Flu, COVID-19 and menopause: a perfect storm?

With flu season upon us, this trio might look like a scary combination – but there are ways to keep yourself safer 

By Dr Ornella Cappellari 


Flu season is fast approaching. This year, though, it will be a little bit different, thanks to COVID-19. To complicate matters further, COVID can be mistaken for flu, and vice versa. While research suggests that female hormones provide protection against coronavirus, the fact that oestrogen decreases during perimenopause means women may be more vulnerable to the virus in menopause and beyond.   

Let’s start from the beginning… 

What are the symptoms of flu? 

Common influenza (flu) can cause mild to severe illness, and can sometimes even lead to death. Flu is different from a cold and usually comes on suddenly. People with flu often experience some or all of these symptoms: 

  • Fever or feeling feverish/chills (remember that not everyone with flu will have a fever)
  • Sore throat 
  • Cough 
  • Muscle or body aches 
  • Runny or stuffy nose 
  • Headaches 
  • Fatigue (tiredness) 
  • Some people may also have vomiting and diarrhoea, though this is more common in children 
What are the symptoms of COVID-19? 

Most common symptoms: 

  • Fever  
  • Tiredness 
  • Dry cough 

Less common symptoms: 

  • Aches and pains 
  • Loss of taste or smell 
  • Diarrhoea and gastrointestinal symptoms 
  • Conjunctivitis 
  • Sore throat 
  • Headache 
  • Skin rash, or discoloration of fingers or toes 

Serious symptoms: 

  • Difficulty breathing or shortness of breath 
  • Chest pain or feeling pressure 
  • Loss of speech or movement 

How are the COVID and influenza viruses similar? 

As you’ve probably noticed from the symptoms listed above, the COVID-19 and influenza viruses have a similar presentation. In fact, they both cause respiratory disease, which can present as a wide range of symptoms and severity, from asymptomatic or mild through to severe disease and even death.  

Both viruses have the same means of transmission: by contact and through droplets. As a result, the same public-health measures used for COVID, such as hand hygiene and good respiratory “behaviour” (coughing into your elbow or into a tissue, and wearing a mask), are also important with flu – they can help prevent infection as they dramatically reduce the spread of the virus.  

What can we do in terms of prevention? 

By now we should all be aware with COVID-19 that it’s paramount to wear a mask and follow guidelines on hand sanitising and social distancing. It might also be a good idea to get a flu vaccination, in order to be able to exclude influenza as a cause if you start experiencing symptoms. Of course, vaccination may not be available for everyone. It’s important that those at higher risk should get the vaccine as soon as possible (for example, elderly people and those with existing health problems). 

What about menopause and COVID-19?  

The menopause (or, more precisely, perimenopause) is a period of active hormonal “restructuring” in the body, in which you are getting used to new “low” levels of hormones. This means that your system is already more fragile as it adapts to your new situation, so the combination of menopause and COVID-19 could potentially have serious consequences. 

According to various studies, the older generation are more at risk from COVID-19. Around 80% of deaths occur in people who are over 60, while in children and adolescents below the age of 20 the virus is not considered a threat. Also at risk are those with pre-existing chronic conditions such as asthma, diabetes and cardiovascular disease – precisely the issues that can affect women around perimenopause, thanks to lack of oestrogen. 

Why is oestrogen so important? First, estradiol (E2) – one of the three oestrogens naturally produced in the body – has receptors on all innate and adaptive immune cells (the cells responsible for our immune-system response) and is a key player in the immune response itself. 

Estradiol (E2) is also a modulator of the renin-angiotensin-aldosterone system, a major force both in starting the inflammatory response and in the resolution of inflammation. E2 also plays a pivotal role in regulating the lipid mediators and peptides needed for an optimal immune response, improving the likelihood of a positive outcome in the fight against infectious agents such as SARS-CoV-2.  

Women taking HRT are in a much safer position when it comes to fighting Covid-19 – so it’s important to understand the significance of hormone replacement therapy in relation to this landmark disease. As always, that’s what we’re trying to do here at MegsMenopause.com – to inform, connect and care.