Abstract

Background: Emerging data suggest that estrogen could play a protective in women affected with coronavirus disease 2019 (COVID-19).

Methods: PUBMED search until September 23, 2020. Search terms include COVID-19, men, women, mortality, estrogen, pregnancy, safety. Retrospective, meta-analyses and pre-print studies are included.

Results: Women with COVID-19 have lower mortality compared to men with similar age even after controlling for co-morbidities. In premenopausal women, estradiol serum levels above 70 pg/ml were associated with decreased risk of having severe COVID-19. Pre-menopausal women using combined oral contraceptives (COCP) may have decreased risk of COVID-19. In post-menopausal women, one retrospective study from UK showed that hormone replacement therapy may have increased risk of COVID-19. However, another multinational study showed that estradiol use after menopause was associated with significant reduction in mortality from COVID-19. During pregnancy, when circulating levels of estrogen are normally very elevated, the course of COVID-19 is generally similar to that in non-pregnant women.

Conclusion: Preliminary data suggest that estrogen could be protective in women with COVID-19. However, data are sometimes inconsistent and exclusively based on retrospective studies. Nevertheless, available data justify the evaluation of the potential therapeutic role of estrogen in COVID-19 in the context of randomized trials.

Keywords: COVID-19; Estrogen; Inflammatory Markers; Mortality; Severity; Pregnancy

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