Reflections

Almost 2 years ago, on 31st December 2019, the WHO was informed of cases of pneumonia of unknown cause in Wuhan City, China. On 7th January 2020, Chinese authorities identified the cause as a novel corona virus, subsequently named COVID-19.

As we all know, COVID-19 has led to global pandemic which, at the time of writing, had accounted for 226 million infections and 4.9 million confirmed deaths globally. Unconfirmed infections and deaths are undoubtedly many times higher than the ‘official’ numbers (www.who.int).

Whereas the great pandemics of the past spread relatively slowly, courtesy of infected soldiers or seamen, COVID-19 has had the benefit of globalization of commerce and international travel. The unprecedented speed at which the virus has travelled and its deadly consequences have led to rarely seen actions by governments including the bypassing of normal legislative processes to limit spread of disease. Some have fared better than others in their endeavours but the common ground for all has been limitation of civil liberties in the interests of overall public health, an issue which has divided public opinion worldwide [1].

From the start, researchers and clinicians have worked overtime seeking to enable science to catch up. Effective vaccines have been developed at a pace faster than ever before in our history [2] and almost 7000 clinical trials and 180,000 papers related to COVID-19 have been conducted.

Of interest to those concerned with women’s health might be the difference in rates of COVID-19 infection and associated deaths between the genders. Overall, more women have become infected but more men have experienced serious infection and death [3]. This gender difference is lost after the menopause. A recent retrospective case study [4] of 300 patients from Wuhan found that, overall, men had higher disease severity than premenopausal women but that this gender difference disappeared after the menopause. Apart from age, postmenopausal women appear more at risk for COVID-19 than those who are premenopausal. Possible explanations for this include the loss of protective effects of estrogen, and perhaps androgens on the immune system or a direct effect of two X chromosomes on the genetic pool [5]. This is not the first disease to exhibit a different incidence or severity after the menopause but, like many others, a pertinent question is whether exogenous estrogens might provide some benefit. A recent UK study [6] confirmed the positive association between menopause and COVID-19 infection and reported an inverse association between use of the combined oral contraceptive pill and COVID-19 infection. The same was not seen for postmenopausal women using hormone replacement therapy (HRT). The authors noted that this null finding should be treated with caution due to lack of data on HRT type, route of administration, duration of therapy and confounders. Nonetheless, a recent US review [7] suggested that endogenous sex hormones should be considered as possible therapeutic options to ameliorate COVID-19 infection, citing immunomodulating effects of estrogens and beneficial effects against similar viruses such as SARS and SARS-CoV-2. Clearly, much more research is required.

After a 2-year global battle against the COVID-19 pandemic, there are signs that we are turning the corner, although that corner is further away in some parts of our world than in others. Although 43.5% of the world’s population had received at least one dose of a COVID-19 vaccine by October 2021, only 2% of people in low-income countries had received one dose. When it comes to equity in health care, it is clear we have much to do.

Much of the discontent associated with temporary loss of civil liberties in the name of health has been brought about by poor communication at all levels and, sadly, by misinformation. Just as globalization has facilitated the spread of COVID-19, social media have facilitated a pandemic of misinformation, usually from ill-informed sources. As health-care workers, we must overcome this ‘misinformation pandemic’ by pro-actively communicating evidence-based information clearly to our patients, our leaders and the broader community and by using social media, in appropriate ways, to correct the imbalance between evidence-based and ignorance-based health care. By so doing, we can improve the well-being of women worldwide. Together we can make a difference.

As 2021 draws to a close, I would like to take this opportunity to thank all authors who have submitted papers to Climacteric and our editorial staff, Jean Wright and Susan Brown who have made the processing of submissions so seamless. My sincere thanks to our many reviewers, our tireless associate editors, and, of course, James Pickar, Nicole Jaffe, Pauline Maki and Nick Panay who served as guest editors during 2021. You are the cornerstones of our success and our scientific integrity. May I also acknowledge, with thanks, Dr Beverley Lawton and Dr Lian Ulrich who, after many years of service, have decided to stand down from our Editorial Board. I am delighted to welcome our new Editorial Board members, Dr Nicole Jaffe, Professor Pauline Maki, Professor Xiangyan Ruan and Dr Mike Savvas. Lastly, with great sadness, I acknowledge the passing of Professor John Studd. John served the profession of Obstetrics and Gynaecology and The International Menopause Society in so many ways over many years, enjoyed a stellar career, was a remarkable communicator, and an irreplaceable and irrepressible mentor to many of us.

From all of us at Climacteric, I wish you a happy, healthy and successful New Year and look forward to seeing you at the IMS World Congress in Lisbon from 26 to 29 October 2022.