Effects of Post-COVID-19 Conditions on Endometriosis
-
Maryam Matouri
,
Ameneh Koochaki
,
Fahimeh Ramezani Tehrani
,
Shahla Noori Ardebili
,
Mostafa Haji Molla Hoseini
,
Marzieh Saei Ghare Naz
,
Nariman Mosaffa
Abstract
Evidence indicates that Long COVID is associated with menstrual cycle disruptions, hormonal changes, immune dysfunction, and persistent inflammation. Owing to these overlapping inflammatory mechanisms, Long COVID may aggravate endometriosis, potentially worsening pelvic pain and increasing the risk of developing the disease. We searched Scopus, PubMed, Google Scholar, and Science Direct for English-language articles from 2000 to 2024. After screening titles and abstracts, the authors assessed the full texts of potentially relevant studies. Studies were included if they provided robust, impactful data pertinent to the topic. Direct clinical evidence indicates that women with endometriosis report worsening of pelvic pain, dysmenorrhea, and fatigue after COVID-19, and that Long COVID causes menstrual cycle irregularities and chronic inflammation. Extrapolation of separate studies in Long COVID and endometriosis, several hypothesized mechanisms may contribute to symptom exacerbation: elevated C-X-C motif chemokine ligand 5 (CXCL5) and vascular endothelial growth factor (VEGF) may promote ectopic endometrial tissue growth and angiogenesis; neutrophil extracellular trap (NET) formation and extracellular matrix (ECM) alterations could further endometriosis progression; stress-related hormonal fluctuations may enlarge lesions; and altered pain perception and fatigue may limit beneficial physical activity. The long-term effects of COVID-19 could exacerbate the severity of endometriosis through several mechanisms.
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3. Thanh HN, Minh DC, Thu HH, Quang DN. Symptoms, Mental Health, and Quality of Life Among Patients After COVID-19 Infection: A Cross-sectional Study in Vietnam. J Prev Med Public Health. 2024;57(2):128-37.
4. Altmann DM, Reynolds CJ, Joy G, Otter AD, Gibbons JM, Pade C, et al. Persistent symptoms after COVID-19 are not associated with differential SARS-CoV-2 antibody or T cell immunity. Nat Commun. 2023;14(1):5139.
5. Castanares-Zapatero D, Chalon P, Kohn L, Dauvrin M, Detollenaere J, Maertens de Noordhout C, et al. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022;54(1):1473-87.
6. Jahankhani K, Mosaffa N. Inflammatory Outcomes of COVID-19, Post-Complication Disorders, and Related Factors that Could Affect the Intensity of COVID-19. Novelty in Biomedicine.11(1):41-54.
7. Pollack B, von Saltza E, McCorkell L, Santos L, Hultman A, Cohen AK, Soares L. Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review. Front Rehabil Sci. 2023;4:1122673.
8. Sigfrid L, Drake TM, Pauley E, Jesudason EC, Olliaro P, Lim WS, et al. Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. Lancet Reg Health Eur. 2021;8:100186.
9. Sylvester SV, Rusu R, Chan B, Bellows M, O'Keefe C, Nicholson S. Sex differences in sequelae from COVID-19 infection and in long COVID syndrome: a review. Curr Med Res Opin. 2022;38(8):1391-9.
10. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-56.
11. Pašalić E, Tambuwala MM, Hromić-Jahjefendić A. Endometriosis: Classification, pathophysiology, and treatment options. Pathol Res Pract. 2023;251:154847.
12. Wang S, Farland LV, Gaskins AJ, Mortazavi J, Wang YX, Tamimi RM, et al. Association of laparoscopically-confirmed endometriosis with long COVID-19: a prospective cohort study. Am J Obstet Gynecol. 2023;228(6):714.e1-.e13.
13. Saunders PTK, Horne AW. Endometriosis: Etiology, pathobiology, and therapeutic prospects. Cell. 2021;184(11):2807-24.
14. Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823.
15. Denny E. Women's experience of endometriosis. J Adv Nurs. 2004;46(6):641-8.
16. Barretta M, Savasta F, Pietropaolo G, Barbasetti A, Barbera V, Vignali M. COVID-19 susceptibility in endometriosis patients: A case control study. Am J Reprod Immunol. 2022;88(4):e13602.
17. Moazzami B, Chaichian S, Samie S, Zolbin MM, Jesmi F, Akhlaghdoust M, et al. Does endometriosis increase susceptibility to COVID-19 infections? A case-control study in women of reproductive age. BMC Womens Health. 2021;21(1):119.
18. Kabani Z, Ramos-Nino ME, Ramdass P. Endometriosis and COVID-19: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2022;23(21).
19. Nicolás I, Martínez-Zamora M, Gracia M, Feixas G, Rius M, Carmona F. Impact of SARS-COV2 Pandemic on Patients with Endometriosis and Their Health Care. J Womens Health (Larchmt). 2022;31(4):480-6.
20. Madaan S, Talwar D, Jaiswal A, Kumar S, Acharya N, Acharya S, Dewani D. Post-COVID-19 menstrual abnormalities and infertility: Repercussions of the pandemic. J Educ Health Promot. 2022;11:170.
21. Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ, Re'em Y, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021;38:101019.
22. Maybin JA, Walker C, Watters M, Homer NZM, Simpson JP, Robb C, et al. The potential bidirectional relationship between long COVID and menstruation. Nature Communications. 2025;16(1):8187.
23. Lai YJ, Liu SH, Manachevakul S, Lee TA, Kuo CT, Bello D. Biomarkers in long COVID-19: A systematic review. Front Med (Lausanne). 2023;10:1085988.
24. Buonsenso D, Piazza M, Boner AL, Bellanti JA. Long COVID: A proposed hypothesis-driven model of viral persistence for the pathophysiology of the syndrome. Allergy Asthma Proc. 2022;43(3):187-93.
25. Ye C, Yuan L, Wu K, Shen B, Zhu C. Association between systemic immune-inflammation index and chronic obstructive pulmonary disease: a population-based study. BMC Pulm Med. 2023;23(1):295.
26. Foo SS, Chen W, Jung KL, Azamor T, Choi UY, Zhang P, et al. Immunometabolic rewiring in long COVID patients with chronic headache. bioRxiv. 2023.
27. Clemente I, Sinatti G, Cirella A, Santini SJ, Balsano C. Alteration of Inflammatory Parameters and Psychological Post-Traumatic Syndrome in Long-COVID Patients. Int J Environ Res Public Health. 2022;19(12).
28. Avcioğlu SN, Altinkaya S, Küçük M, Demircan-Sezer S, Yüksel H. Can platelet indices be new biomarkers for severe endometriosis? ISRN Obstet Gynecol. 2014;2014:713542.
29. Ardestani SK, Salehi MR, Attaran B, Hashemi SM, Sadeghi S, Ghaffarpour S, et al. Neutrophil to Lymphocyte Ratio (NLR) and Derived NLR Combination: A Cost-effective Predictor of Moderate to Severe COVID-19 Progression. Iran J Allergy Asthma Immunol. 2022;21(3):241-53.
30. Ansari-Moghaddam B, Ahmadi SAY, Matouri M, Ghaemmaghami A, Amiri A, Tavakkol E, Shahsavar F. Screening role of complete blood cell count indices and C reactive protein in patients who are symptomatic for COVID-19. Disaster and Emergency Medicine Journal. 2022;7(3):176-81.
31. Keshavarz F, Ghalamfarsa F, Javdansirat S, Hasanzadeh S, Azizi A, Sabz G, et al. Patients with Covid 19 have significantly reduced CH50 activity. Virusdisease. 2021;32(4):681-9.
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How to Cite
1.
Matouri M, Koochaki A, Ramezani Tehrani F, Noori Ardebili S, Haji Molla Hoseini M, Saei Ghare Naz M, Mosaffa N. Effects of Post-COVID-19 Conditions on Endometriosis. Iran J Allergy Asthma Immunol. 2026;:1-15.
