Researchers at Johns Hopkins University found that women are more likely than men to struggle with long COVID, according to a study published in the Journal of the American Medical Association (JAMA) in late January 2025. Since the emergence of the COVID-19 virus, many have suffered from fatigue, brain fog, and shortness of breath long beyond their initial infection. These persistent symptoms led doctors to recognize and diagnose long COVID as a distinct condition. Now, scientists have discovered that these lingering effects may be linked to estrogen, offering potential new pathways for treatment and prevention.
To better understand this connection, researchers analyzed data from 12,276 adults who had tested positive for COVID-19. Participants shared details about their symptoms, overall health, and hormone-related factors through an online survey. The team also examined women using hormone-based treatments, like birth control or menopause therapy, to examine how different estrogen levels might influence long COVID risk.
The study found that women were 31% more likely than men to develop long COVID, with the highest risk—up to 45%—seen in women aged 40 to 55. Researchers believe this increased risk is linked to hormonal changes, particularly shifting estrogen levels during perimenopause. These fluctuations may lead to an exaggerated immune response after infection, causing lingering issues like hair loss, gastrointestinal problems, dry eyes, and a loss of smell and taste.
This finding may share mechanisms with autoimmune conditions, where women are nearly twice as likely as men to develop diseases like lupus, rheumatoid arthritis, and multiple sclerosis. Experts suggest that estrogen’s role in regulating immune responses could be a common factor in both scenarios. In contrast, men with long COVID are more likely to experience issues like sexual dysfunction, highlighting how the condition can manifest differently based on sex. As Dimpy Shah, an assistant professor of population health sciences with the Joe R. and Teresa Lozano Long School of Medicine at the University of Texas Health Science Center at San Antonio, who led the study, noted, “Even if they end up in the same place, the underlying drivers of disease can be quite different.”
Shah also pointed out the study’s limitations. Much of the data relied on self-reported symptoms, which can be influenced by personal perception and access to healthcare. Additionally, while the study identified a link between estrogen and long COVID risk, it did not directly measure hormone levels in participants, leaving room for other factors to play a role. Shah and her team emphasize that more research is needed to fully understand the biological mechanisms behind these differences, including how hormonal changes, genetics, and pre-existing health conditions might contribute.
This research could eventually lead to sex-specific treatment approaches for long COVID patients, potentially including hormone-based therapies that might help millions of women still suffering from this debilitating condition.
SOURCES
https://www.health.harvard.edu/womens-health/menopause-and-long-covid-whats-the-connection