Why Women Seem To Have a Better COVID-19 Outcomes than Men?

The COVID-19 pandemic has caused an enormous strain on societies and healthcare systems. Although women are infected, they appear to be protected from poor outcomes when compared with men even after adjusting confounding factors. 

In a new study, researches from Sweden tried to determine wheter aufmentation of estrogen in postmenopausal women decreases the risk of death following COVID-19. 

The study included a nationwide cohort of women diagnosed with COVID-19 between 4 of February and 14 of September 2020 in Sweden. The researchers included 16,693 postmenopausal women between the age of 50 and 80 who tested positive during the study period. 

The researchers were interested in women who were under medications that affect estrogen levels. 227 women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic estrogen levels), and 2,500 were undergoing hormone replacement therapy.

After they take into account all the women’s comorbidities, such as age, and socioeconomic factors, the researchers found that women who were taking medications that raised estrogen levels were about half as likely to die from COVID-19 as women who were not taking these medications. 

The researchers concluded that estrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in their study population. 

Research has shown an association between estrogen and the immune response that may limit inflammation. In COVID-19 most of the damage caused by the disease is secondary to an increased activation of the immune system, known as cytokine storm. It seems like estrogen could be a protective factor in women against this overactivation of the immune system, which could be a protective factor and the reason by which they have better outcomes compared to men. 


Sund M, Fonseca-Rodríguez O, Josefsson A, et al. Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort studyBMJ Open 2022;12:e053032. doi: 10.1136/bmjopen-2021-053032

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