By now we've all heard about "long Covid", a syndrome of chronic symptoms following acute Covid-19 infection, which can manifest as fatigue, muscle aches, palpitations, cognitive impairment ("brain fog"), and sleep disturbances. Many of these symptoms can overlap with symptoms experienced due to peri-menopause and menopause. It can make diagnosis and management more challenging for women in the 40 to 55 year age range, in whom both factors could be at play. Long Covid appears to disproportionately affect women, in particular women under the age of 50. [1]
There is now research and evidence to suggest that men and women have a different immunological response to Covid-19 infection, possibly in part due to the role of the sex hormones and their influence on levels of inflammation and the speed of the antibody response. It has also been noted in observational research that many women experienced transient menstruation abnormalities during acute Covid-19 infection, possibly due to a temporary disruption of ovarian steroid hormone production, which could acutely worsen symptoms of peri-menopause and menopause.
Common symptoms of peri-menopause and menopause include changes in menstruation, hot flashes, brain fog, memory problems, fatigue, anxiety, joint pains, headaches, sleep disturbance, and depressed mood. The symptoms of peri-menopause and menopause, as well as the symptoms of long Covid, can be debilitating, and therefore must be screened for and addressed.
When diagnostic uncertainty exists, simple blood tests to measure female sex hormone levels can be performed to help clarify the picture. FSH is a hormone that increases as the ovarian function starts to decline. Failing to recognize when a woman is experiencing symptoms that are due to peri-menopause or menopause, can mean delaying treatment, and putting her at increased risk for conditions known to affect post-menopausal women (like osteoporosis, cardiovascular disease, obesity, type 2 diabetes, and possibly dementia).
When appropriate, a trial of hormone replacement therapy may be given, and if symptoms improve, this may support a diagnosis of hormone deficiency. Obviously this will depend on the individual's personal and family medical history, in order to determine if she is an appropriate candidate for HRT.
One thing that stands out in my mind is this: our society has normalized suffering, particularly in women. We have gone through painful menses, childbirth, and later menopause and not a lot of attention or research, or even medical education has been dedicated to the alleviation of the uncomfortable symptoms that these bring. Quality of life matters, women matter, and it's time to focus on conditions that women experience that can benefit from diagnosis and treatment.
[1] Sigrid L. Drake TM. Pauley E. Jesudason EC. Olliaro P. Lim WS. et al.
Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.
Lance Reg Health- Eur. 2021 Aug
#Covid19 #longcovid #perimenopause #menopause #womenshealth #chronicfatigue #brainfog #insomnia #hotflashes #muscleaches #hormones #HRT
In good health,
Dr. B
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