# Post-COVID fatigue disproportionately affects women: evidence from the DEFEAT Corona cohort

## TL;DR

Women experience more severe and frequent fatigue after recovering from COVID-19 compared to men, with symptoms often worsening during their menstrual cycle.

## Contribution

This study provides evidence that post-COVID fatigue disproportionately affects women, including menstrual cycle-related symptom worsening.

## Key findings

- Female participants reported higher prevalence and severity of fatigue-related symptoms compared to males.
- Around two-thirds of menstruating patients with PCS reported worsening fatigue symptoms during their menstrual cycle.

## Abstract

Post COVID syndrome (PCS) affects approximately 6–10% of COVID-19 survivors, with fatigue being one of the most prevalent and debilitating symptoms. While emerging evidence suggests sex and gender-based differences in PCS manifestation, the specific impact on fatigue-related symptoms remains poorly understood, particularly regarding women’s experiences.

We analyzed data from 2,549 participants with PCS (80.6% female, 19.2% male, 0.2% non-binary) from DEFEAT, an online platform surveying people with and without PCS. Participants with confirmed SARS-CoV-2 infection were included if they reported symptoms typical for PCS persisting >4 weeks post-infection. Fatigue-related symptoms including fatigue, brain fog, sleep disturbances, and associated quality of life measures were assessed using validated instruments.

Female participants reported significantly higher rates of fatigue-related symptoms compared to males: fatigue was more prevalent in females (53.5% vs. 46.3%, p < 0.001), as were brain fog (54.9% vs. 44.7%, p < 0.001), and sleep disturbances (54.8% vs. 45.3%, p < 0.001). Female participants also reported significantly higher fatigue severity scores and poorer health-related quality of life (mean EQ-5D score 0.66 (SD 0.23) vs. 0.71 (SD 0.23) in males, p < 0.001). Around two thirds of menstruating PCS patients reported menstrual cycle associated worsening of fatigue symptoms.

Our findings demonstrate significant gender-based differences in fatigue-related symptoms in PCS, with women experiencing both higher prevalence and severity, and menstrual cycle associated symptom worsening. These results highlight the importance of sex and gender-specific approaches to understanding and managing PCS-related fatigue, with implications for clinical care and future research directions.