Association of laparoscopically-confirmed endometriosis with long COVID-19: a prospective cohort study

• Published in: American journal of obstetrics and gynecology 2023-06, Vol.228 (6), p.714.e1-714.e13
• Main Authors: Wang, Siwen, Farland, Leslie V., Gaskins, Audrey J., Mortazavi, Jasmine, Wang, Yi-Xin, Tamimi, Rulla M., Rich-Edwards, Janet W., Zhang, Dan, Terry, Kathryn L., Chavarro, Jorge E., Missmer, Stacey A.
• Format: Article
• Language: English
• Subjects: COVID-19; endometriosis; Endometriosis - diagnosis; Female; Humans; Infertility; inflammation; laparoscopically-confirmed endometriosis; long COVID; Middle Aged; Post-Acute COVID-19 Syndrome; post-COVID-19 conditions; Prospective Studies; SARS-CoV-2
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2023.03.030

Women are at greater risk than men of developing chronic inflammatory conditions and “long COVID.” However, few gynecologic health risk factors for long COVID-19 have been identified. Endometriosis is a common gynecologic disorder associated with chronic inflammation, immune dysregulation, and comorbid presentation with autoimmune and clotting disorders, all of which are pathophysiological mechanisms proposed for long COVID-19. Therefore, we hypothesized that women with a history of endometriosis may be at greater risk of developing long COVID-19. This study aimed to investigate the association between history of endometriosis before SARS-CoV-2 infection and risk of long COVID-19. We followed 46,579 women from 2 ongoing prospective cohort studies—the Nurses’ Health Study II and the Nurses’ Health Study 3—who participated in a series of COVID-19-related surveys administered from April 2020 to November 2022. Laparoscopic diagnosis of endometriosis was documented prospectively in main cohort questionnaires before the pandemic (1993–2020) with high validity. SARS-CoV-2 infection (confirmed by antigen, polymerase chain reaction, or antibody test) and long-term COVID-19 symptoms (≥4 weeks) defined by the Centers for Disease Control and Prevention were self-reported during follow-up. Among individuals with SARS-CoV-2 infection, we fit Poisson regression models to assess the associations between endometriosis and risk of long COVID-19 symptoms, with adjustment for potential confounding variables (demographics, body mass index, smoking status, history of infertility, and history of chronic diseases). Among 3650 women in our sample with self-reported SARS-CoV-2 infections during follow-up, 386 (10.6%) had a history of endometriosis with laparoscopic confirmation, and 1598 (43.8%) reported experiencing long COVID-19 symptoms. Most women were non-Hispanic White (95.4%), with a median age of 59 years (interquartile range, 44–65). Women with a history of laparoscopically-confirmed endometriosis had a 22% greater risk of developing long COVID-19 (adjusted risk ratio, 1.22; 95% confidence interval, 1.05–1.42) compared with those who had never been diagnosed with endometriosis. The association was stronger when we defined long COVID-19 as having symptoms for ≥8 weeks (risk ratio, 1.28; 95% confidence interval, 1.09–1.50). We observed no statistically significant differences in the relationship between endometriosis and long COVID-19 by age, infertility history, or comorbid