If the research postulates hormone therapy is beneficial, it could be that what I am experiencing, albeit worse than the first infliction of the virus, has been lessened overall because I’m taking a low dose progesterone and estrodial. It’s scary then to think just how challenging it could be for women not on HRT or, worse, have been misdiagnosed because her menopause symptoms are being overshadowed by or attributed to the virus.
The Complex Interplay Between Long Covid and Menopause
Long Covid, a condition where symptoms persist for weeks or months following an acute COVID-19 infection, presents a significant health challenge. Many symptoms of Long Covid, such as brain fog, fatigue, reduced stamina, headaches, dizziness, poor sleep, irritability, reduced concentration, and muscle pains, closely mirror common perimenopause and menopause symptoms.
In a study conducted in 2021 by Dr Louise Newson and a team of researchers, results found that the average age of individuals with Long Covid was 46.5 years, with 83% of them being female. The study also noted that 36% of women reported disturbances to their menstrual cycles. This overlap of symptoms between Long Covid and menopause raises important questions about the role of hormones and the potential for misdiagnosis. The findings also highlight the necessity for healthcare professionals to consider hormonal changes when treating women with Long Covid. Proper diagnosis and management, including hormone replacement therapy (HRT), could significantly improve patient outcomes.
Hormonal Influence on Inflammation
So, what exactly is happening when we are fighting a virus while also losing our sex hormones? Apart from its reproductive role, estrogen helps modulate the inflammatory response that Covid has on the body. It does this by reducing the levels of pro-inflammatory cytokines - chemicals that are produced by these immune cells (Newson et al. 2021). The pro-inflammatory cytokines, as explained in my recent podcast episode, are important to fight off infections and disease. Their role is to send messages to coordinate the body's immune response for fending off attackers.
In another study conducted by Ding et al. (2020) findings revealed that higher estrogen levels were associated with lower levels of these cytokines, thereby reducing inflammation and potentially preventing severe respiratory complications. Other emerging research suggests that hormonal imbalances, particularly in estrogen and other reproductive hormones, may influence the severity and persistence of long COVID symptoms. For example, Sunada et al. (2022) highlighted that in patients suffering from long COVID symptoms, there were significant hormonal trends, including reduced estrogen levels and that these hormonal imbalance could exacerbate the already challenging symptoms of long COVID.
Psychological and Physical Health
The pandemic's impact extends beyond physical health, affecting the psychological well-being of postmenopausal women. A study by Lami et al. (2023) highlighted that postmenopausal women experienced heightened anxiety and depression during the pandemic. These symptoms were exacerbated by the physical symptoms of menopause, such as hot flashes and night sweats. Estrogen replacement therapies were shown to alleviate some of these psychological and physical symptoms, emphasizing that estrogen has an overall protective role when the body is fighting infectious viruses.
Role of Hormone Replacement Therapy (HRT)
The potential of HRT to alleviate long Covid symptoms still remains an area of active research. After all, it has only been a little over four years since the virus became wide spread and better understood. And, while HRT is primarily used to manage menopausal symptoms, research conducted within just a few years since the pandemic began concludes that its role in supporting the immune system and reducing inflammation may extend to mitigating the symptoms associated with Covid. In answer to my own concerns, its evident from th research that taking hormones to alleviate the cognitive effects or menopause is helping and it would be irresponsible, according Rodrigues et al. (2021), to interrupt or halt therapy. In fact, healthcare professionals should be encouraging women who are taking hormone therapy to remain on HRT as higher levels of estrogen and progesterone may help switch on a more robust immune response.
This growing are of research underscores the significant impact of menopause and estrogen on COVID-19 outcomes in menopausal women. Estrogen's role in enhancing immune response and reducing inflammation highlights its protective effects against severe Covid symptoms. Furthermore, the potential benefits of HRT in managing long Covid symptoms offer a promising avenue for supporting postmenopausal women and, ultimately, reduce the disease's overall burden on this unique demographic.
Disclaimer
The author neither promotes nor discourages the use of Hormone Replacement Therapy (HRT). This choice is best made by the individual in consultation with her healthcare professionals. If you are experiencing symptoms linked to Covid, it is advisable to seek advice from your family doctor or a healthcare provider.
References
Menopause, cognition, hot flashes and COVID-19: is estrogen a fundamental piece in the puzzle?
Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
Hormonal trends in patients suffering from long COVID symptoms
Menopause, cognition, hot flashes and COVID-19: is estrogen a fundamental piece in the puzzle?
