Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 08 20 1 15 Maryam Matouri Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ameneh Koochaki Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fahimeh Ramezani Tehrani Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Foundation for Research and Education Excellence, Vestavia Hills, Al, USA Shahla Noori Ardebili Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mostafa Haji Molla Hoseini Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Marzieh Saei Ghare Naz Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Nariman Mosaffa Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2026 03 03 2026 05 21 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. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4771 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4771/2393