Long COVID risk - a signal to address sex hormones and women's health, 2021, Stuart Stewart et al

Wonko

Wonko

Senior Member (Voting Rights)
Tonight I was made aware of this 'study'. It is being floated as an explanation for long covid, by at least one GP (my sisters).

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00228-3/fulltext

(no abstract available)

Sample (edited to introduce paragraphs/spacing);
...
From a biological perspective, we propose the asymmetry in risk and outcomes between sexes, and an overlap of symptoms of Long COVID with those of perimenopause and menopause point towards sex hormone differences as targets for further investigation.

Furthermore, the higher prevalence of Long COVID in women under the age of 50 years is an important and supporting clue as the mean age of natural menopause (in the UK) is 51 years.

Oestrogen and androgen receptors are ubiquitous, present in almost all tissues in the body, evidencing the widespread and important roles of sex hormones, well beyond their obvious roles in the reproductive system. Viral-induced sex hormone dysfunction resulting in early menopause, menstruation abnormalities and miscarriage are documented in HIV and Hepatitis B and C infections.

In the context of viral infections, sex hormone dysfunction may be related to multisystem disruption or due to organ-specific effects. The role of sex hormones in COVID-19 infection are now beginning to emerge. A recent study highlights important clinical and immunological differences between sexes in acute COVID-19 infection; women had lower mortality, lower levels of inflammation, higher lymphocyte counts, and faster antibody responses than men. Specifically, oestradiol may be implicated here owing to its immunomodulatory effects as well as antiplatelet and vasodilatory activity.

Observational research highlights transient menstruation abnormalities during acute COVID-19 possibly owing to the expression of the ACE2 receptor proteins in the ovaries. Such findings support a hypothesis of temporary disruption to physiological ovarian steroid hormone production, which could acutely exacerbate symptoms of perimenopause and menopause.
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It appears, to me, to have null content, other than fairly explicit say that some symptoms of LC are similar to that of the menopause so therefore all women who attend a LC clinic should be evaluated for that, and given HRT regardless.

Which may, or may not, be a good idea, but it's hardly science, and tells us nothing (IMO).

It appears to be implying that LC is probably caused by the menopause.

Which seems an 'odd' thing for medical type people to think, let alone put in writing. Historically speaking of course.

I am interested in others opinions as to whether this paper says any more than my limited capability has discerned.
 
From the link given by @Wonko :

Many symptoms of Long COVID [[3]] (fatigue, muscle aches, palpitations, cognitive impairment, sleep disturbance) have a significant overlap with the perimenopause and menopause [[6]], both which can affect women of all ages.
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I really don't believe that the combination of symptoms given is unique to perimenopause and menopause. But doctors and researchers believe that women are slaves to their hormones, don'tchaknow, so something to do with periods must be the answer to all their problems.
 
I don't doubt hormones could play a role but it would be good to actually have some research.

Purely anecdotal and correlations.
Those I know who had significant side effects to vaccination were all on HRT in my age group.

In my daughter's age group those on long term contraception ( 3 month type loading) had more varied and longer side effects.

Small number groups though

Generally there seems to be irregular or different menstrual bleeding to various degrees . Not everyone is reporting it.

There may be something in it.
 
It appears to be saying that they think some longCOVID is misdiagnosed menopause.

It also mentions the ovaries express ACE2 so can be infected by COVID but there is a bias in the interpretation towards attributing symptoms to menopause.

They state ...
Observational research highlights transient menstruation abnormalities during acute COVID-19 possibly owing to the expression of the ACE2 receptor proteins in the ovaries. Such findings support a hypothesis of temporary disruption to physiological ovarian steroid hormone production, which could acutely exacerbate symptoms of perimenopause and menopause.
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Whereas I would interpret that as meaning the symptoms of ovary infection could exacerbate longCOVID with pseudomenopausal symptoms.

IMHO there does appear to be an element of longCOVID denial involved here.

Many symptoms of Long COVID (fatigue, muscle aches, palpitations, cognitive impairment, sleep disturbance) have a significant overlap with the perimenopause and menopause, both which can affect women of all ages. Such overlap may create diagnostic uncertainty and requires clinicians to assess for this additional diagnosis as it offers an opportunity to treat perimenopause and menopause symptoms with safe and effective hormone replacement therapy (HRT). Failure to recognise this overlap misses an opportunity to treat many debilitating symptoms affecting both physical and mental health, but also to reduce some women's risk of cardiovascular disease, type 2 diabetes, osteoporosis, obesity and possibly dementia - all of which increase after the menopause. Furthermore, it could lead to women with symptoms of the perimenopause and menopause being misdiagnosed with Long COVID.
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Menopausal symptoms due to COVID infection of ovaries are logically longCOVID not natural menopause, surely?

Meaning in clinical terms any benefit from HRT could only be regarded as partial therapy for a bigger problem caused by longCOVID.

In a medico-legal context I think that could be an important distinction, since HRT for menopause is not the same liability as HRT for partial treatment of longCOVID as the latter implies a necessity for further treatment.

I agree with you @Wonko its not properly logical.
 
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I considered trying HRT for menopausal symptoms (mostly exhaustion which was different from M.E type fatigue), but my GP told me that HRT would not improve my energy levels, it does reduce night sweats/hot flashes which helps improve sleep.

So HRT isn't going to help pwLC with fatigue/lack of energy/exhaustion which is the most common complaint.
 
I've done a little reading and it seems oestrogen is seen as protective against some viruses, so it looks like they pretty much tried to see if it was also protective against covid/LC (unclear which or if both as the info may be uninterpretable, by me, in the more technical paper below).

The hypothesis seems to be based on the different purposes/priorities of the immune system between the sexes, and, to a lay reader, me, seems quite neatly woven together.

Which probably means it's wrong.

Guardian article which covers the basics, simply;

https://www.theguardian.com/society/2021/jun/13/why-are-women-more-prone-to-long-covid

and a more scientific looking paper (really quite long and far more technical than I can handle, but the impression I get from it seems to provide 'some' justification for trying HRT on women with LC, that has nothing to do with their menopausal status);

https://www.frontiersin.org/articles/10.3389/fnut.2021.649128/full

I still don't like the 'study' in the first post, even if it seems to have some very basic basis behind it, as it does seem to be a blatant attempt to deny the existence of LC. I am, obviously, not against people getting treatment for their symptoms, HRT or otherwise, I am against the probably inappropriate attribution of all of a patient's symptoms to something that should have been picked up, and treated, by a GP anyway.

The same GP who presumably referred to an LC center.

Seemingly as an attempt to say that all, or most, cases of LC weren't.
 
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Making a judgement on a paper like this really needs close reading of the references - in this case I'd say especially ref [2] https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00163-0/fulltext

To my non expert eye both papers read as non problematic. The conclusion that a) women may carry a higher post pandemic burden than men, b) that women who are already affected by socio economic and health stress are likely to be most at risk of that burden, c) such women despite presenting as a large body of need when encountering the NHS deserve good care d) that statistical analysis suggests that i) peri-menopause and menopause are a higher 'risk' in the presenting population and ii) unwanted but treatable symptoms of peri-menopause and menopause can be confused with non treatable symptoms attributed to "long COVID" seems wholly reasonable. Who want's to carry on with avoidable discomfort when there's a potential available solution ?

I can't see that the authors are claiming that post COVID illness doesn't exist only that peri-menopause and menopause are identifiable, can be confused with post COVID symptoms and that women should be offered treatments to help the unwanted effects.
 
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