{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:21:07Z","timestamp":1771935667101,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post COVID syndrome (PCS) affects approximately 6\u201310% 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\u2019s experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &amp;gt;4\u202fweeks post-infection. Fatigue-related symptoms including fatigue, brain fog, sleep disturbances, and associated quality of life measures were assessed using validated instruments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Female participants reported significantly higher rates of fatigue-related symptoms compared to males: fatigue was more prevalent in females (53.5% vs. 46.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), as were brain fog (54.9% vs. 44.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and sleep disturbances (54.8% vs. 45.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). 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,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Around two thirds of menstruating PCS patients reported menstrual cycle associated worsening of fatigue symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1755106","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:36:15Z","timestamp":1771223775000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-COVID fatigue disproportionately affects women: evidence from the DEFEAT Corona cohort"],"prefix":"10.3389","volume":"14","author":[{"given":"Mareike","family":"Meier-Maiwald","sequence":"first","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School","place":["Hannover, Germany"]},{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Riester","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"St\u00f6lting","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Klawonn","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Ostfalia University of Applied Sciences","place":["Wolfenb\u00fcttel, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Th\u00f6lking","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolin","family":"Beinhauer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktoria","family":"Lampe","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena-Marie","family":"Theil","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg MN","family":"Behrens","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imke","family":"Von Wasielewski","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, Hannover Medical School","place":["Hannover, Germany"]},{"name":"Department of Medical Education, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]},{"name":"Department of Family Medicine, Michigan State University","place":["Grand Rapids, MI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Steffens","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]},{"name":"Department of Medical Education, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Dopfer-Jablonka","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Happle","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School","place":["Hannover, Germany"]},{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hannover, Germany"]},{"name":"German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Mikuteit","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, Hannover Medical School","place":["Hannover, Germany"]},{"name":"Department of Medical Education, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1038\/s41579-022-00846-2","article-title":"Long COVID: major findings, mechanisms and recommendations","volume":"21","author":"Davis","year":"2023","journal-title":"Nat Rev Microbiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.1001\/jama.2022.18931","article-title":"Estimated global proportions of individuals with 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