Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study.

Costeira, Ricardo, Lee, Karla A, Murray, Benjamin, Christiansen, Colette, Castillo-Fernandez, Juan, Ni Lochlainn, Mary, Capdevila Pujol, Joan, Macfarlane, Heather, Kenny, Louise C ORCID: 0000-0002-9011-759X, Buchan, Iain ORCID: 0000-0003-3392-1650
et al (show 7 more authors) (2021) Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study. PloS one, 16 (9). e0257051 - e0257051.

Access the full-text of this item by clicking on the Open Access link.


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.

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 16 Dec 2021 09:38
Last Modified: 07 Sep 2022 05:10
DOI: 10.1371/journal.pone.0257051
Open Access URL: