March 2, 2022
2 min read
Menopausal hormone therapy significantly reduced the risk of death from COVID-19 among postmenopausal women, according to data from a nationwide registry-based study.
Women appear to be protected from poor performance with COVID-19 compared to men, even after adjusting for confusing risk factors, according to Malin Sund, MD, PhD, Visiting Professor in the Department of Surgical and Perioperative Sciences at Umeå University in Sweden, and colleagues.
“This implies biological differences between the sexes in terms of sensitivity to severe COVID-19,” they wrote.
Healthy and colleagues performed the analysis to better understand the role of estrogen augmentation in postmenopausal women with COVID-19, as the hormone has been identified as a potential therapeutic candidate.
The study involved 14,685 postmenopausal women from a Swedish nationwide cohort who were between 50 and 80 years old and had verified COVID-19. The women were divided into three groups: group 1 included 227 women previously diagnosed with breast cancer and receiving endocrine therapy (decreased systemic estrogen levels); group 2 included 2,535 women receiving menopausal hormone therapy (elevated systemic estrogen levels); and a control group. Researchers adjusted for potential confounders, including age, annual disposable income, highest level of education and the weighted Charlson Comorbidity Index (wCCI).
Deaths after COVID-19 served as the primary outcome measure.
Results revealed that unadjusted surgery for death after COVID-19 was 2.35 (95% CI, 1.51-3.65) for group 1 and 0.45 (95% CI, 0.34-0.6) for group 2 compared to the control group. After adjustment, only OR for death in group 2 maintained statistical significance (0.47; 95% CI, 0.34-0.63). In addition, the absolute risk of death was 4.6% in the control group compared to 10.1% in group 1 and 2.1% in group 2.
In other mortality data, factors associated with the risk of death due to COVID-19 included older age and higher wCCI. Specifically, with each year of increase in age, the OR for dying was 1.15 (95% CI, 1.14-1.17), while each increase in wCCI resulted in an OR for dying of 1.13 (95% CI, 1, 10-1.16). In addition, low income and only having a primary education also increased the chances of dying from COVID-19.
“This study shows a link between estrogen levels and COVID-19 death,” the researchers wrote. “Therefore, drugs that increase estrogen levels may play a role in therapeutic efforts to alleviate COVID-19 severity in postmenopausal women and could be studied in randomized controlled trials.”
The limitations of the study included, according to the researchers, lack of information on compliance with pharmaceutical modulation of estrogen; inaccessible information on the exact duration of postmenopausal hormone therapy; and the lack of measurement of circulating estrogen levels.