Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
It has been widely observed that adult men of all ages are at higher risk of developing serious complications from COVID-19 when compared with women. This study aimed to investigate the association of COVID-19 positivity and severity with estrogen exposure in women, in a population based matched cohort study of female users of the COVID Symptom Study application in the UK. Analyses included 152,637 women for menopausal status, 295,689 women for exogenous estrogen intake in the form of the combined oral contraceptive pill (COCP), and 151,193 menopausal women for hormone replacement therapy (HRT). Data were collected using the COVID Symptom Study in May-June 2020. Analyses investigated associations between predicted or tested COVID-19 status and menopausal status, COCP use, and HRT use, adjusting for age, smoking and BMI, with follow-up age sensitivity analysis, and validation in a subset of participants from the TwinsUK cohort. Menopausal women had higher rates of predicted COVID-19 (P = 0.003). COCP-users had lower rates of predicted COVID-19 (P = 8.03E-05), with reduction in hospital attendance (P = 0.023). Menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P = 2.22E-05) for HRT users alone. The findings support a protective effect of estrogen exposure on COVID-19, based on positive association between predicted COVID-19 with menopausal status, and negative association with COCP use. HRT use was positively associated with COVID-19, but the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential unaccounted for confounders and comorbidities.
Article activity feed
-
-
SciScore for 10.1101/2020.07.30.20164921: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable On 7 May 2020 we asked all female app-users if they are presently taking any forms of hormonal therapies including hormone replacement therapy (HRT), hormonal contraceptives and testosterone (S1 Fig). Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:However, our study also has several …
SciScore for 10.1101/2020.07.30.20164921: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable On 7 May 2020 we asked all female app-users if they are presently taking any forms of hormonal therapies including hormone replacement therapy (HRT), hormonal contraceptives and testosterone (S1 Fig). Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:However, our study also has several limitations. Data are self-reported, and questions on medication use were non-standard, to ease large-scale app-based reporting. Data on type, route, duration, and dose of hormone therapies, and importantly HRT, were not collected due to difficulties faced collecting very detailed data using an app-based interface. As such, untangling the effect of differing types of HRT was not possible. Most COCPs contain between 20-35 micrograms of ethinylestradiol along with a progestogen, while HRT estradiol doses are generally lower and more physiological. As such, lower estrogen doses and lack of detailed data may have resulted in the lack of effect seen amongst HRT-users. Another limitation relates to reporting bias within both symptoms and test results. Additionally, sampling using an app will under-represent individuals without smartphones, including older participants, and is likely to under-represent those severely affected by COVID-19. Other limitations include the effects of unmeasured confounding and systematic differences between individuals prescribed different types of hormone therapy. There is also potential for selection bias where, for example, experiencing gynaecological problems and menopause may influence likelihood of hormonal therapy use. To ascertain the consistency of our results, we performed multiple cumulative data extracts over the period 7 May 2020 - 15 June 2020, and observed that association results were consistent through...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04359329 Recruiting Estrogen Patch for COVID-19 Symptoms NCT04365127 Completed Progesterone for the Treatment of COVID-19 in Hospitalized M… NCT04331509 Recruiting COVID-19 Symptom Tracker Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
-
-
-