It was while working at home, that Dr Sarah Glynne and her husband, Paul, began to grow suspicious.

Sarah, an NHS GP in Oxshott, Surrey, and menopause specialist at London’s Portland Hospital, was seeing increasing numbers of women who appeared perimenopausal, but also had good reason to think they were suffering with long Covid.

Paul, a general practitioner and consultant at University College Hospital, was being inundated with long Covid patients and was inadvertently becoming a specialist in that area.

What surprised the couple was the realisation that a significant proportion of the symptoms they were seeing crossed over. During virtual appointments, they found they were running up and downstairs asking one another’s advice. 

“The symptom profiles of long Covid and menopause are almost identical,” says Dr Glynne, 46. “Brain fog, fatigue, exhaustion, not being able to exercise, headaches, chest pain, palpitations, irritable bowel, skin rashes – they’re hard to differentiate.”

The National Institute for Health and Care Excellence (Nice) defines long Covid as any effects of the virus that continue more than 12 weeks after the initial infection. According to the ONS data published this month, 1.3 million Britons – one in 50 of us – were living with long Covid before omicron hit, and 40 per cent have been suffering for more than a year. And while men over 50 have tended to be hit harder by acute Covid infections, it is women who seem to be suffering with longer-term effects. UCLH – which opened the UK’s first long Covid clinic – has reported that 66 per cent of its patients are female. “Women aged 40 to 50 are twice as likely to get long Covid compared to men of the same age,” adds Dr Glynne.

So what’s going on? Is long Covid being confused with the menopause, or is there a link? And could HRT be the answer?

For specialists like Dr Glynne, one clue lies in how Covid attacks the body – via ACE2 receptors that are present in the lungs, heart, blood vessels and ovaries. If they become inflamed, this could easily lead to dysfunction in the production of oestrogen and testosterone.

And initial research has pointed to a connection between Covid and hormone levels. A February 2021 study using the Oxford Royal College of General Practitioners database found that women already taking HRT were 78 per cent less likely to die of Covid. In September 2021, the Zoe app demonstrated that women on the contraceptive pill were less likely to catch it in the first place. And in a survey by menopause specialist Dr Louise Newson in October, 80 per cent of women with long Covid reported their menstrual cycles hadn’t returned to normal, with 62 per cent saying their symptoms were worse just before their period – when hormone levels are at their lowest.

This spurred Dr Glynne to do her own research: she now estimates that approximately a third of all long Covid patients are women in that perimenopausal or menopausal age bracket, and for whom oestrogen deficiency might be driving symptoms. 

“That’s a lot of women, with families and jobs,” she says. “Given that there are no alternative effective treatments for long Covid, and HRT is very safe and cheap, it seemed sensible to try it. There was nothing to lose.”