Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
By Dr. Melissa (Mel) Irvine, DNP – Clinical Sexologist Specializes in Sexual Medicine and Beauty
COVID-19 is most notably known for its effects on the respiratory system, specifically the cough it can cause and how some people experience shortness of breath. However, less well-known is that it can also influence your hormone levels and, in some cases, last weeks or months after your infection. This condition is termed long COVID, and it is becoming a topic of greater discussion as people connect their new or lingering symptoms with previous COVID-19 infection.
What Is Long COVID?
Long COVID is a term coined to describe the side effects that last after someone has been infected by COVID-19. It may also be referred to as long-haul COVID or post-COVID conditions as it relates to the new, returning, or ongoing health problems that those infected by SARS-CoV-2 can experience for weeks or even months after infection.
The timeline for COVID-19 looks like this for most people: they are infected by SARS-CoV-2, develop COVID-19, and then, after a couple of weeks, recover and feel better. For those with long COVID, though, symptoms may linger, or, in some cases, entirely new symptoms can develop.
Some of the most common symptoms associated with long COVID include fatigue and brain fog, although other symptoms can include:
– changes in taste and smell
– chest pain
– shortness of breath
– insomnia
– dizziness
– anxiety
– depression
Causes of Long COVID
The interesting thing about long COVID is that it can affect anyone, no matter how severe their COVID-19 infection. For instance, some people with a mild infection experience long COVID, while others with severe infections requiring hospitalization do not.
As such, there is no known cause of long COVID, but there are some speculations. Some scientists hypothesize that long COVID results when the virus or viral remnants, such as viral RNA or protein, linger in tissues and cause chronic inflammation. Others cite how acute respiratory infections can induce autoimmune conditions, which may be the cause of long COVID symptoms. Finally, there is speculation that some long COVID symptoms come from a dysregulated gut microbiome, which can result from infection.
While the cause of long COVID remains uncertain, research has shown that it can have lasting effects that extend further than expected, and this includes its impact on your hormones.
How Does Long COVID Affect Estrogen and Progesterone?
Considering how instrumental balance is for hormone production, it should come as minimal surprise that something as disrupting as COVID-19 can also affect your hormones. However, not only can it affect your hormones, but the sex hormones in your body (or lack thereof) may also influence whether or not you are more likely to develop long COVID.
Long COVID has been shown to be more common in women compared to men, and women between the ages of 40-60, in particular, are at the highest risk of long COVID. Period changes are a common symptom reported by women who have long COVID, and one study found that one-third of their surveyed women reported changes in their periods that began after their COVID infection. These changes included how frequently their periods occurred, their length, and the heaviness of their flow. In some women, their periods stopped entirely.
Furthermore, the study revealed that 77% of women notice their symptoms of long COVID worsen right before their period. Of note, this is the time of the menstrual cycle when the estrogen levels are at their lowest.
These discoveries have caused researchers to question if there is a link between female hormones and long COVID, but when looking into this connection, it is helpful to understand the mechanism of action of SARS-CoV-2.
The COVID-19 virus binds to angiotensin-converting enzyme 2 (ACE2) receptors, and it is this binding that allows the virus to enter the cell. While COVID-19 is most well-known for affecting the respiratory system, there are also ACE2 receptors in the ovaries. When the virus enters the cells in the ovaries, this impedes the ovary’s ability to work at its full functionality, and the result may be a lower production of hormones, particularly estrogen. This may explain why women experience more severe menopausal symptoms when infected with COVID-19.
Interestingly, research has shown that progesterone may offer some protection from COVID-19, which could also explain why men fare worse off than women. In particular, it is the anti-inflammatory properties of progesterone which show promise.
However, it has also been shown that hypoxia, or low blood oxygen levels common in COVID-19, can decrease progesterone synthesis. Low progesterone synthesis could then lead to greater inflammation in the body, which could incite long COVID symptoms.
Another Gender-Based Difference
As previously discussed, researchers have three hypotheses for how long COVID occurs, and the autoimmune hypothesis may explain the higher incidence of long COVID in men compared to women. This is because women have a higher immune response, making autoimmune reactions more frequent.
This could also explain why men are more likely to have a severe COVID-19 infection (their immune system is weaker), but women are more likely to develop long COVID (they are more likely to have autoimmune reactions).
How To Combat Hormone Imbalance from Long COVID
When it comes to low hormone levels due to the lasting damage of COVID-19, they tend to persist because the ovaries become vulnerable and less likely to recover from infection. This creates a cycle where the ovaries cannot produce enough estrogen and then continue to be vulnerable.
However, hormone replacement therapy (HRT) can help to break this cycle by giving women the correct amount of hormones and returning their estrogen and progesterone levels to normal. With the female hormones back in balance, the ovaries can finally heal.
In many cases, it can be helpful to start HRT as soon as a woman experiences COVID-19 infection not only because it can help reduce mortality by more than 70% but also because it can help determine which symptoms are due to low hormone levels and which require an alternative method of treatment.
Recovering from Long COVID
In addition to the use of HRT to combat the hormonal deficiencies that can arise during long COVID, there are other steps you can take to help mitigate your symptoms and feel better.
Focus On Your Sleep
Sleep is crucial for allowing your body to fight illnesses, repair itself, and feel better. Unfortunately, sleep problems can be common in those with long COVID, which can make symptoms such as brain fog, fatigue, and anxiety worse. Because of this, it’s critical that you focus on getting enough good, quality sleep.
To improve your sleep, it’s best to focus on your sleep hygiene, or the habits you complete to help promote a good night of sleep. These include following a sleep schedule, getting physical exercise during the day, and avoiding caffeine before bedtime.
Help Your Gut
Your gut houses trillions of bacteria, some good and some bad. However, the most important thing for this microbiome is the balance between the two, namely that the good bacteria outweigh the bad.
The beneficial bacteria in your gut have many vital roles, including their aid in digestion, the absorption of nutrients, and the immune system. Their influence is wide-reaching, so a disruption to your gut microbiome can have significant consequences.
Research into COVID-19 has shown that it can affect the gut microbiome by reducing the number of good bacteria and increasing the number of bad bacteria. This can lead to symptoms such as bloating and diarrhea. Furthermore, this bacterial imbalance can also cause inflammation throughout the body.
If you’re recovering from COVID, it’s often best to focus on a diet that promotes gut health. This includes eating a variety of fruits, vegetables, seeds, and nuts along with fermented foods (e.g., kimchi, sauerkraut) as they are rich in probiotics.
Other Hormones Affected by COVID-19
It’s not just estrogen and progesterone that relate to long COVID; other hormones can also factor in.
For example, men may experience low testosterone levels. In some cases, low testosterone precedes COVID-19 infection and is what increases the risk of infection, while in other cases, it can develop as a result of the virus’s effect on the body.
Research has also shown that those with long COVID have lower cortisol levels than those without. While cortisol is the body’s stress hormone, and it’s good to keep it from getting too high, there can be consequences of having it low as well, including headaches, weakness, and low blood pressure.
While research into long COVID is ongoing, the findings already made show just how much this virus can disrupt your hormonal balance, and the side effects that can result.
Navigating the Hormonal Implications of Long COVID
Having COVID-19 is no longer the sole object of our concerns; for some people, the implications of this infection linger weeks or even months afterward, severely declining their quality of life.
Women, in particular, are more susceptible to long COVID, and research suggests that this is because of their hormones and the way that COVID-19 affects them. Namely, COVID-19 can cause a decline in estrogen levels and, should hypoxia occur, in progesterone. Unfortunately, these imbalances don’t tend to fix themselves, and temporary HRT is often needed to correct them.
Other hormones can also be influenced by COVID-19, including testosterone and cortisol. Furthermore, these hormonal imbalances may share symptoms with other complications of COVID-19, making it difficult to ascertain the true cause of the symptoms. As such, the best way to treat your long COVID and get your health back on track is by meeting with a hormone specialist to determine if you are experiencing any hormonal imbalances and what can be done to correct them.
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Shah S. B. (2021). COVID-19 and Progesterone: Part 2. Unraveling High Severity, Immunity Patterns, Immunity grading, Progesterone and its potential clinical use. Endocrine and metabolic science, 5, 100110. https://doi.org/10.1016/j.endmts.2021.100110
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