Review Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review

Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation.

Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID.

These associated illnesses, whose patients are 70%–80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth.

Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.

https://www.frontiersin.org/articles/10.3389/fresc.2023.1122673/full

 

Article makes the claim that "Evidence suggests that LC affects twice as many women as men" which is based on a single reference (Long Covid in adults discharged from UK hospitals after Covid-19) which was a 2021 study of just 357 hospitalised patients, that study says:

"In our study, being young, female and having a high severity of acute disease were the strongest independent predictors of poor long-term outcomes. It is unclear why females had the worst outcomes. This could be to do with the effects of initial exposure, where females are more likely to be in industries where exposure to SARS-CoV-2 may be higher [34], however recent data suggests teachers do not have greater exposure than other working-age populations and there is emerging evidence of divergent host responses to SARS-CoV-2 infection [35,36]. Another explanation is that females are more likely to survive severe acute disease than men, so could have worse long-term outcomes as a result. However, in our data, we could not find any differences by sex across several measures of disease severity. A further possibility is that men felt less able or inclined to disclose symptoms. There is some discussion in the literature that recall bias, and also reporting of symptoms may differ between males and females, which may account for some of the gender difference seen – however this would not account for these differences being also related to age as well as gender."

my bolding

Taking a single study of hospitalised only patients and which produced nuanced results when the available data on PASC is vast, looks like cherry picking.