Low oestrogen may increase coronavirus risk

UK preprint research shows postmenopausal women are more likely to develop severe disease than other women

5th August 2020

Postmenopausal women with lower levels of oestrogen appear to be at higher risk of developing severe COVID-19, research suggests.

The study, led by a team at King’s College London, UK, found high levels of oestrogen may have a protective effect against the virus.

Using data from the COVID Symptom Study App, researchers examined the rate of predicted infection among postmenopausal women, premenopausal women using the combined oral contraceptive pill and postmenopausal women taking hormone replacement therapy (HRT).

More than 500,000 women were included in the study that took place between 7 May and 15 June 2020.

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The researchers hypothesised that oestrogen could protect against COVID-19, according to the preprint study published in medRxiv.

Previous studies on SARS-CoV and MERS had suggested this might explain why men of all ages were at a higher risk of severe infection, they noted.

The study found postmenopausal women had a higher rate of predicted COVID-19 than the other women.

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Women in the 45-50 age group were most likely to be at risk with reported symptoms of anosmia, fever and persistent cough.

The need for oxygen treatment in hospital was also significant in this group.

Women between 18 and 45 years who were taking the pill had a lower rate of predicted infection and reduced frequency of symptoms, including persistent cough, delirium, anosmia, skipped meals, severe fatigue and pain.

The rate of hospitalisation was also significantly lower in this group.

Postmenopausal women between 50-65 years who took HRT had an increased rate of predicted COVID-19, but not with hospitalisation.

The researchers advised the HRT results should be considered with caution due to the lack of information about therapy type, route of administration and duration of treatment.

“We hypothesised that premenopausal women with higher oestrogen levels would have less severe COVID-19 when compared to women of the same age and BMI who had been through the menopause, and our findings supported this,” said joint lead author Dr Karla Lee from the university’s school of life course sciences.

“Additionally, when we compared a younger group of women on the combined oral contraceptive pill (COCP) with a similar group not taking the COCP we saw less severe COVID-19 among those taking the COCP, suggesting hormones in the COCP may offer some protection against COVID-19.

“More research is certainly needed to further our knowledge.