The following is a summary of “Association of laparoscopically-confirmed endometriosis with long COVID-19: a prospective cohort study,” published in the JUNE 2023 issue of Obstetrics and Gynecology by Wang, et al.
Women are more susceptible to chronic inflammatory conditions and long COVID-19 than men, but limited research has identified gynecologic health risk factors for long COVID-19. Endometriosis, a prevalent gynecologic disorder characterized by chronic inflammation and immune dysregulation and associated with autoimmune and clotting disorders, shares pathophysiological mechanisms proposed for COVID-19. For a study, researchers sought to assess the potential association between a prior diagnosis of endometriosis and the risk of developing long COVID-19 in women.
They conducted a prospective cohort study involving 46,579 women from the Nurses’ Health Study II and the Nurses’ Health Study 3. Surveys related to COVID-19 were administered between April 2020 and November 2022. Endometriosis, confirmed through laparoscopic diagnosis before the pandemic (1993-2020), was recorded. Self-reported SARS-CoV-2 infection and long-term COVID-19 symptoms (lasting ≥4 weeks), defined by the Centers for Disease Control and Prevention, were assessed during follow-up. Poisson regression models were utilized to analyze the association between endometriosis history and the risk of long COVID-19, adjusting for potential confounding factors.
Of the 3,650 women with self-reported SARS-CoV-2 infections, 386 (10.6%) had a history of laparoscopically-confirmed endometriosis. Additionally, 1,598 (43.8%) reported experiencing long COVID-19 symptoms. Most participants were non-Hispanic White, with a median age of 59 years. Women with a history of endometriosis had a 22% higher risk of developing long COVID-19 than those without endometriosis (adjusted risk ratio 1.22, 95% CI 1.05-1.42). The association was more pronounced when long COVID-19 was defined as symptoms lasting ≥8 weeks (risk ratio 1.28, 95% CI 1.09-1.50). No statistically significant differences between endometriosis and long COVID-19 were observed by age, infertility history, or comorbidity with uterine fibroids. However, there was a suggestive trend indicating a potentially stronger association in women aged <50 years (risk ratio 1.37, 95% CI 1.00-1.88 for <50 years; risk ratio 1.19, 95% CI 1.01-1.41 for ≥50 years). Among individuals who developed long COVID-19, women with endometriosis reported an average of one additional long-term symptom compared to those without endometriosis.
The study’s findings suggested a modestly increased risk of developing long COVID-19 in women with a history of endometriosis. Healthcare providers should consider the history of endometriosis when evaluating patients for persistent symptoms following SARS-CoV-2 infection. Further research was needed to elucidate the potential underlying biological mechanisms driving this association.