Open AccessEstrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study
Author(s) -
Ricardo Costeira,
Karla A. Lee,
Benjamin Murray,
Colette Christiansen,
Juan Castillo-Fernandez,
Mary Ní Lochlainn,
Joan Capdevila Pujol,
Heather Macfarlane,
Louise C. Kenny,
Iain Buchan,
Jonathan Wolf,
Janice Rymer,
Sébastien Ourselin,
Claire J. Steves,
Timothy D. Spector,
Louise Newson,
Jordana T. Bell
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0257051
Subject(s) - medicine , covid-19 , estrogen , cohort study , cohort , hormone replacement therapy (female to male) , menopause , pill , population , young adult , physiology , environmental health , disease , testosterone (patch) , infectious disease (medical specialty) , pharmacology
It has been widely observed that adult men of all ages are at higher risk of developing serious complications from COVID-19 when compared with women. This study aimed to investigate the association of COVID-19 positivity and severity with estrogen exposure in women, in a population based matched cohort study of female users of the COVID Symptom Study application in the UK. Analyses included 152,637 women for menopausal status, 295,689 women for exogenous estrogen intake in the form of the combined oral contraceptive pill (COCP), and 151,193 menopausal women for hormone replacement therapy (HRT). Data were collected using the COVID Symptom Study in May-June 2020. Analyses investigated associations between predicted or tested COVID-19 status and menopausal status, COCP use, and HRT use, adjusting for age, smoking and BMI, with follow-up age sensitivity analysis, and validation in a subset of participants from the TwinsUK cohort. Menopausal women had higher rates of predicted COVID-19 (P = 0.003). COCP-users had lower rates of predicted COVID-19 (P = 8.03E-05), with reduction in hospital attendance (P = 0.023). Menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P = 2.22E-05) for HRT users alone. The findings support a protective effect of estrogen exposure on COVID-19, based on positive association between predicted COVID-19 with menopausal status, and negative association with COCP use. HRT use was positively associated with COVID-19, but the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential unaccounted for confounders and comorbidities.