COVID-19 and Menstruation: What is the missing link?

Like a ravaging forest fire, COVID-19 has engulfed the entire world with its famished monstrosity. Amongst the multitude of its devastating effects is our menstrual health. The least talked about, but most important to women, our reproductive health and hygiene have been majorly impacted by the coronavirus.

As we are witnessing, COVID-19 knows no boundaries. It has infected people all over the world, regardless of age, race, gender, and ethnicity. However, recent data shows that men are more likely to be severely infected and that death rates are higher in men when compared to women.

This data seems odd, especially considering the fact that 70% of the frontline healthcare workers are female. Because of this women are more susceptible to acquiring the infection, and yet are less likely to acquire a severe infection and die from it.

So what does that mean? And why is it so?

The answer lies in what sets us apart from men, our biological differences, our menstrual cycle.

This significant difference in data amongst genders prompted research. What is the link between COVID-19 and the menstrual cycle? What can be done about it?

That link is, drumroll please, estrogen!

It has been long known that estrogen has immunoprotective effects, that it enhances our immune system. Our immune cells respond to estrogen, which stimulates the body to produce antibodies and fight against the virus. Estrogen also has anti-inflammatory effects in the body by decreasing the levels of cytokines. Cytokines control the inflammatory response produced by the body, therefore the decrease will lead to an overall reduced inflammatory response and severity of the infection. Thus, because of these reasons, estrogen does play an important role in providing protection against infections and diseases.

Multiple studies indicate that non-menopausal females present with milder disease severity and better outcomes when compared with age-matched males. But, when menopausal females were compared with their age-matched males, these differences disappeared. Taking age and severity into account, it was also found that non-menopausal women tended to have shorter stays at the hospital and would be discharged earlier than menopausal women.

A similar study revealed that women who used Combined Oral Contraceptive Pills had reduced frequency of symptoms and a lower rate of hospitalization.

This means that estrogen does provide some protection to pre-menopausal women against COVID-19.

COVID-19 is known to infect multiple organs to produce a wide range of symptoms. It can infect the lungs to produce pneumonia-like symptoms, or the kidneys leading to kidney failure. In short, the virus can enter multiple organs to infect them. Interestingly a study revealed that the endometrium of the uterus is relatively safe from this viral entry. This is because the endometrial tissue does not express the genes that the virus requires to enter a cell. Even though this is quite a fascinating fact, more research is needed to reach a compelling conclusion.

Now that we know about how estrogen may protect us from COVID-19, another question arises regarding this hormone. What about women who have reached menopause? What happens to those who lack estrogen, do they lose their protective cloak? The answer to this is yes, research shows that post-menopausal women are more likely to experience severe symptoms and longer hospital stays. Therefore, menopause is considered to be an independent risk factor for COVID 19. It is important to note that this does not mean that post-menopausal women are more likely to test positive for COVID-19. So far, there is no association between menopausal status and testing positive for the virus.

All these recent findings regarding estrogen and COVID-19 have led researchers down a distinct path. Can Hormone Replacement Therapy (HRT) be useful in helping us fight against COVID-19? HRT is commonly used by post-menopausal women to help mitigate the symptoms of menopause. It consists of estrogen and progesterone, however, it’s intake does come with some harmful side effects. Currently, there are ongoing clinical trials to evaluate if HRT will be helpful in decreasing the severity and frequency of COVID-19 symptoms.

As the COVID-19 pandemic rages on and with the whole world under lockdown, what can we do for our menstrual health? Because the spotlight is on this virus, fewer resources are being directed towards the reproductive health sector. We do not have easy access to reproductive

health services, we are unable to visit our ob-gyn, obtain birth control, or menstrual hygiene products. Most of us are dealing with stress and anxiety, we are probably experiencing irregular menses and PMS. Maybe some of us are dealing with pregnancy or menopause. It is a scary time, and we are stuck at home. But it is important to know that we are not alone. Thousands of women all over the world may be experiencing what we are going through right now. The best all we can do is to take care of ourselves and reach out.

One way to take care of ourselves in these unprecedented times is to turn to natural products such as Scarlet. Scarlet mainly contains Chasteberry and Wild Yam, which will help regulate our menstrual cycle and improve our reproductive health. Wild Yam contains dioscin, which is converted to diosgenin in the gut. Diosgenin then acts on estrogen receptors, increases estrogen levels, and exerts estrogenic effects.

Who would have thought that estrogen would be one of the warriors in our fight against COVID-19? Truly fascinating, and as I’m writing this while menstruating, I can’t help but feel special. I have estrogen, and I may stand a chance against the coronavirus.