COVID-19 from the perspective of a gynecological endocrinologist

Abstract

The infectious respiratory disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) shows striking differences in its course and severity depending on the gender of affected patients. The incidence in women is higher than in men, whereas severe forms of the disease are significantly more common in men as well as the mortality; however, premenopausal and postmenopausal women again present a dimorphism in the course depending on hormonal status. Premenopausal women have lower rates of hospitalization and need respiratory support less often. Postmenopausal women who receive hormone replacement therapy seem to benefit from this intervention. The results of basic research in a murine model show that in the case of influenza the female sex steroids have a positive effect on the course of inflammation and in the case of the SARS-CoV‑2 virus, reduce the susceptibility to the virus, while androgens result in an increase in the infection rate. This is also the case in patients with polycystic ovarian disease syndrome (PCOD). The first results of a treatment study with progesterone, albeit with small numbers of patients, indicate that such a treatment with this sex steroid can have a positive effect on the course of the disease in affected men; however, complications after vaccination against COVID-19 show a clear gender difference, with an increased relative risk for younger women.