5 Ways COVID-19 Can Impact A Woman’s Health

Though no one has been left unscathed by COVID-19, the impact on women and their health bears special consideration. The status of women in today’s world puts them at increased risk of infection. And for some women, there are reported changes to the menstrual cycle, pregnancy, menopause journey, thyroid, and emotional and mental state. As we learn more about this virus every day from science and continued research, it’s vital that women stay up-to-date on the latest learnings and its impact on their body and health.

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    Women+ and COVID-19 risks

    What we don’t know about COVID-19 far exceeds what we have yet to discover. Still, trends have emerged as it relates to women and their risk of getting COVID-19, and the impact on their health, including during menopause.

    • Women+ can be affected by COVID during all stages of their reproductive lives – menstruation, pregnancy, and menopause.
    • In addition, COVID can impact a woman’s emotional and mental health and thyroid.
    • Women are also twice as likely as men to develop long COVID, a condition typically defined as ongoing symptoms of COVID-19 that continue for more than 12 weeks and are not explained by an alternative diagnosis.

    Think you have long COVID? Read the pausitive health long COVID 101 guide.

    Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine also found 63% of long COVID patients worldwide during the first two years of the pandemic were women.

    Additionally, almost 10% of women+ older than 20 who had a symptomatic COVID infection, but did not require hospitalization, developed persistent symptoms vs. 5% of men.

    As if that’s not enough, just being a woman puts you at greater risk of getting COVID-19.

    Throughout the pandemic, specific segments of the population have been at increased risk of infection:

    • Healthcare workers
    • Jobs with frequent exposure to the general public, e.g., grocery store workers, bus drivers, law enforcement
    • Densely populated neighborhoods and living quarters
    • The homeless
    • Those living in poverty

    When you consider “who” makes up the majority of these population segments, you’ll find it’s women.

    Pay gap

    Women are more likely to live in poverty or have a lower socioeconomic status.

    Consider the statistics:

    • 81% of low-wage earners are women.

    Women overall are paid 82 cents for every dollar a man earns. 

    The story is even worse for subpopulations of women. Black women earn 63 cents, Native American and Alaska Native women – 60 cents, and Hispanic/Latina women – 58 cents.

    • 77.6% of workers in the healthcare and social assistance industries are women.

    The average hourly pay for a caregiver was < $15 per hour in 2022. That translates to an annual income of < $30,000 and is only ~$3000 more than the official poverty line in the U.S. for a household of four.

    The pay gap exists even at higher compensation levels, including for female physicians, where the gap begins in residency and never closes throughout their careers.

    healthy woman and her mom

    Health of women

    In addition to the pay gap, other factors also increase the chances of getting a serious case of COVID-19 and the risk of complications, hospitalization, ICU admission, need for a ventilator, and death.

    They include:

    • Having an underlying medical condition, including diabetes, overweight/obesity, sickle cell disease, thalassemia, asthma, COPD, cystic fibrosis, heart disease, dementia, hypertension, stroke, chronic liver disease, chronic kidney disease, mental health disorders, HIV infection, cancer, autoimmune conditions, immunocompromised status, substance use disorder, or TB
    • Being a current or former smoker 
    • Being a transplant recipient
    • Disabled status
    • Pregnancy
    • Physical inactivity
    • Being a member of a community of color
    • Congregate living
    • Age ≥ 65
    • Issues with access to healthcare
    • Unvaccinated status

    Women are more likely to experience several of the factors above:

    COVID researchers

    How COVID affects a woman’s body

    Beyond the immediate infection and risk of long COVID, there are other ways the virus can impact a woman’s body and well-being, some of which was learned because of women speaking up and being persistent in the report of their experiences.

    For example, menstrual changes have now been documented after women first complained about the issue. COVID also impacts a woman during pregnancy and menopause and can put her at greater risk for thyroid disease and mental and emotional health conditions.

    1. Menstrual changes after COVID-19

    There have been reports of changes in menstrual cycles following COVID-19 infection, including the amount of blood loss and amount of time between consecutive periods.

    Some women have also experienced a change following COVID-19 vaccination, including a change in cycle length and the amount of blood loss, as well as breakthrough bleeding in those on hormone therapy to suppress menstruation. Additional symptoms that have been reported include breast soreness, cramping, and bloating.

    Those at greater risk of changes in menstrual flow following vaccination include:

    • Being a Latina/Hispanic 
    • Taking hormonal contraception
    • Prior pregnancy
    • Prior birth of a baby
    • Development of fatigue and/or fever after vaccination
    • Underlying reproductive system condition – endometriosis, PCOS (polycystic ovary), menorrhagia (menstrual bleeding lasting > 7 days), adenomyosis (tissue lining the uterus grows into the muscle wall of the uterus), and fibroids

    Studies are underway to identify the degree of causality between COVID-19 infection and/or vaccination.

    To date, no ties have been found between infertility and COVID infection or vaccination.

    2. Pregnancy

    Although pregnant women are less likely to become infected than their non-pregnant counterparts, being pregnant increases the risk of more severe disease with a COVID-19 infection as well as the risk of complications, hospitalization including ICU admission (5 times greater risk) and a need for a ventilator, and death (22 times greater risk).

    Additionally, individuals who are Black or Hispanic/Latina and pregnant are at greater risk of becoming infected with COVID-19.

    Women who suffer a COVID infection during pregnancy are more likely to experience:

    • Premature delivery (60% more likely)
    • A stillborn delivery (4 times greater risk)
    • Miscarriage

    Their infants can be affected as well:

    • Potential negative impact on the development of the brain, heart, and kidneys
    • Low birth weight
    • Neurodevelopmental differences (social interaction like cuddling, more difficulty with moving the head and shoulders)

    3. Menopause and COVID-19

    Studies are underway, but the nature of the repercussions of the COVID-19 virus on those who are on the menopause journey is unclear.

    Research seems to indicate the impact depends on the stage of the menopause journey – perimenopause, menopause, or post-menopause.

    In some studies, women who were perimenopausal and therefore had higher estrogen levels than those on the other side of the menopause journey were less likely to suffer from a severe COVID-19 infection.

    The potential protective effect of estrogen relative to the severity of COVID-19 infection in perimenopausal women is similar to that noted in women with regard to both heart disease and osteoporosis.

    Premenopausal women are less likely to suffer a severe infection, but post-menopausal women may experience a severity similar to men, who generally are at greater risk of complications, hospitalization, and death.

    Additionally, women who take hormone replacement therapy (HRT) for menopausal symptoms may also experience a protective effect. In studies in the UK, women who were menopausal had a higher rate of COVID-19 infection than would have been predicted than their counterparts who had estrogen supplementation via birth control pills.

    4. Thyroid disease

    Women are 5 – 8 times more likely to be diagnosed with a thyroid condition than men. Having a COVID-19 infection increases the risk further.

    Some studies have noted the development of new-onset thyroid dysfunction following COVID-19 infection, with inflammation found out to one year in those with a severe infection.

    Other studies indicate subacute thyroiditis has been found to be more common in women following a COVID-19 infection.

    Thyroid disease is a commonly undiagnosed condition, particularly as you get older. Many women find it helpful to discuss with their provider getting a baseline thyroid panel performed and how often it should be checked thereafter. 

    Have your thyroid checked at appointments and discuss how often you should have your thyroid labs checked. thyroid disease is a commonly underdiagnosed condition, particularly as you get older.

    Thyroid disease can mimic some menopause symptoms. For example, hair loss, mood swings, weight gain, and difficulty sleeping can be symptoms of both thyroid disease and the menopause transition.

    Talk to your doctor about how you’re feeling and if you need a diagnostic work-up to identify if thyroid disease plays a role during your journey.

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    5. Emotional and mental health

    Women are reported to have a higher prevalence of depression and anxiety than men.

    During menopause, the North American Menopause Society estimates 45-68% of women experience depression.

    In addition, the pandemic has had a tremendous impact globally on mental health and well-being. It has been felt in higher rates of emotional distress (including depression and anxiety), exacerbation of preexisting mental health conditions (including substance use disorder), and, in some cases, the development of new-onset depression and anxiety as a result of COVID-19 infection.

    Symptoms may be different than those typically associated with these conditions, e.g., fewer issues with sleep and a greater risk of suicide than typically seen with “regular” depression.

    During the menopause transition, a woman’s risk for depression also increases, especially in perimenopause. Know if you’re at greater risk, as there are several factors including previous emotional health issues, overall health status, gynecological health and history, stress, socioeconomic status, and family health history.

    Like COVID depression, symptoms may be different than other times in your life. During the menopause transition, you may not feel blue, which people often associate with depression.

    Instead, you may feel irritable, nervous, or experience mood swings. For some women, menopause is an emotional rollercoaster of highs and lows which often seem unpredictable.

    In a way, menopause is a second adolescence. Remember your teen years? As your hormones fade, your emotional health may be reminiscent of your teen years, when your hormones first began flaring.

    Make your health a priority

    Given these risks for women, now is the time to prioritize health. It’s never too late to start.

    Take preventive care seriously, whether you’ve had COVID-19 or not.

    Know the tests and immunizations you need, based on your age and personal and family history. Get them done on time so you can catch potential problems as early as possible.

    Get your mammograms, PAP smears/HPV, and annual exams, and find out from your PCP the other preventive care services you need based on your age and personal and family history.

    Earlier in the pandemic, there were recommendations for those who were pursuing COVID-19 vaccination to obtain their mammogram screening for breast cancer either prior to vaccination or to wait 4 – 6 weeks after vaccination to avoid a potential false reading of potential cancer due to the time-limited enlargement of lymph nodes that is common following vaccination.

    However, a study published in 2022 in Radiology indicated no need for delay.

    Yearly visits are an opportunity to have frank discussions crucial to healthy aging, menopause, and living a healthy lifestyle that meets your needs and fits your schedule and budget.

    Have your thyroid checked at appointments and discuss how thyroid disease is a commonly underdiagnosed condition, particularly as you age.

    A healthy lifestyle reduces the risk of chronic conditions like diabetes, heart disease, and cancer and can help mitigate the impact of preexisting conditions.

    • Healthy eating also makes a significant difference. It can help you avoid developing obesity and its associated conditions, e.g., heart disease, hypertension, reflux, and sleep apnea, and make it easier to maintain a healthy weight. If you’re in menopause, try these foods packed with nutrients you need during menopause.
    • Getting a sufficient number of hours of sleep of good quality is critical to brain health, weight management, and emotional balance. If you need more sleep, try these day and night relaxation remedies.
    • Identifying techniques that help you cope with life’s challenges and manage stress will stand you in good stead.
    • If you’re inactive, find a way to move. Even taking a walk, can have a beneficial effect on women. It can also help you clear your mind and reduce stress while increasing your heart rate.

      If you’re up for more physical activity, you watch these menopausal exercise videos and try them at home. Mix up your routine. You’re less likely to stick with exercise if you’re always doing the   same thing. Also, think beyond traditional exercise and do something you actually enjoy!. Just being active – like gardening and dancing – will increase your overall activity and could potentially improve your health.

    Talk with your doctor before you start an exercise routine, especially if you have been sedentary.

    In addition to staying healthier overall and trying to be as strong as possible should you get COVID-19 or another illness, exercise can also help manage menopause symptoms.

    diverse women sitting around talking

    The future of women’s health

    Historically, scientific and medical research in the U.S. has been focused on (usually white) men, with findings, recommendations, and guidelines then extrapolated to the rest of the population.

    Additionally, in instances of diseases specific to one sex, or more predominantly found in one sex, those related to men’s health are disproportionately overfunded while women’s health is dramatically underfunded.

    Women going through menopause and experiencing a COVID-19 infection (and any repercussion thereof) find themselves in a “double jeopardy” situation:

    1. We are still in a learning phase regarding the novel coronavirus in general, regardless of gender/sex.
    2. Medical school, residency, and fellowship training is inadequate relative to providing a way to gain the requisite knowledge of menopause and treatment options to address the unmet needs of women on the journey, who will number more than 1 billion by 2025.

    And then to add to a “trifecta of avoidable suffering,” the myriad and numerous symptoms of COVID-19 lend themselves easily to women being subjected to, with their symptoms being minimized, attributed to stress or “hormones,” or being dismissed and ignored altogether.

    Thankfully, one of the “silver linings” of the pandemic is an opportunity to address these gaps and pursue a more inclusive approach to scientific and medical research. The NIH has released a 2019 – 2023 strategic plan for women’s health research. The plan is based on these two definitions:

    • Sex = a biological variable defined by characteristics encoded in DNA, such as reproductive organs and other physiological and functional characteristics
    • Gender = the social, environmental, cultural, and behavioral factors and choices that influence a person’s self-identity and health

    Health and well-being, or the lack thereof, are at least as dependent on factors such as lifestyle, culture, access to high-quality, cost-effective care delivered by culturally competent clinicians, socioeconomic status, education level, disability status, race/ethnicity, discrimination, and healthcare policies as they are on factors such as an individual’s genetics and environmentally-induced mutations, family history, and physiology.

    The novel coronavirus has changed our lives forever and is likely to be with us for years to common. Things are changing quickly, and we learn something new every day. What we believe to be true today will not necessarily be what we believe to be true tomorrow.

    Therefore, it is more important than ever to stay up-to-date on COVID-19 in general and to pay particular attention to its impacts on women’s health.

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