CAN COVID TRIGGER PERIMENOPAUSE?

Just when we were getting a handle on recognizing signs of peri, along came covid to throw a spanner in the works. Brain fog. Fatigue. Palpitations. Dizziness. Anxiety. Sleep problems. Muscle / joint aches and pains. All are symptoms of long covid, but all can be signs of peri, too. Add to the list night sweats and shortness of breath, and it’s nigh on impossible to know if you’re in peri or experiencing lingering effects of the virus.

Women disproportionately suffer from long covid

Much is still unknown about covid, but one thing we do know is that women disproportionately suffer from long covid, particularly women over 40. Researchers have made a connection to hormones-- namely estrogen, progesterone, and testosterone-- all of which are produced by your ovaries. From your mid-30s onwards, levels of estrogen and progesterone fluctuate you enter into perimenopause, and testosterone levels are declining, as well.

During peri, ovarian function gets erratic. You may notice your periods aren’t quite as predictable, arriving every 24-26 days instead of 28-30, for example. Changing levels of estrogen and progesterone causes a litany of shit, like sleep issues, mood changes, brain fog, fatigue, and a million other things ranging from the inconvenient to the unbearable. The decrease in testosterone has an impact, too.

A covid infection can really aggravate the situation. When you catch covid, the virus floods the body, latching onto cell receptors -- proteins that help cells interact with other cells -- known as angiotensin-converting enzyme 2 (ACE2) receptors and there are tons of these receptors in the ovaries. Instead of working their usual full-time job, the ovaries now have to work overtime to fight the virus, so their day job suffers. The ovaries’ ability to efficiently produce estrogen and progesterone takes a dive, and as a result, peri symptoms can worsen. According to research, depending on how far you are into peri, the ovaries may be less likely to make a full recovery after covid, and this can trigger the onset of perimenopause symptoms. Before covid, your peri symptoms may have started to show up gradually, but after an infection, symptoms can show up quite suddenly. To add insult to injury, long covid can exacerbate the severity of peri symptoms, and vice versa.

If you’ve noticed a change in your cycle after a bout with the virus, you’re not alone. This British study led by Dr. Louise Newson of Newson Health Menopause Society showed noticeable differences in the cycles of more than a third of women with long covid, including changes in frequency of periods and heavier or lighter flow. Some women’s periods completely stopped, suggesting that the hammering their ovaries took from covid brought on peri (or menopause) faster. Over three-quarters of the women in the study reported their long covid getting worse right before their period.

Jemma, 41, caught covid in November 2021: “I had no idea what was happening. I did a rapid test and it was negative, I couldn’t breathe properly and thought I was having a heart attack, so I went to the ER.” A PCR confirmed covid, and although she spent just one night at the hospital, within a fortnight she was admitted again with pneumonia, after which she developed long covid.

“Some days and weeks I was fine, others I was too tired to even watch television,” she says. “and even the mere thought of a walk around the block exhausted me.” The week before her period, when estrogen is low, is when symptoms worsened.

Low hormone levels can be one of the so-called ‘barriers’ to long covid recovery

Living between the UK and the US, Jemma enrolled in a long covid trial at University College London. Part of her treatment involved estrogen therapy, which she took via a spray twice a week. Estrogen acts as an anti-inflammatory agent in cells, balancing out the body’s immune response. Dr. Paul Glynne, who led the trial, discovered that low hormone levels can be one of the so-called ‘barriers’ to long covid recovery. Other barriers include poor sleep and stress. Poor sleep and anxiety are associated with peri, thus impacting long covid recovery, so if peri symptoms are resolved with hormone therapy, there is a greater chance of improvement in long covid as well.

Estrogen was earmarked by some doctors as a possible treatment for long covid relatively very early in the pandemic, thanks to a 2016 study that had observed the positive impact of estrogen on viruses such as the flu and HIV. The study by Johns Hopkins Bloomberg School of Public Health showed that estrogen reduced the amount of flu virus that replicated in infected cells in women, but not in men. When the pandemic hit, some researchers and doctors decided to see if the same would apply to covid as well. A Swedish study in February 2022 of almost 15,000 women with covid showed those taking estrogen hormone therapy had a 53% reduced risk of death, compared to women in the same age group who were not taking estrogen. This part of the study focused on women over 50 when estrogen is consistently low. At Tulane University in Louisiana, a November 2022 study concluded that women taking HRT who developed covid had a decreased risk of death and a significantly decreased need for prolonged hospitalization.

Misconceptions about the safety of estrogen have long plagued women’s health. A 2002 billion-dollar study by the Women’s Health Initiative reported that taking hormone therapy dramatically increases the risk of breast cancer. The risk is actually non-significant, but the misleading results scared the living daylights out of everyone. Millions of women stopped taking their HRT, doctors were scared to prescribe it, and for the past 20 years, the physical and mental health of women over 35 has suffered immeasurably.

During the pandemic, those same study results managed to obstruct the treatment of long covid, too. In April 2020, at the Renaissance School of Medicine at Stony Brook University on Long Island, Dr. Sharon Nachman started a trial to look at the benefits of estrogen in treating covid. She planned to enroll 110 patients and give half of them a small estrogen patch to stick to their skin, and see if it helped with both immune and repair responses. The trial didn’t go anywhere. Why? “Many adults did not want to participate, even at the height of covid, due to misplaced concerns about the estrogen patch,” Dr. Nachman told us via email.

Covid-19 infection is affecting women’s ovaries more severely than other common infections

At the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University, Dr. Kathryn Sandberg led an investigation into the effects of estrogen on covid, and in the rats who’d been given estrogen, the ACE2 receptors in the kidneys were less affected by covid. Dr. Sarah Glynne, a British doctor who studies women’s health and covid co-wrote a fascinating booklet with Dr. Louise Newson of Newson Health Menopause Society on the connection between hormones and covid in which they surmised that “Covid-19 infection is affecting women’s ovaries more severely than other common infections and it appears to be having a more severe effect on the production of hormones such as estrogen and testosterone. Long covid symptoms due to low estrogen and testosterone levels tend to persist unless women are given the right dose and type of Hormone Replacement Therapy (HRT), which often includes testosterone replacement as well as estrogen.” Testosterone may help with brain fog and energy levels.

Because long covid and peri symptoms are so similar, it is possible that many women are being misdiagnosed with long covid, when they may simply be experiencing symptoms of peri. Treatment that targets long covid will simply have no effect (or worse, result in a negative effect) unless hormone therapy is included in the protocol.

If a woman isn’t sure what’s causing her brain fog, fatigue, or sleep issues, one way doctors may attempt to determine if it’s long covid or peri is to trial HRT. If symptoms haven’t improved within 2-3 months, then covid treatment may be added. If the symptoms improved? It can mean that the woman was simply experiencing peri symptoms.

But it's not just HRT, the Newson Health paper suggests that an overall holistic approach is vital in tackling both peri and long covid. Lifestyle adjustments can build a stronger foundation of good health, and where peri and long covid are concerned, if the foundation isn’t laid well, adding treatments on top can just be a house of cards. Science and medicine are incredible, but the responsibility of maintaining good health also lies with the individual.

When the doctor impresses a need to prioritize sleep, eat healthier, and move more, we need to start seeing it as a prescription, not a suggestion! Unfortunately, unless something is scribbled on a prescription pad, many people don’t see it as important as whatever is picked up at the pharmacy.

Prioritizing quality sleep is high on the list. Poor sleep hurts mood, energy, focus, diet…everything. Sub-par sleep harms the human ability to handle challenges both physically, emotionally, and mentally. Of course, it’s easier said than done, but even small changes like reducing caffeine and alcohol and cutting back on screen time are known to contribute significantly to a more blissful slumber.

As the booklet says, the gut, too, is highly impacted by both peri and covid. Both can cause imbalances in the microbiome, resulting in irritating issues such as bloating, constipation, and IBS-type symptoms. Pre and probiotics-- both as a supplement and in food form like sauerkraut, kimchi, etc. – are known to make a huge difference in balancing gut bacteria. Fiber is high on the list as well.

Peri issues can suck. But when you compare them with the alternative of a chronic illness like long covid? We'll take peri any day of the week.

The Perisphere is not medical advice. The information provided should not be used for diagnosing or treating a health problem. Always seek the advice of your doctor or other qualified health provider.