If you’re going through menopause during the COVID-19 crisis, or if someone you love is, you may be wondering if the novel Coronavirus affects menopausal women. Are menopausal women more at-risk? Are there ways to decrease the risk?
These are all good questions, since menopause can already complicate the daily life routine, without any pandemic impact.
Are menopausal women specifically more at risk for the Coronavirus?
There are different opinions on the topic of discussion. According to gynecologist Barb DePree, MD, “COVID-19 is not likely to be a significant additional risk to menopausal women per se, but menopause is a time women begin to have increased risk for heart disease and type 2 diabetes, once they lose the protective effects of estrogen. These co-morbidities definitely increase risk for women who may contract COVID-19.”
In fact, the Centers for Disease Control and Prevention (CDC) says age, heart disease, and diabetes can all increase your chance of being severely ill with the Coronavirus. More so, weight gain, which may be caused by menopause, can also complicate matters. Frustratingly, for women in menopause, a decrease in estrogen could potentially cause increased vulnerability to severe symptoms. “There is some investigational research data suggesting estrogen may be somewhat protective for women exposed to the Coronavirus,” Dr. DePree says.
Menopause itself can therefore impact immunity, says Dr. DePree. “Immunity is a complex issue that is impacted by multiple factors — some of which we control, and some less so,” she says. The hormone estrogen is shown to have a protective role in women, so women who are not on hormone therapy during menopause might be more at-risk than those without a decline in estrogen.
Menopause is also linked to cancer risk, as well as a decrease in T-cells, the immune system’s cells that work to fight off cancer cells and foreign invaders, and which bolster the immune response in general. Inflammation is yet another issue. According to studies, as women age, inflammatory levels increase — leading to pain, autoimmune issues, weight gain, and susceptibility to illness.
In one study based on reported symptoms, Dr Claire Steves, a member of the Covid symptom study app team at King’s College London and her colleagues, found post-menopausal women were at greater risk of having Covid than non-menopausal women of similar age and body mass index. There are also some hints that the former may be at greater risk of more severe symptoms.
The team also found that users of the combined oral contraceptive pill – which contains estrogen – had a lower risk of Covid than their peers.
In another study, the team found women were at greater risk of having “long Covid” than men, with women aged 50 to 60 at greatest risk of developing lingering symptoms.
Meanwhile, a study from China found menopausal women with Covid spent less time in hospital than non-menopausal women once age and disease severity were taken into account.
Some have pushed back against the long-Covid findings of Steves and colleagues, noting the results are based on people who had a positive Covid test, meaning it did not fully consider those who had Covid at home. But Steves said the team found long Covid in a wide range of people, including younger people and men.
Dr Betty Raman of the University of Oxford also confirmed the viewpoint that both age and sex appeared to be important when it came to Covid. Raman and her colleagues are following up a cohort of 58 people who were hospitalized for at least two days with coronavirus. Among this cohort, 41% are women, 67% of whom are over 50 years old. But of the 55 participants who completed a subsequent survey, 50% of men and 61% of women had moderate to severe fatigue. What is more, 10 of these 14 women were over 50.
“There is a lack of firm evidence that estrogen is protective for Covid-19, though it is clear that being male is a risk factor for disease severity,” said Raman. But she added: “We do have correlations and associations between levels of hormones and severity of disease, and of course sex of the individual and severity of the disease.”
Raman added that estrogen was known to be beneficial in some other diseases – including coronary artery disease, which is more common in men than women.
Could coronavirus trigger a sudden menopause, years before your time?
Coughing fits that send shockwaves down to your toes. Breathlessness that feels as though you’re drowning. Haunted by a cloud of constant, paralyzing exhaustion. All symptoms that crept up on 46-year-old Dawn Knight in March, after she returned from a family holiday in Thailand. There could be little doubt: it was a classic case of Covid.
But a few weeks into her illness came another symptom, one which she had not yet heard of in the flurry of news reports. She missed her period. There was no chance that she could be pregnant, but by April, there was still no sign of it.
As the months went on, it became clear that Dawn had developed so-called long Covid – where individuals are no longer infectious, but symptoms such as crushing fatigue, breathlessness and brain fog continue. The phenomenon of long Covid is now well documented. It is thought to affect as many as one in 20 people, and especially women, although researchers are not entirely sure why.
In June, Dawn visited her doctor when even more symptoms emerged – a racing pulse and a burning sensation in her hands and feet. Blood test results proved startling: her levels of follicle-stimulating hormone (FSH), an indication of fertility, were found to be ‘post-menopausal’.
Dr Louise Newson, a GP and menopause specialist who runs a private clinic in Stratford-upon-Avon, is working with experts from the University of Edinburgh and University College London to investigate whether the virus could be triggering early menopause. Dr Newson says that although some common long Covid symptoms – such as dizziness, fatigue and brain fog – are also symptoms of the menopause, mounting reports mean the links between the two ‘feel more than just coincidence’.
It is already known that other infections, such as sepsis or a bad bout of flu, can disrupt periods or cause them to stop temporarily.
The problem is thought to lie with the control center in the middle of the brain, called the hypothalamus, which is responsible for regulating a host of bodily functions. When the hypothalamus detects signs of stress, be it mental or physical, it signals for the release of chemicals that safeguard basic survival functions, and stops other less important ones – for instance, those connected with reproduction.
As Mary Jane Minkin, a gynecologist at the Yale School of Medicine in the US, explains: ‘It’s a really intricate set-up, and any stressor can whack the whole thing up.’
Consultant gynecologist Dr Jackie Maybin, a senior research fellow at the University of Edinburgh, who is collaborating on the new research with Dr Newson, adds: ‘Shutting down processes like menstruation, which isn’t needed, is a natural way of conserving energy and prioritizing the immune system.’ And perhaps for those women whose hormones are already depleting as a natural by-product of age, their hormones don’t recover – and periods stop for good.
There’s another even more concerning theory. According to some experts, coronavirus could be directly attacking the ovaries, reducing the production of crucial progesterone, estrogen and testosterone. If this is actually happening, it’s not clear but the answer could lie with receptors, called ACE2, through which Covid enters the body’s cells to cause infection – a bit like a key in a lock. There are lots of these receptors in the heart and lungs, which is thought to be why they are so badly affected.
But they are also in the ovaries, the womb lining and, in men, the testes. It means the virus could, in theory, spread to the cells in the ovaries through the bloodstream, having entered the body through the nose, eyes or mouth.
What happens in practice isn’t clear and hasn’t yet been studied. But Chinese research has shown that men’s fertility is also affected by the virus.
There is evidence too that having already dwindling hormones can make coronavirus far more disruptive for some.
Studies show that while women are 50 per cent more likely to be affected by longer-term Covid than men, it’s post-menopausal women who are even more at risk. After the menopause, women are increasingly likely to both get Covid and experience more severe symptoms, experts say.
On the flip side, having higher levels of estrogen and progesterone has a protective effect against Covid, so women with the highest levels experience milder symptoms.
This finding is further reflected in reports from women
with long Covid whose symptoms worsen in the 48 hours before their period
begins. This is when levels of progesterone and oestrogen drop from very high
to quite low.
Sources and
Additional Information:
https://www.endocrineweb.com/conditions/menopause/coronavirus-menopause
https://www.theguardian.com/world/2020/dec/04/calls-investigate-possible-link-menopause-covid-risk
https://covid.joinzoe.com/post/post-menopause-covid
