ArticleBMJ open2022
Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception: a Cochrane systematic review.BMJ sexual & reproductive health · 2023Pooled it
- Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.The Cochrane database of systematic reviews · 2023Pooled it
- Acute estradiol and progesterone therapy in hospitalized adults to reduce COVID-19 severity: a randomized control trial.Scientific reports · 2024Trial
- Humulus lupus extract rich in xanthohumol improves the clinical course in critically ill COVID-19 patients.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2023Trial
- Endocrine therapy and COVID-19 outcomes in women with breast cancer: a nationwide register- based matched cohort study.BMC cancer · 2026Article
- Digital physiological biomarkers predict within-person symptom changes in complex chronic illness.NPJ digital medicine · 2026Article
- Being in postmenopause may be associated with lower prevalence of COVID-19 symptoms among women over 45 years of age with and without HIV.Menopause (New York, N.Y.) · 2025Article
- First real-world evidence from the Emilia-Romagna region suggests tamoxifen protects breast cancer patients from COVID-19.Scientific reports · 2025Article
- Association of hormone therapy and outcomes in COVID-19.Menopause (New York, N.Y.) · 2025Article
- Exploring the association of social isolation and loneliness on the experience of COVID-19 infection and hospitalization in the Japanese population: the JACSIS study.Social psychiatry and psychiatric epidemiology · 2025Article
- Effect of Pituitary-Target Gland Axis on RAAS in the Context of COVID-19.International journal of medical sciences · 2025Review
- Aromatase, testosterone, TMPRSS2: determinants of COVID-19 severity.Biology of sex differences · 2024Article
- Current use of estrogen-containing oral contraceptives or hormone therapy and risk of COVID-19 infection and hospitalization: a population-based cohort study.American journal of epidemiology · 2024Article
- Estrogen-modulating treatment among mid-life women and COVID-19 morbidity and mortality: a multiregister nationwide matched cohort study in Sweden.BMC medicine · 2024Article
- COVID-19 and abnormal uterine bleeding: potential associations and mechanisms.Clinical science (London, England : 1979) · 2024Review
- Long-term survival after intensive care for COVID-19: a nationwide cohort study of more than 8000 patients.Annals of intensive care · 2023Article
- Article
- Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants.Virology journal · 2023Review
- Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.The Cochrane database of systematic reviews · 2023Review
- Renin-Angiotensin System and Sex Differences in COVID-19: A Critical Assessment.Circulation research · 2023Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveDetermine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19.
designNationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals who tested positive for SARS-CoV-2); Statistics Sweden (socioeconomical variables) and the National Board of Health and Welfare (causes of death).
participantsPostmenopausal women between 50 and 80 years of age with verified COVID-19.
interventionsPharmaceutical modulation of oestrogen as defined by (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic oestrogen levels); (2) women receiving hormone replacement therapy (increased systemic oestrogen levels) and (3) a control group not fulfilling requirements for group 1 or 2 (postmenopausal oestrogen levels). Adjustments were made for potential confounders such as age, annual disposable income (richest group as the reference category), highest level of education (primary, secondary and tertiary (reference)) and the weighted Charlson Comorbidity Index (wCCI). PRIMARY OUTCOME MEASURE: Death following COVID-19.
resultsFrom a nationwide cohort consisting of 49 853 women diagnosed with COVID-19 between 4 February and 14 September 2020 in Sweden, 16 693 were between 50 and 80 years of age. We included 14 685 women in the study with 11 923 (81%) in the control group, 227 (2%) women in group 1 and 2535 (17%) women in group 2. The unadjusted ORs for death following COVID-19 were 2.35 (95% CI 1.51 to 3.65) for group 1 and 0.45 (0.34 to 0.6) for group 2. Only the adjusted OR for death remained significant for group 2 with OR 0.47 (0.34 to 0.63). Absolute risk of death was 4.6% for the control group vs 10.1% and 2.1%, for the decreased and increased oestrogen groups, respectively. The risk of death due to COVID-19 was significantly associated with: age, OR 1.15 (1.14 to 1.17); annual income, poorest 2.79 (1.96 to 3.97), poor 2.43 (91.71 to 3.46) and middle 1.64 (1.11 to 2.41); and education (primary 1.4 (1.07 to 1.81)) and wCCI 1.13 (1.1 to 1.16).
conclusionsOestrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in this nationwide cohort study. These findings are limited by the retrospective and non-randomised design. Further randomised intervention trials are warranted.
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