By Joseph E. Scherger, MD, MPH
Core Faculty, Eisenhower Health Family Medicine Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles
SYNOPSIS: Swedish researchers found taking postmenopausal estrogen was associated with a lower death rate from COVID-19 infection. Taking estrogen suppression therapy for breast cancer was associated with a higher death rate compared with controls.
SOURCE: Sund M, Fonseca-Rodríguez O, Josefsson A, et al. Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: A cohort study. BMJ Open 2022;12:e053032.
Researchers in Sweden used national registry data to study whether augmentation of estrogen in postmenopausal women affected the death rate from COVID-19 infection. In 2020, between Feb. 4 and Sept. 14, 16,693 postmenopausal women between ages 50 and 80 years were diagnosed with a COVID-19 infection. A total of 14,685 women met the study criteria. They were divided into three groups. Group 1 included 227 women previously diagnosed with breast cancer and who were on endocrine therapy to lower estrogen levels. Group 2 included 2,535 women who were receiving estrogen replacement therapy. Group 3 included 11,923 women — a control group of patients with COVID-19 infections. The authors controlled for confounding variables, such as age, income, education, and a morbidity index.
Based on the control group (normal risk), the odds ratio for death in women on estrogen suppression therapy was 2.35. The odds ratio for women on estrogen replacement was 0.45. These findings suggest postmenopausal estrogen is protective against death from a COVID-19 infection and that suppression of estrogen in postmenopausal women raises the risk of death.
COMMENTARY
Healthy hormone levels are associated with numerous health benefits in women and men. This study highlights the role estrogen may play in preventing death from COVID-19. The immune system is a diverse and complex web of biology. Sex hormones are known to determine immune response.1 These findings give credence to this biology. Cortisol also affects immunity by regulating T cell-mediated inflammation.2 Medical practice should be integrated, with the primary care physician promoting the overall health of the patient. The benefits are likely to be beyond our current understanding, given the interconnectedness of body systems.
REFERENCES
- Taneja V. Sex hormones determine immune response. Front Immunol 2018;9:1931.
- Sherman B, Wysham C, Pfohl B. Age-related changed in the circadian rhythm of plasma cortisol in man. J Clin Endocrinol Metab1985;61:439-443.
Swedish researchers found taking postmenopausal estrogen was associated with a lower death rate from COVID-19 infection. Taking estrogen suppression therapy for breast cancer was associated with a higher death rate compared with controls.
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