Shortness of breath, joint pain, fatigue, mental fog: the risk of developing long Covid is 41% higher for women suffering from endometriosis than for other women, concludes a French study conducted by the Foch Hospital (Paris), the University of Versailles Saint-Quentin-en-Yvelines (UVSQ) and the University of Fribourg (Switzerland). This result is particularly important given that endometriosis affects 10% of women, who are themselves twice as at risk of long Covid as men, according to Public Health France.
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Long Covid and endometriosis, pathologies with significant similarities
“ I don't know anyone else with long Covid and endometriosis, but there must be so many", writes an Internet user on the Reddit forum looking for cases similar to hers. After three years of long Covid, she reports a worsening of certain symptoms over the past year, including pelvic pain and intestinal problems. An anonymous testimony that reflects the latest results from the gynecology and obstetrics teams at Foch Hospital published in the journal BMC Women's Health.
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"Endometriosis and long Covid have similar pathophysiological impacts, which impact the same mechanisms, particularly inflammatory ones, causing a potential harmful synergy", explains to Science and Future Dr. Alexandre Vallée, head of the Epidemiology and Public Health Department at Foch Hospital and lead author of the study. The team collected data from previous studies on more than 200,000 women to assess the risk of long-term Covid with endometriosis. We observed similarities between these pathologies and drew parallels. Both involve chronic inflammation with immune deregulation and endothelial dysfunction.", explains Alexandre Vallée.
41% risk in addition to developing long Covid in the presence of endometriosis
Meta-analysis of these data reveals an increased risk of 41% in women with endometriosis compared to women without it. This is a lot, these values surprised us a little because they are linked to a single parameter, endometriosis", comments Alexandre Vallée. But the link between these two diseases seems logical. " A woman with endometriosis already has altered mechanisms related to long Covid, which makes her more fragile at the time of infection by the virus.. »
In addition, the ACE2 receptor serving as a gateway for the Covid-19 virus is particularly abundant in endometriotic tissues, " which could promote systemic infection (of the whole organism, editor's note),” suggests Alexandre Vallée. While the correlation or cause-and-effect link between the two pathologies remains to be confirmed, researchers estimate the occurrence of long Covid at 16.2% in women infected with endometriosis, compared to 10% for those who do not suffer from it.
Adapting the management of long Covid
The worsening of endometriosis symptoms reported by the anonymous internet user is also corroborated by the clinical observations of the study doctors. "After developing long Covid, women with endometriosis showed an exacerbation of their symptoms, probably due to the persistence of cytokines (immune system regulatory proteins, editor’s note) which exacerbate inflammation and prolong the symptoms of the initial infection", interprets Alexandre Vallée. Exacerbated pain or coagulation disorders can thus be reinforced in these patients.
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For these doubly affected women, Alexandre Vallée hopes for an adaptation of the treatment, which is currently heavily focused on cardio-respiratory rehabilitation. "Since endometriosis is hormonally dependent, we should check whether menstruation increases the symptoms of long Covid at the same time as those of endometriosis," he explains. And adapt the treatment based on the patient's cycle, or even test medications that affect the hormones themselves to control the symptoms.
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