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Hormonal health

Study reveals why women more likely to get severe long Covid

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New research has uncovered biological differences that explain why women with long Covid experience more severe and persistent symptoms than men.

Long Covid is diagnosed when neurological, respiratory or gastrointestinal symptoms persist for three months or more after SARS-CoV-2 infection.

Women are about three times more likely than men to develop it, but the biology behind this gap has been unclear.

The research from the University of Alberta suggests potential treatment targets that could help the 3.5 million Canadians who reported long Covid as of June 2023, according to Statistics Canada.

Principal investigator Shokrollah Elahi is an immunology professor in the Mike Petryk School of Dentistry.

The researcher said: “We are focusing on a subset of patients with the most devastating symptoms that are very similar to chronic fatigue syndrome.

“They didn’t have these symptoms prior to Covid and most had only mild Covid-19 disease, so they were not hospitalised.”

Elahi’s team ran blood and genetic tests on 78 patients with long Covid one year after their acute diagnosis, plus 62 controls who did not develop long Covid after infection.

By analysing immune cells, blood biomarkers (measurable signals of disease) and RNA sequencing (a method to read gene activity), the researchers identified a distinct immune signature in female versus male patients.

They found evidence of “gut leakiness” in female patients — when the intestinal barrier becomes more permeable and allows substances to pass into the bloodstream — including raised levels of intestinal fatty acid-binding protein, lipopolysaccharide and soluble CD14.

These signs of gut inflammation can trigger wider inflammation once in circulation.

“This suggests that probably at the earliest stage of disease when patients get acute SARS-CoV-2 infection, there is a tendency that the females’ guts are more prone to viral infection,” Elahi said.

The team also observed lower red blood cell production — anaemia — in female patients, suggesting elevated inflammatory factors in women with long Covid may impair blood formation.

In addition, they reported dysregulated sex hormones in long Covid: reduced testosterone in affected women, decreased oestrogen in male patients, and lower cortisol in both.

Women with lower testosterone had higher inflammatory markers. Because testosterone can help dampen inflammation, reduced levels may leave women more vulnerable to ongoing inflammatory responses. Lower testosterone was also linked to brain fog, depression, pain and fatigue.

The findings suggest hormone imbalance plays an important role in long Covid, particularly in how it affects women, Elahi said.

These results mirror some features of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which also disproportionately affects women.

For example, chronic inflammation is common to both, although anaemia is not typically associated with chronic fatigue.

The team’s conclusions are supported by another recent international study of more than 500 patients that also identified anaemia as a major biological driver of long Covid.

Elahi plans to validate the findings by testing potential treatments in mouse models of long Covid and is seeking funding for a clinical trial.

He proposes an individualised approach guided by test results that could include anaemia treatment, anti-inflammatory medicines and, in some cases, sex hormones.

He also aims to further explore similarities between neurological symptoms of long Covid and those seen in HIV.

Wellness

Swimming, periods and finding freedom in my body

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By WUKA sports ambassador, Hannah Miley MBE 3x Olympian & Commonwealth champion

I started swimming when I was really young, I just loved being in the water.

The pool quickly became my second home, the place where I felt most like myself. I wasn’t a natural swimmer, but I loved to work hard, and racing gave me that outlet for my competitive side.

There was something about the rhythm of the strokes, the smell of chlorine, and the quiet hum beneath the surface that made me feel free.

I got my first period around age 12, and it was daunting. My body was changing, and I didn’t know what that meant for my swimming.

Wearing a swimsuit every day made me feel exposed, and I just assumed everything I was going through (heavy bleeding that lasted up to two weeks, cramps so bad they left me doubled over) was normal.

There were moments that really knocked my confidence: not realising my tampon string was visible, or climbing out of the pool to find blood running down my leg.

At competitions, I’d sometimes sit on my towel because I’d leaked through.

The heavy bleeding left me anaemic and constantly tired, but I kept pushing through. I wanted to swim at the highest level I could even if it meant battling my body every month.

Competitions & The Pill

I’ll never forget the 2004 Commonwealth Youth Games. My period started mid-competition, and during one race, the cramps hit hard.

Swimming through that pain was frustrating, all that training felt wasted. When I saw my GP back home, I was told the best way to “fix my period problems” was to go on the pill.

Those two words, fix and problems, shaped how I thought about my body for years.

At first, the pill seemed like the perfect solution. No more painful, unpredictable periods! I ran packets back to back to skip bleeds during competitions, thinking I was being smart.

What I didn’t realise was that the seven day break wasn’t a real period at all, it was a withdrawal bleed. I thought I was in control of my cycle, but I was actually masking it.

I didn’t understand how important my hormones were for health, recovery, and performance.

On the surface, everything looked fine. Beneath that, I was struggling. Under-fuelling, getting ill before big meets, and picking up constant shoulder and knee niggles.

But I didn’t connect any of it to my hormonal health. The pill blurred the picture, and for years, I lived in fear of my period returning at the “wrong” time.

Nothing compares to the emotion you feel when you make an Olympic team.

When I realised I had qualified for my first Olympics in 2008, it was surreal the culmination of years of early mornings, long sessions, and relentless dedication.

Standing on the pool deck with “Team GB” on my kit felt like stepping into a dream that little Hannah could only have imagined.

Racing around the world, representing Scotland and Team GB, was the greatest honour of my career.

Each competition taught me more about resilience, discipline, and the incredible things the human body can do when you push it to its limits.

I went on to swim at three Olympic Games, and while each one was different, they all shaped me not just as an athlete, but as a person learning to listen to and respect her body.

It wasn’t until 2020, during lockdown, that I finally came off the pill after more than 15 years. I was speaking to Dr Georgie Bruinvels when she asked a simple but powerful question:

“When was the last time you actually had a period?”

That question stopped me in my tracks. The answer? Not since before I started the pill as a teenager, over 15 years ago.

I learned that I should have taken longer breaks to let my hormones reset after five years.

It was probably mentioned when I first started but at 15 the chances of me remembering were going to be slim. I wished someone had reminded me.

For the first time, I began tuning into my body, tracking my cycle, adjusting my nutrition, and paying attention to the signals I’d ignored for so long. The difference was incredible.

My periods now last about five days, my cramps are mild and manageable, and I finally feel in sync with my body instead of fighting against it. And no little pill to remember to take each day.

The knowledge I have now would’ve been game changing for me as a young athlete.

Finding Freedom Again — This Time, on My Period

WUKA Sports Ambassador

Becoming a WUKA Sports Brand Ambassador felt like everything coming full circle.

To work with a company whose values aligned with my mission, supporting and empowering female athletes was incredible.

As an athlete, I only ever used tampons because I thought that was my only option.

But discovering products like period underwear and period swimwear has completely changed how I feel about my body and my period.

The first time I tried WUKA period pants, I couldn’t believe how comfortable they were. No rustling, no movement, and no fear of leaks. I actually forgot I was wearing them!

And their period swimwear? Game changer. No more worrying about climbing out of the pool and noticing blood running down my leg just confidence and freedom.

I can’t help but think how different my experience as a teenager could have been if products like this had existed then.

They would’ve given me comfort, reassurance, and a sense that my period wasn’t something to hide or fear.

That’s why I’m so passionate about opening up conversations around periods in sport.

For so many young athletes, missing training isn’t an option, but competing while bleeding can be stressful and distracting.

Period-proof swimwear can take away that anxiety — letting you focus on your performance, not your period.

What I’ve Learned

My journey has taught me that periods aren’t a “problem” to be fixed, they’re a natural, powerful part of who we are.

With the right knowledge, support, and tools, we can work with our bodies, not against them.

Period proof swimwear might seem like a small thing, but for a young swimmer, it can mean the world. It can mean the difference between fear and freedom, between shame and Confidence.

Periods are not the enemy of performance.

Ignoring them is.

Find out more about Wuka at wuka.co.uk 

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Features

Half of countries lack endometriosis care policies

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Nearly half of countries lack national policies or clinical guidance for endometriosis care, a new global review has revealed.

Endometriosis affects about one in ten women and girls worldwide. Across 194 WHO member states, researchers found striking disparities in care.

More than a quarter of countries have no publicly available clinical recommendations, and only 7 per cent have government-endorsed care guidelines.

In many places, the only guidance comes from informal sources such as advocacy sites or social media, leading to inconsistent care.

Europe had the widest guideline availability, while many low- and middle-income countries had little or none.

Devon Evans, assistant professor at the University of Manitoba, said: “Our findings show that many people living with this chronic condition are navigating care in regions where no official recommendations exist.”

A companion analysis reported that half of all countries had no policy information available.

Ninety-six countries recognised endometriosis as a national problem, 48 put it on the political agenda, and 12 adopted policies for a national strategy.

Notable examples include national action plans in Australia and France that are being implemented and evaluated.

Tatjana Gibbons if from the University of Oxford’s Nuffield Department of Women’s & Reproductive Health.

Gibbons: “Despite increasing awareness of endometriosis, addressing the challenges faced by those living with the condition requires coordinated national strategies developed in collaboration with policymakers, advocates and patients themselves, to reduce its global burden.”

The authors called for governments, medical societies and patient groups to collaborate on clear, region-specific care standards to cut diagnostic delays, improve quality of life and ensure equitable access to treatment.

An accompanying editorial urged a shift “from awareness to action”, with WHO noting the condition’s physical, mental and socioeconomic impact and the need to demonstrate that policies and guidelines translate into real-world improvements.

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Wellness

Sleep-related disorders linked to hypertension in postmenopausal women

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New research suggests sleep disorders in postmenopausal women may raise the risk of hypertension — abnormally high blood pressure.

Postmenopausal women tend to have poorer blood pressure control than men of the same age, partly due to falling oestrogen.

They also report more sleep problems, including short sleep, trouble sleeping or obstructive sleep apnoea (when breathing repeatedly stops and starts during sleep).

A study of more than 3,500 naturally postmenopausal women examined links between sleep-related disorders and the odds of hypertension.

The study found that trouble sleeping and obstructive sleep apnoea were associated with higher odds of hypertension.

It also suggested a U-shaped pattern for sleep duration — both too little and too much sleep were linked with increased risk.

A subgroup analysis indicated body mass index played a role, with stronger effects seen in women with obesity.

The findings highlight the value of sleep health and weight management in reducing hypertension risk in this group.

Dr Monica Christmas, associate medical director for The Menopause Society, said: “Although it isn’t possible to determine causality or which came first—sleep dysfunction or hypertension—the study findings raise awareness around the importance of improving sleep quality and optimal weight management during and after the menopause transition as key factors in mitigating long-term cardiovascular risk.”

Sleep is fundamental to cardiovascular health, and women after the menopause commonly report difficulty getting adequate rest.

Despite a research gap focused specifically on postmenopausal women, evidence increasingly supports sleep disturbance as a substantial, often undervalued, risk factor.

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