For many people, Covid-19 symptoms — the hacking cough, fever, and runny nose — fade within a few weeks. But for others, the struggle doesn’t end there: Lingering problems like fatigue and brain fog can persist for months, or even years, after the initial infection. And according to new research, women are at a significantly greater risk of experiencing these long-term issues than men are.
A recent study published in the medical journal JAMA Network analyzed data from over 12,000 adults, and found that women were 31 percent more likely than men to develop long Covid. But there was an even higher risk seen in women aged 40 to 54 who hadn’t yet reached menopause — that cohort was 45 percent more likely to develop long Covid, compared to men of the same age. (The study showed no significant difference in risk for postmenopausal women, or those aged 18 to 39, when compared to men of similar age.)
These eye-opening findings are part of the National Institutes of Health’s nationwide RECOVER initiative, which is focused on better understanding the long-term impacts of Covid. Here’s what you need to know from this groundbreaking report.
Why are women at a higher risk for long Covid?
Women may be more susceptible to developing long Covid due to a combination of biological and hormonal factors, with estrogen playing a key role. As the primary female sex hormone, estrogen helps regulate the immune system, but it can also trigger a stronger immune response to the virus, potentially contributing to persistent symptoms.
That’s why women aged 40 to 55 are at the highest risk for long-term health issues post-Covid: They have elevated levels of estrogen (which naturally declines during menopause) compared to older women. This hormonal shift may explain why women in this age group are more likely to experience persistent symptoms following an infection.
Other factors might be at play when it comes to the differing long Covid rates between men and women, too. Dimpy Shah, who led the recent research, stated in the study that differences in autoimmune disease rates and preexisting health conditions between men and women could further influence these disparities.
The promising aspect of this research is its potential to pave the way for new treatments for long Covid. As the study’s authors highlighted, “Understanding the mechanisms of sex differences can provide preventive and management strategies for not only long Covid but also other postviral illnesses.”
How do women’s long Covid symptoms differ from men’s?
Not only do men and women develop long Covid at differing rates, it may manifest in different ways as well. The study noted that men and women with long Covid tend to experience different symptoms, a finding supported by other research, including insights from immunobiology expert Akiko Iwasaki.
Iwasaki shared with The Washington Post that men with long Covid are more likely to experience sexual dysfunction, while women tend to deal with symptoms like hair loss, gastrointestinal issues, dry eyes, and a loss of smell and taste. Overall, women with long Covid also report a higher number of more severe symptoms compared to men.
Did the study have any limitations?
While the study provides valuable insights, it has a few restrictions: For instance, there may have been unintentional bias at work if women were more likely to report symptoms in the first place, or if they were more inclined to voluntarily participate in the study. (To address this, the researchers focused on participants enrolled during the acute phase, which led to a smaller sample size.)
The study also lacked critical data, such as hormone levels, the timing of infection relative to the menstrual cycle, and information on hormone-related medications or pregnancy history. Additionally, there may have been differences in dropout rates between men and women due to symptoms. The absence of control groups — such as individuals with pre-existing symptoms or those infected with other viruses — also limited the ability to make clear comparisons.
What makes these findings unique?
This study still stands out for several compelling reasons. By tracking participants at various stages before and after a Covid infection, the researchers were able to pinpoint sex-based differences at multiple points in the recovery process. What sets this study apart even more is its large and socioeconomically diverse cohort, offering a more-complete picture of how different groups are affected — something many previous studies have lacked.
Ensuring accuracy was a key focus for the researchers: They made sure their estimates were reliable by factoring in details like vaccination status and the specific Covid variant which participants were exposed to. This careful balancing helped them produce the most dependable results possible.
One of the study’s biggest strengths, however, lies in its data collection through a standardized questionnaire. This approach minimizes the risk of reporting bias and disparities in healthcare access — common pitfalls in studies relying on routine clinical care data.
Beyond the numbers, this research could have a powerful impact on how long Covid is understood, particularly for women. By validating women’s experiences with the disease, the study not only reinforces that their concerns are real, but also encourages those struggling with lasting symptoms to seek the medical attention they need.
