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Endometriosis and Covid-19 – Is there a particular risk?

It’s been a year since we’ve started to hear about Covid-19. A year of uncertainty, of dealing with potential yet invisible threat. And a lot of us have been asking ourselves: Am I at risk?

For people affected by endometriosis, this question is particularly important. They are suffering from a chronic disease, oftentimes associated with debilitating pain in various contexts, fatigue (if you want to learn more about Endometriosis, please click here). When the media discusses risk groups for Covid-19, the elderly (60+) and those with chronic illnesses are most often mentioned. In this blog article, I am going to throw light onto the question of whether there is a particular risk for people with endometriosis.


First off, there is (sadly) no simple “yes” or “no” answer when it comes to this question. The Robert-Koch-Institute (RKI), as well as the American Centers for Disease Control and Prevention, don’t explicitly cite Endometriosis as a condition leading to a higher risk of severe illness from the virus that causes Covid-19 (Centers for Disease Control and Prevention, 2020; Robert-Koch-Institut, 2020).


This is a good thing; it means that endometriosis in general doesn’t put you at a higher risk. However, it’s important to look further into it especially if your endometriosis is located in the lungs or the liver. The RKI cites diseases affecting the lungs or the liver as possible risk factors for a severe course of Covid-19 (Robert-Koch-Institut, 2020). There is yet no evidence indicating that there is a higher risk when suffering from thoracic Endometriosis (Leonardi et al., 2020). Though I would recommend you speak to your physician or gynaecologist if you feel uneasy.

In a case-control study, Moazzami et al.(2020) compared the risk of Covid-19 among women with a diagnosis of Endometriosis and without Endometriosis. They found that the prevalence for both groups was the same. However, women with Endometriosis seemed who were infected with Covid-19 seemed to present somewhat different symptoms during their illness. They suffered more from “uncommon” symptoms of gastrointestinal, dermatologic, hematologic and neuronal nature. What does this mean?

Well, it might indicate the need to pay further attention to women with Endometriosis displaying “uncommon” symptoms. Additionally, the authors of the study found that women with Endometriosis had a lower frequency of asymptomatic infections. Of course, the results of this study have to be handled with care, as these are only observations and a causal relationship can’t be inferred. Still, this study gives a first insight into possible relationships between Endometriosis and the virus that causes Covid-19.


Furthermore, if you suffer from other diseases like an immunological or thyroid disease and you take medication that impacts your immune system the RKI classifies you as a risk group for a severe illness from the virus that causes Covid-19 (Robert-Koch-Institut, 2020). If you’re unsure whether the medication you’re taking has an impact on your immune system, talk to your physician or gynaecologist. They can also inform you about your options if you feel uncomfortable about going back to work.

The question of whether Endometriosis leads to a higher risk from Covid-19 can’t be answered in a general manner. It’s necessary to look at each patient individually. If you’re worried I would definitely recommend you to talk to your physician or your gynaecologist. Especially if you suffer from thoracic Endometriosis or take medication that influences your immune system.


Even if you’re not at risk of a more severe Covid-19 infection or more prone to it due to your Endometriosis: the pandemic may lead to a decrease of quality of life for patients with Endometriosis (Leonardi et al., 2020). In a lot of countries, the healthcare system is in disarray due to Covid-19 and the rising numbers of infected people and especially of those with severe illness. The hospitals are focusing on Covid-19 patients as well as vital treatments. Elective treatments that are done in an inpatient setting are oftentimes postponed to maintain open capacities in case of rising infections. Outpatient treatment centres may be closed or working at a lower capacity. This could have an impact on the management of Endometriosis as well. You should be aware of this; if you suffer from acute exacerbations, contact your physician or gynaecologist and decide together whether a face-to-face consultation in the emergency department is indicated. Otherwise, in case of ongoing outpatient treatments discuss with your physician or gynaecologist the best possibilities to continue your current treatment.


I can imagine that you were probably hoping for a clearer answer. But as it’s often the case when it comes to Endometriosis (and to Covid-19 for that instance) there is still a lack of research and basically a lot of things we do not know. So, it’s important that you stay in contact with your physician or gynaecologist and apart from that practice the AHA-formula: Abstand Halten – Keep your distance. Hygiene Beachten – Practice good hygiene. Alltagsmaske Tragen – Wear a mask and cover your mouth and nose. If you want to read up on the more legal aspects of Endometriosis and Covid-19, the Endometriose-Vereinigung Deutschland e.V. has a leaflet on the topic (https://www.endometriose-vereinigung.de/files/endometriose/Veranstaltungen/Geh%C3%B6re%20ich%20mit%20meiner%20Endometriose%20zur%20Risikogruppe.pdf). Stay safe everyone!


References

Centers for Disease Control and Prevention. (2020, November 2). Coronavirus Disease: People wih Certain Medical Conditions. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Leonardi, M., Horne, A. W., Armour, M., Missmer, S. A., Roman, H., Rombauts, L., Hummelshoj, L., Wattiez, A., Condous, G., & Johnson, N. P. (2020). Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Considerations. Frontiers in Reproductive Health, 2, Article 5. https://doi.org/10.3389/frph.2020.00005

Moazzami, B., Chaichian, S., Samie, S., Zolbin, M. M., Jesmi, F., Akhlaghdoust, M., Pishkuhi, M. A., Mirshafiei, Z. S., Khalilzadeh, F., & Safari, D. (2020).Does Endometriosis Increase Susceptibility to COVID–19 Infections? A case-control study in Women of Reproductive Age. https://doi.org/10.21203/rs.3.rs-45026/v1

Robert-Koch-Institut. (2020). Informationen und Hilfestellungen für Personen mit einem höheren Risiko für einen schweren COVID-19-Krankheitsverlauf. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogruppen.html

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