Menopausal hormone therapy and postcovid syndrome: new realities

Abstract

Due to the total aging of the population, within the framework of the concept of “active longevity”, age-related aspects of women’s health have been paid close attention in the last decade. The physiological features of the menopausal period of life are due to the consequences of estrogen deficiency, while the protective effect of menopausal hormone therapy (MHT) in relation to diseases associated with age and aging leaves no doubt. At the same time, in the context of the ongoing COVID-19 pandemic, there are many open questions related to the appointment of MHT, both in terms of possible additional mechanisms for protecting the vascular wall, and in terms of risks, including against the background of changes in the state of immunity and the coagulation system. New realities require the development and justification of often fundamentally different approaches to the management of patients in gynecological practice, both in connection with coronavirus infection and in the postcovid period. That is why the organization of gynecological care during a pandemic requires a personalized approach to the management of patients with hormone-dependent diseases and the risk of unplanned pregnancy, as well as the development of clear algorithms that can be relied on in the daily work of both a practitioner and health care organizers.

Clinical and genetic aspects of menopausal hormone therapy - a modern paradigm. What changed COVID-19 pandemic?

“…However, there is no doubt that the combination of a number of alleles of the coagulation system genes and the immune response aggravate the course of COVID-19 and postcovid syndrome in people with age-related hypogonadism. This is especially important to consider in women taking MHT [8].…”

“…The ongoing discussions about its safety have good reasons. On the one hand, a review of numerous data shows that MHT increases the risks of thromboembolic diseases and hypercoagulation-related complications characteristic of COVID-19, including iatrogenic [6][7][8]. On the other hand, estrogens have been proven to protect the vascular endothelium, since their expression increases the synthesis of endothelial NO synthase, an enzyme involved in the formation of a powerful vasodilating factor nitric oxide (NO).…”

“…On the other hand, estrogens have been proven to protect the vascular endothelium, since their expression increases the synthesis of endothelial NO synthase, an enzyme involved in the formation of a powerful vasodilating factor nitric oxide (NO). In addition, estradiol increases the number of CD 4+ T cells, providing an adequate immune response when infected with SARS-CoV-2 [4,8].…”