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man looking out the window at a giant COVID-19 virus

man looking out the window at a giant COVID-19 virus

The World’s most significant recent public health crisis is the COVID-19 pandemic. The pandemic resulted in an estimated 90 million COVID-19 cases, and more than a million COVID deaths in the US. New highly transmissible coronavirus variants continue to emerge, with Omicron subvariants BA.5 and BA.4 being the dominant strains. These strains can evade older home tests and prior immunization, luckily causing mostly mild disease with few hospitalizations in vaccinated and boosted healthy individuals. 

Unfortunately, about 10% of women and men, will suffer non-infectious “Long-COVID”, an unwanted aftermath of their COVID-19 infection. Long-COVID refers to more than two hundred different signs and symptoms, and fifty associated conditions. Some Long-COVID symptoms are the direct effects of the virus, while others seem unrelated with no apparent causal link. Long-Covid is a severe enough public health problem that The Federal Government recently established a Long-COVID office within the Department of Health and Human Services (HHS) to tackle the crisis.

The five most common symptoms of Long-COVID in order of prevalence are: 1) anosmia (loss of the ability to smell), 2) hair loss, 3) sneezing, 4) ejaculation difficulty (men), and 5) reduced libido (men and women). Two different sexual problems…that really got my attention. 

As I thought about this further, it seemed to make sense, until it didn’t. At first, I thought: no one who is really fatigued or chronically ill (two known symptoms of Long COVID) would likely be interested in sex, so loss of sexual desire seemed consistent. But new-onset difficulty with ejaculation (orgasm) seemed weird. Clearly, ejaculatory disfunction is well known in men, but recent onset as one of the most common symptoms of long-COVID, well that screamed vascular AND neurologic dysfunction from this viral disease. Having just published a paper suggesting that the same dysfunctions in men also affect women, and in both men and women, these disorders are a harbinger of underlying cardiovascular disease, you can understand my concerns. 

So, if you or a woman you know, is suffering from a sexual dysfunction (lost desire, poor lubrication, sexual pain, weak or absent orgasm, etc.), whether related to Long-COVID or not, we are here to help. Call for an in person or virtual appointment today: 202-293-1000

 

Subramanian, A., Nirantharakumar, K., Hughes, S. et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med (2022). 

Levine RL. Addressing the Long-term Effects of COVID-19. JAMA. Published online August 03, 2022. doi:10.1001/jama.2022.14089

August 5, 2022. Coronavirus Roundup: HHS is Establishing a New Office Focused on Long COVID

Cipriani S, Simon JA. Sexual Dysfunction as a Harbinger of Cardiovascular Disease in Postmenopausal Women: How Far Are We? J Sex Med. 2022 Jul 19:S1743-6095(22)01489-8. doi: 10.1016/j.jsxm.2022.06.007. Epub ahead of print. PMID: 35869024.

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Back in April 2020, an article in the Journal of Women’s Health prompted me to think about the differences between men and women’s life and death responses to COVID-19. That article illustrated what we’ve heard in the news over, and over, and over again. Namely, that men tend to fare much worse than women if hospitalized with coronavirus (sars-cov-2) related diseases. Since then, we have come to know that, in this context, men are clearly the weaker sex. But even more data has emerged around the why, demonstrating that reproductive hormones are, in fact, an important part of women’s resistance to severe COVID-19 disease and can possibly even prevent death.

For most postmenopausal women, whether currently using menopausal hormone therapy or not, hormone therapy in early menopause (i.e., started in the first 10 years since their last menstrual period) is of significant benefit. Menopause specialists strive to determine the risk-benefit ratio for any woman before starting hormone therapy. It’s now clear that early menopausal women without absolute contraindications should seriously consider utilizing hormone therapy for disease prevention (i.e., heart attack and osteoporosis) and now to help prevent severe COVID-19 infections and even death.

Prevention of severe cases of COVID-19 may not be a good enough single reason to start hormone therapy, particularly as vaccinations are becoming more readily available. However, recent evidence documents that in women who start on hormone therapy for its basic, well-established benefits (treatment of hot flashes and night sweats, vaginal dryness and pain with sexual activity, prevention of osteoporosis etc. etc. etc.), may also benefit from the protection it provides against COVID-19 disease.

So, if you or someone you know wants a consultation to evaluate the benefit/risk ratio of postmenopausal hormone therapy, factoring in the potential benefits against severe COVID-19 infections, make an appointment to talk with us about all the options. All staff at IntimMedicine Specialists are fully vaccinated and we maintain careful CDC precautions, though we are also available for virtual visits. Menopausal hormone therapy may not only be good for you, it may save your life!

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doctor in a white coat holding a green medicine bottle, sitting across from a patient

It’s been 18 years since the landmark Women’s Health Initiative (WHI) initial hormone therapy (HT) results. They gained worldwide attention by throwing HT “under the bus,” alleging the risks outweighed the benefits. I didn’t, and still don’t, endorse that conclusion, because estrogen therapy reduces the risks for heart disease, Alzheimer’s disease, and osteoporotic fractures among other benefits. Regardless of one’s point of view, almost 80% of women abruptly went off their HT.1 Here, I want to talk about the latest “potential” benefit of estrogen therapy… prevention of COVID-19 infection, and reduction in disease severity. Yes, you heard me, I can’t make this “stuff” up!2,3

The basics are these:

  • The severity of coronavirus infection appears to be greater in men than in women.
  • Estrogen reduces both influenza virus growth (replication) and the inflammation it causes.
  • These benefits of estrogen (replication and inflammation) are eliminated in animals when they lose ovarian function, like menopause, and are restored if those animals receive estrogen.
  • Pregnant women have high levels of reproductive hormones, including estrogen. 92% of pregnant Chinese women from Wuhan with COVID-19 had mild symptoms, and the other 8% all recovered from their disease. There were no deaths in pregnant women.

Taken together, estrogen seems to be protective against COVID-19, both the prevention of infection, and reduction in disease severity. So much so that clinicians and scientists from Stony Brook University Hospital in New York have launched a clinical trial using menopausal estrogen patches for the reduction of COVID-19 severity in both women and MEN!4,5 Yes, we are now giving menopausal estrogens to MEN. So, before you throw away your menopausal hormone therapy, think twice, it may be helpful in this COVID-19 pandemic.

 

  1. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012;120(3):595‐603. doi:10.1097/AOG.0b013e318265df42
  2. Suba Z. Prevention and therapy of COVID-19 via exogenous estrogen treatment for both male and female patients. J Pharm Pharm Sci. 2020;23(1):75‐85. doi:10.18433/jpps31069
  3. https://www.healio.com/endocrinology/hormone-therapy/news/online/%7B334d4dd8-cc70-4672-952f-735440eef7da%7D/study-investigates-estrogen-patch-use-to-lessen-covid-19-complications
  4. https://clinicaltrials.gov/ct2/show/NCT04359329

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