‘To see what is in front of one’s nose needs a constant struggle,” wrote George Orwell, and seeing in front of our masks in this endless pandemic turns out to be even harder.
Take the compelling case of the effect of oestrogen, the female hormone, on the coronavirus. Quite simply, research suggests that women with more oestrogen in their bodies are less likely to die and more likely to have milder symptoms of Covid-19. Doctors are also discovering that topping up low hormone levels seems to help some women suffering from long Covid. Yet, this area of research is being sorely neglected. I wonder why?
We know that two thirds of coronavirus deaths occur in men. But the female Covid mortality rate starts to rapidly increase as women hit their fifties – after menopause, when their protective hormones, oestrogen and progesterone, drain away.
It turns out, however, that women who take either the combined contraceptive pill or hormone replacement therapy – both of which include oestrogen – have a lower risk of ending up in hospital and of dying. Generally, oestrogen enhances the immune system, while testosterone has an immunosuppressive effect.
As Caroline Criado Perez’s book Invisible Women – Exposing Data Bias in a World Designed for Men, says, gender blindness in medicine and areas like tech just produces a “one-size-fits-men” culture. There is a gender data gap here that is not just irritating, but life threatening.
I’ve become fascinated by oestrogen’s superpowers during research over the past year for a book and an forthcoming Channel 4 documentary about the menopause. Aside from being a female sex hormone, oestrogen does sterling work throughout the body and brain. It regulates immunity and inflammation, and that terrifying “cytokine storm”, which rips coronavirus patients apart in hospitals, is less severe in women than men.
Hormone replacement therapy comes in many forms now. The latest body-identical hormones are a big improvement on the early synthetic ones that brought screaming headlines on the risks of breast cancer. When the newer transdermal oestrogen HRT – a £4-a-month gel or patch – is used, it’s been proven to protect women from heart attacks, osteoporosis, diabetes, colon cancer and memory loss, as well as stopping hot flushes. Why not Covid-19 too?
The good news is that it might. A recent study of more than 5,451 deaths in women from 465 GP practices in the Oxford Royal College of General Practitioners database showed that women who were using any form of HRT were 78% less likely to die of Covid. Of course, there’s a slight healthy user bias for women who opt to take HRT, but that’s still a mighty protective effect.
In September, the Zoe Covid Symptom Study app showed that women on the contraceptive pill were less likely to catch the virus. Later, a TriNetX global database survey from 17 countries, showed women taking oestrogen HRT were 50% less likely to die of the virus.
The science on oestrogen is not all there yet – we need more extensive studies as we follow the trail from hospital to patients at home with long Covid. An online survey of 1,294 women suffering the miserable symptoms of long Covid found a majority reported that their periods had changed and said their symptoms were worse before or during their periods when oestrogen levels are at their lowest.
The Covid app found that long Covid is particularly prevalent in women between the ages of 50 and 60 and, aside from respiratory problems, the rest of the reported symptoms in women have a huge crossover with those of menopause – fatigue, insomnia, brain fog, joint pain and heart palpitations.
Dr Louise Newson, a menopause specialist, said: “These symptoms are likely to be related to low oestrogen and also testosterone levels in women, so consideration should be given as a priority to replacing these low hormone levels with the right dose and type of HRT.”
So far, Newson and others have treated a number of patients of menopausal age privately with HRT, and their Covid symptoms have improved or disappeared. But there’s no suggestion of hormonal help on the long Covid section of the NHS website.
NHS experts have seen these latest academic papers on hormones, HRT and long Covid, but so far there’s been no announcement of further research – or hands-on treatment with oestrogen, a cheap drug we already know to be safe. The NHS website has pages of information on long Covid, but the suggested solution to chronic fatigue is “get a good night’s sleep”.
Science bends and sways with the news cycle: rules and vaccine doses change not always because of medical proof, but according to government expediency. Research is fast-forwarded in these times of trouble, so why has oestrogen been left behind? Any answers, gentlemen?
• Kate Muir’s book on the menopause is published by Simon and Schuster this summer.