COVID-19, gender and estroprogestins, what do we know?

Abstract

The new coronavirus disease-19 (COVID-19) pandemic has rapidly spread all around the world, eliciting many questions and doubts about the pathogenesis of the disease and treatment. Mortality has been related to a prothrombotic state. Risk factors for the infection and for severe forms of COVID-19 have still to be defined. According to data collected, women appear to be less prone to severe forms of the disease and their mortality was lower than for men. The role of female hormones in the modulation of inflammation may be the reason behind this gender gap.

Considering the prothrombotic state activated by the virus, hormone therapies have been placed under investigation as possible increasing risk factors for severe forms. Moreover, new vaccines and their rare thrombotic side effects have increased the concern about this issue.

The goal of this review is to go over the mechanisms that lead up to thrombosis during COVID-19, trying to explain the possible reasons why women seem to be naturally protected. The expert opinions about whether to continue/discontinue hormonal therapies are reviewed. Moreover, available data about the so-called ‘vaccine induced immune thrombotic thrombocytopaenia’ caused by vaccines against COVID-19 are discussed.

新型冠状病毒肺炎、性别和雌孕激素, 我们知道什么? 摘要

新型冠状病毒肺炎（COVID-19）在全球范围内迅速蔓延, 引发了人们对其发病机制和治疗方法的诸多疑问。COVID-19导致死亡的机制与血栓前状态有关。感染的高危因素和疾病的重症表现仍有待确定。根据目前的数据, 女性似乎不容易进展为重症, 死亡率也低于男性。造成这种性别差异的原因可能与女性激素的炎症调节作用有关。由于病毒可能激活血栓前状态, 激素替代治疗是否可能会增加患重症的风险, 值得进一步研究。新疫苗及其罕见的血栓副作用使人们对这一问题更加关注。本综述旨在回顾COVID-19形成血栓的机制, 并试图解释女性可能存在内源性保护的原因。对于是否继续/停止激素治疗的专家意见进行了总结。并对COVID-19疫苗引起所谓的“疫苗诱导免疫血栓性血小板减少症”的证据进行了讨论。

Keywords:

• SARS-CoV2
• inflammation
• cytokine storm
• combined hormonal contraceptives
• vaccine-induced immune thrombotic thrombocytopenia

Disclosure statement

No potential conflict of interest was reported by the authors.