Postmenopausal women who have higher estrogen levels as a result of taking hormone replacement therapy (HRT) may have a lower risk of death from COVID-19 than women with natural levels of the hormone, a new Swedish study shows.
The research, published February 14 in BMJ openalso found that women who took estrogen-blocking therapy because of a past breast cancer diagnosis had more than twice the risk of dying; on the other hand, after researchers adjusted for several factors that could affect COVID-19 risk, the correlation was no longer statistically significant.
About 4 percent of American women take hormone therapy
Estrogen is a group of hormones produced by a woman’s ovaries. As women get older and approach menopause, their ovaries produce less estrogen. HRT can be prescribed to relieve some symptoms of menopause (primarily hot flashes) by increasing estrogen levels.
There are some women who should not use HRT, including those who have problems with vaginal bleeding, who have had certain cancers, or who have had a stroke, heart attack, blood clots or liver diseaseaccording to MedlinePlus.
It is estimated that 4 percent of American women take hormone replacement therapy, according to University of Southern California.
Women on HRT were 50 percent less likely to die from COVID-19
The researchers’ goal was to see how estrogen can affect the death rate of postmenopausal women who had COVID-19. Based on national data from the Swedish Public Health Authority and the National Board of Health and Welfare, the study sample included a total of 14,685 women aged 50 to 80 years, who received a COVID-19 diagnosis between 4 February and 14 September 2020. Investigators grouped participants in one of Three categories:
- 227 women (2 percent) had previously been diagnosed with breast cancer and were being treated with estrogen blockers (adjuvant therapy) to reduce the risk of cancer recurrence.
- 2,535 (17 percent) took hormone replacement therapy (HRT) to raise estrogen levels and relieve menopausal symptoms.
- 11,923 (81 percent) were not on any estrogen enhancing or reducing treatment and were used as a control group.
Researchers found that women on HRT were more than 50 percent less likely to die from COVID-19 than women with natural estrogen levels. After checking for potentially influential factors such as age, annual income, level of education, and coexisting health conditions, the chances of dying from COVID-19 remained significantly lower for women taking estrogen.
Those women who had decreased estrogen levels due to adjuvant endocrine therapy for breast cancer were more than twice as likely to die from COVID-19 compared to the control group, although the association was not significant after adjusting for age income, education, and coexisting health. relationship.
The authors acknowledge limitations in the study: The researchers had no way of knowing whether the women had been accommodating in terms of taking HRT treatment, how long they had been on HRT, or the actual estrogen levels in the individual women.
Because this research was conducted before there were vaccines against COVID-19, the results of this study do not show whether or how much estrogen reduces the risk of serious illness and death among vaccinated women, the authors noted.
“These are interesting results, but it is important to note that this is only a first study,” he says Sharon Nachman, MD, director of the Department of Pediatric Infectious Diseases and director of the Office of Clinical Trials at Stony Brook Medicine in New York, who was not involved in the research. “As the authors here suggest, more information is needed before we draw conclusions about the effect of estrogen on COVID-19,” says Dr. Nachman.
Estrogen levels may affect a key entry point for SARS-CoV-2
The authors of the study suggest that a possible mechanism for the reduced risk of COVID-19 death among women with high estrogen levels is the effect of the hormone on the ACE2 receptor, an important starting point for SARS-CoV-2, the virus that causes COVID-19.
A study published in November 2020 in American Journal of Physiology Lung Cellular and Molecular Physiology found that cells exposed to testosterone and estrogen behaved differently – while testosterone upregulates ACE2 expression in cells, estrogen downregulates it.
Do not start HRT or stop estrogen-blocking medication without first talking to your doctor
No one should change any treatments they take based on these preliminary results, Nachman says. “Remember, we do not yet know if and how estrogen contributes, and in what form it contributes,” she says.
Discuss any questions or concerns with your doctor before starting or stopping medications that affect your natural estrogen levels, Nachman says.
“For women who have undergone cancer treatment, it is important to continue taking their medication to reduce the risk of cancer recurrence. This study provides no reason to stop, “said the study’s first author, Malin Sund, MD, Ph.D.professor at Umeå University, in a release.
“But of course they need to be careful about getting vaccinated and not exposing themselves to unnecessary risk of infection,” she said.