Covid-19: Middle aged women face greater risk of debilitating long term symptomsBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n829 (Published 25 March 2021) Cite this as: BMJ 2021;372:n829
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Hormone use in women? Re: Covid-19: Middle aged women face greater risk of debilitating long term symptoms
Long Covid and hormone use in women?
Ingrid Torjesen reports that middle aged women have more risk of long term symptoms after having Covid-19.1 Females under age 50 years were 4x more likely to have greater disability, 2x more likely to report worse fatigue and 7x more likely to become more breathless than men of the same age. They were also 5x less likely to report feeling recovered.2
An obvious reason for this is that most women take progestogens and/or oestrogens for contraception or menopausal withdrawal symptoms. Such hormones uses increases the risk of thromboembolic disease, obesity, breast, ovarian, cervical, endometrial and CNS cancers. Hormone use also increases the risk of infections and autoimmune diseases. Chronic fatigue syndrome (myalgic encephalopathy) is often post viral. Patients with chronic fatigue syndrome and mitochondrial dysfunction are also 4-5x more likely to be women. 3-6
1 Ingrid Thorjensen. Covid-19: Middle aged women face greater risk of debilitating long term symptoms. BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n829 (Published 25 March 2021) Cite this as: BMJ 2021;372:n829
2 Sigrid L, Drake TM, Pauley E, 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.
Preprint from medRxiv, 23 Mar 2021
3 Myhill M, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med 2009;2:1-16.
4 Booth NE, Myhill S, McLaren-Howard J. Mitochondrial dysfunction and the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Int J Clin Exp Med. 2012;5(3):208-20.
5 Myhill S, Booth NE, McLaren-Howard J. Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) - a clinical audit. Int J Clin Exp Med. 2013;6:1-15.
6 Myhill S. In "Chronic Fatigue Syndrome It’s mitochondria, not hypochondria.” 2014 Hammersmith Health Books, London PP 44-72.
Competing interests: No competing interests
In common with an unfortunately many papers on physically debilitating conditions, this paper uses standard mental health tools (PHQ9,...) with the normal recommended cuts for a healthy patient.
At the same time as measuring significant physical disability to the point many patients have had to give up work, or reduce work, the scales useduncritically ask patients 'Do you enjoy the things you used to do' and 'Are you worried about your health'.
These answers supposedly inform on mental health.
All of the MH tools used need careful thought to see what the appropriate baseline that would be expected given the persons physical condition.
Using the standard cuts makes as much sense as concluding that people with one leg are at high risk of low blood pressure following asking them 'do you wobble when you standup'.
This is more than an academic issue. This mismeasurement gets swallowed into meta analysis, where it is even further distanced from verification, and then may be used to drive treatment policy based on the fact that anxiety/depression is a meaningful component of the illness.
Competing interests: No competing interests