Estrogen and COVID19

What the science is telling us about estrogen in Post COVID Syndrome


Good news for women

I first became aware of the possibility of menstrual dysregulation due to COVID, after a patient casually mentioned during her intake that her period had changed after a COVID infection.  She communicated that her period  “ felt weird and that the length had gotten shorter”. Around the same time, female friends expressed similar complaints and colleagues were expressing the same conversations with their patients. I went in search of some possible scientific explanation. A search on PubMed and google scholar begins to scratch the surface and give context to what might be happening.

How COVID interacts with our body 

There is several background information about  COVID -19 that we presently can agree on.  

  1. The fatality is linked to the virus’s capability of inducing cytokine storms, a fancy medical storm for your immune system overproducing immune cells and attacking yourself. 
  2. We know that progression of certain receptors is presented in every cell and are ways that cells can identify one another. 

COVID-19 has the ability to upregulate ACE receptors. 

  1. Progression severity and Post covid syndrome ( the prolonged symptoms after the infectious state) are characterized by ongoing inflammation. 

How estrogen interacts with COVID

We understand the positive role of estrogen and its synergy with our immune system. We know that estrogen acts as an antioxidant, and regulates immune cells which can cause a cytokine storm. Immune cells such as TNF and IL-6. Estrogen can also down-regulate ACE receptors and inhibit the ability of COVID-19 entry into the cell.  And this is where things become interesting; Recent research is showing that women on HRT might have a lower mortality rate and lower Post COVID syndrome incidence.

Observational research has shown women on HRT had lower mortality rates and Post COVID syndrome incidence than their non-HRT counterparts. The HRT group had mortality rates comparable to premenopausal women. It is standard not to remove women from their HRT if they become sick.

As some research strongly suggests that estrogen and HRT can be protective against COVID-19 inflammation. At the same time, a few, but a  growing body of research is reporting premenopausal women who are reporting hormonal dysregulation. Reports are of shorter periods, heavier bleeding, and brain fog.

Many of the same signs that one might encounter in hormonal dysregulation in women that still have their periods. What healthcare providers are seeing clinically is supported scientifically.

What the research means if you are post menopause 

I think women that are considering if bioidentical hormones have more benefits than side effects, can put recent research in the benefits department. It can help a woman that is considering what is best for her to make a decision one way or another.

The takeaway for all women 

I think for one the research speaks to the positive role of estrogen. Estrogen many times receives a bad reputation, these findings are examples that showcase the positives beautifully. 

As a clinician and a woman it is important to know that; 

  1.  COVID-19 can be a cause of new hormonal dysregulations, 
  2. estrogen imbalance might be playing a role, 
  3. and my post-menopausal women on HRT are protected. 

With this information, I encourage patients to have a conversation with their doctor, with their daughters, mothers, and friends. To spread awareness. The cliche is true. Knowledge is power. 


1.Seeland U, Coluzzi F, Simmaco M, Mura C, Bourne PE, Heiland M, Preissner R, Preissner S. Evidence for treatment with estradiol for women with SARS-CoV-2 infection. BMC Med. 2020 Nov 25;18(1):369. doi: 10.1186/s12916-020-01851-z. PMID: 33234138; PMCID: PMC7685778.

2.Youn JY, Zhang Y, Wu Y, Cannesson M, Cai H. Therapeutic application of estrogen for COVID-19: Attenuation of SARS-CoV-2 spike protein and IL-6 stimulated, ACE2-dependent NOX2 activation, ROS production and MCP-1 upregulation in endothelial cells. Redox Biol. 2021 Oct;46:102099. doi: 10.1016/j.redox.2021.102099. Epub 2021 Aug 17. PMID: 34509916; PMCID: PMC8372492.