Endometriosis does not increase COVID-19 risk, worsen with mRNA vaccinations

Key takeaways:

• Endometriosis was not associated with COVID-19 susceptibility or worsening symptoms after vaccination.
• Women with vs. without endometriosis had worsening dysmenorrhea after two mRNA COVID vaccines.

Women with endometriosis do not have a higher risk for COVID-19 infection nor worsened symptoms with mRNA vaccinations, but may experience temporary increases in dysmenorrhea, according to findings published in Reproductive Sciences.

“Given the immunological similarities between COVID-19 and hyperinflammatory disorders, it is plausible that endometriosis and SARS-CoV-2 infection could be positively correlated,” Gaetano Riemma, MD, from the department of woman, child and general and specialized surgery at the University of Campania Luigi Vanvitelli in Italy, and colleagues wrote. “On the other hand, given that women with endometriosis might have already been significantly impacted by the COVID-19 pandemic, some studies investigated about the possible effects of the SARS-CoV-2 immunization to plan and recommend specific care for these patients.”

Riemma and colleagues conducted a systematic review and meta-analysis identifying four studies published through March 2024 (n = 2,249). All studies evaluated COVID-19 infection incidence in women with endometriosis or changes in endometriosis symptoms after receiving two COVID-19 vaccine doses.

Primary outcomes were changes in menstruation, intermenstrual bleeding, changes or worsening in dysmenorrhea and chronic pelvic pain due to COVID-19.

The presence or absence of endometriosis was not associated with an increased risk for COVID-19 susceptibility (RR = 1.42; 95% CI, 0.88-2.27). After receiving two mRNA COVID vaccine doses, women with endometriosis did not have overall worsening of symptoms compared with controls (RR = 1.58; 95% CI, 0.67-3.75). However, researchers observed worsening dysmenorrhea for women with vs. without endometriosis with two vaccine doses (RR = 1.88; 95% CI, 1.11-3.17).

Women with endometriosis had no differences in menstrual flow, intermenstrual bleeding or pelvic pain compared with controls after receiving mRNA COVID vaccines.

“The presence of endometriosis does not seem to increase the risk of susceptibility to COVID-19 infections,” the researchers wrote. “However, the limited number of included studies and its related limitation reduces the overall generalizability of the findings, requiring further clarifications in upcoming research.”