Hormone Therapy in the Era of the COVID-19 Pandemic: A Review

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has impacted the medical, social, and reproductive health of millions of people since its outbreak. The causative virus transmits, reproduces, and manifests through the respiratory tract. COVID-19 can invade any system of the body, including the cardiovascular and endocrine systems, through a secondary immune response. In particular, because the fatality rate is high in those over the age of 50 years, special attention is required during the medical care of this population. However, considering the benefit of therapy and the risk of COVID-19, high-quality evidence regarding individualized management in relation to hormone therapy is still insufficient in the field of gynecology. Furthermore, this review aims to serve as a reference for clinical application by analyzing and summarizing the results of studies reported to date regarding female hormone therapy in the context of the COVID-19 pandemic.

Keywords: COVID-19; Contraceptives; Hormone therapy; Vaccine.

Fig. 1. The mechanism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetration into the body. ANG: angiotensin, ACE2: angiotensin-converting enzyme 2, IL: interleukin, TNF-α: tumor necrosis factor-α, NRP1: neuropilin 1.

Fig. 2. Effects of estrogen on immune-related cellular pathway and organs through the estrogen receptor. ERα or β: estrogen receptor α or β, SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, ACE: angiotensin-converting enzyme, AT1R or AT2R: angiotensin2 receptor 1 or 2, ACE2: angiotensin-converting enzyme 2, MasR: mitochondrial assembly receptor.

Fig. 3. Changes in the course of infection through immunemodulation by estrogen. IL-2, 6, or 10: interleukin-2, 6, or 10, MIP1α or β: macrophage inflammatory protein-1 alpha or beta, MCP1: monocyte chemoattractant protein-1, IFN-γ: interferon gamma, FCN1: ficolin-1, G-CSF: granulocyte-colony-stimulating factor, TNF: tumor necrosis factor.