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Endometriosis and Telehealth: During COVID and Beyond

Posted on July 15, 2020
Medically reviewed by
Georgine Lamvu, M.D., M.P.H.
Article written by
Marie Freeberg, MTM

  • Having endometriosis is not believed to increase the risk for contracting the coronavirus or worsening the severity of COVID-19.
  • COVID-related delays in surgery for endometriosis can be viewed as an opportunity to research other treatment options, try managing endo with medications, or seek a second opinion.
  • Using telehealth, you can ask your doctor questions and they can order tests, prescribe medications, and provide medical advice.
  • There are effective strategies for managing endo symptoms and reducing stress at home.

In partnership with AbbVie, MyEndometriosisTeam presents an interview with Dr. Georgine Lamvu, gynecologic surgeon, pelvic pain specialist, and professor in Obstetrics and Gynecology at the University of Central Florida. Read more about Dr. Lamvu.

Hi my name is Marie Freeberg, Director of Alliance Management at MyHealthTeams where we create social networks for people living with chronic conditions. One of our social networks, MyEndometriosisTeam is made for women living with endometriosis to find support from others who can understand their experience first-hand. Many members of MyEndometriosisTeam have been asking questions about COVID-19 and telehealth and today we get to ask Dr. Georgine Lamvu some of those questions. Dr. Lamvu received her undergraduate and medical degrees from Duke University and she completed her residency in Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. Currently she is a Gynecologic Surgeon, and a Pelvic Pain Specialist who maintains an active educational role as Professor in Obstetrics and Gynecology at the University of Central Florida and Director of Fellowship in Advanced Minimally Invasive Surgery at the Orlando VA Medical Center. She also serves as Chair of the Board for the International Pelvic Pain Society.

Dr. Lamvu, one common question members have been asking recently is,

Does having endometriosis put me at higher risk of getting COVID-19?

Yeah, that’s a great question. So, to date we don’t have any evidence that endometriosis increases the risk of getting COVID-19. Also, endometriosis has not been identified as one of the conditions at high risk for acquiring COVID-19 by the CDC.

Endometriosis is generally considered an inflammatory disease, not an autoimmune disease. So, in this case, the body reacts differently to these types of diseases, like COVID-19. People who have a weakened immune system and autoimmune diseases are considered high risk for getting COVID-19, which is actually not the case with inflammatory diseases like endometriosis. Technically, an autoimmune disease is where the body’s immune system attacks its own cells. So instead, in endometriosis, which is considered an inflammatory disease, what’s happening is the autoimmune system is not clearing the endometriosis cells, so the endometriosis lesions implant throughout different parts of the pelvis and produce a heightened inflammatory response that is linked to higher levels of pain and disease progression. In the case of endometriosis, the body’s immune system tries to fight the endometriosis cells and clear them from the body, but it just cannot do so efficiently, and endometriosis can progress. So, in endo, the immune system is not attacking its own healthy cells, but rather it’s trying to fight off cells that are abnormal and technically need to be removed there, anyways.

At this time, it’s recommended that women with endometriosis follow the same precautions as women without endometriosis, such as social distancing, wearing a mask in public places, and performing frequent hand washing for at least 20 seconds. There’s more information on these precautions and it’s available on the CDC website. And these recommendations may change in the future as we gather more data, but so far, we have not seen any reason for a heightened concern among women with endometriosis.

Does having endometriosis make COVID-19 related symptoms and its duration worse?

Not likely. In fact, we know that COVID-19 tends to affect more men than women. In addition, the severity of COVID-19 symptoms is age related, that is, symptoms are worse in older patients. All patients with endometriosis are women—good—and they tend to be younger, and so this is usually a good thing for us, because endometriosis is inactive in menopause. It tends not to affect—it should not have any severe effect that’s based on age. And so far there really is no scientific evidence that having endometriosis has any impact on the severity of COVID-19 related symptoms or its duration.

What should I do to control my endometriosis when the doctor or hospital cancels my appointment?

First of all, it’s very important to recognize that a hospital and office cancellation is just—these things are being undertaken for patient and staff safety, as well as conservation of resources so that they can be allocated to those who are severely ill. However, that does not diminish the importance of your symptoms and the impact that endometriosis has on your day to day life. There are many things that you can do at this time to help you manage:

  1. First, if you are taking any medications to manage your endometriosis related symptoms, you can continue to do so unless your doctor tells you otherwise.
  2. If your doctor has resources for virtual appointments, change your face to face appointment to an online appointment.
  3. If your appointment was cancelled, or you’ve—and you’ve not been rescheduled, contact your provider and ask to be rescheduled. Make sure that you have not been missed in this time of mass confusion and changing practice.
  4. If you have pain, there’s a couple of thigs that you can try, too:
    1. Practice mindfulness and meditation about twice a day.
    2. Do your pelvic stretches, stay active, because inactivity and prolonged sitting or standing can really make pain worse. See if you can join a ‘virtual gym’ to help you stay active. And if you cannot exercise because of pain, just try something that’s more relaxing, like yoga. If you’re working from home and you sit at a computer all day long, stand up and stretch at least every hour.
    3. Really focus on a healthy diet and moderate fluid intake because dehydration and constipation can make pain—pelvic pain, specifically—much worse.
    4. Keep a journal of things that make you feel good and read it whenever you do not feel well.
    5. Join a virtual support group or a chat group or chat with someone who is supportive at least twice a week, so you have that kind of positive contact.
    6. If you are taking non-steroidal anti-inflammatory medications, or NSAIDS, like ibuprofen or naproxen, or NSAIDS for cramps, you can continue to do so without worrying about increased risk of COVID or adverse events. There was a recent report by the World Health Organization (WHO) that concluded that ‘at present there is no evidence of severe adverse events, or acute health care utilization, or long-term survival, or quality of life changes in patients with COVID-19, because of NSAID use’.

If COVID-19 triggered a delay in my endometriosis-related surgery, what can I do?

Although many women with endometriosis suffer with pain and infertility, endometriosis surgery is generally considered ‘elective’, which means that it doesn’t take priority over conditions such as gynecologic cancers or bleeding problems. This is very distressing to women who have endometriosis-related symptoms. But the good news is that endometriosis is not a disease that progresses rapidly, so a delay of about three to six months is not likely to make the disease worse. Women can use this delay to learn more about treatment options. So, if you were not considering medications to suppress the disease, this may actually be a good time to reconsider medical suppression with combination hormonal pills, oral progestins, the hormonal IUD, GnRH Antagonists, or GnRH Agonists. Three to six months is actually a perfect time to try some of these options, especially GnRH agonists with add-back progestin therapy to reduce side effects, or even GnRH antagonists. This time is a good time to consider second opinions from multiple gynecologic and non-gynecologic specialists, many of whom offer virtual visits now.

Even if you have surgery, with the best endometriosis surgeons, research shows that in as many as 25 to 50 percent of women of reproductive age, symptoms return within two years. So, suppression with medications may be a good way of decreasing the chances of pain recurrence. You may want to do your research and consider a long-term plan that combines surgery, suppression with medications, rehabilitative pelvic physical therapy and cognitive therapies from mental health specialists. The reality is that surgery is rarely a ‘cure’ for endometriosis. Most women who have serious symptoms require therapy using multiple interventions from multiple specialists. And this time of delay may be the perfect time to learn about your options from your healthcare team and make plans for long term care to improve your overall well-being in the future.

As a woman with endometriosis, what should I know about COVID-19 and pregnancy?

Well, the good news is that having endometriosis should not impact your pregnancy care, and if you do not have COVID-19 symptoms, your pregnancy care will not change. The American College of Obstetricians and Gynecologists—also known as ACOG—has issued some guidance around this topic. To date, there is no evidence that COVID-19 gets transmitted from a mother to fetus during pregnancy, which is excellent news. Pregnant women should follow the same precautions for social distancing, so they should be wearing a mask and using frequent hand hygiene, just like non-pregnant individuals. A mask, thoughI just want to emphasize that a mask is highly recommended when visiting a healthcare facility for obstetric care.

ACOG has issued a guideline for management of pregnant patients with COVID-19 symptoms and they basically recommend that anyone who has a fever of 100.4°F or higher, either alone or with respiratory symptoms, should be screened for COVID-19. Pregnant women without symptoms do not need to be routinely screened. And quarantine precautions should be implemented for those who screen positive. And in addition, a facemask is recommended while experiencing symptoms.

So, if you are planning a scheduled cesarean delivery, though, it’s likely that you will be tested for COVID-19 prior to the procedure. However, testing is not being universally implemented for women who arrive at the hospital in labor. For routine OB care, universal testing is also not recommended. So, most medical institutions at this time are screening patients with a temperature check and a survey—a questionnaire—to ensure that the woman does not have symptoms.

How do I interact with my doctor through telehealth?

Well, you know, for the most part your interaction with your doctor should not be any different than when meeting face to face. So, you can still ask questions and your doctor can still order tests and medications and provide medical advice. But there are a few things to consider:

  • First, when you are doing a virtual visit, make sure that you are in a private and safe space where you can discuss your health history.
  • Do put aside time for a telehealth visit, just as you would do for a face to face visit. In other words, really don’t try to, you know, do a televisit while you’re driving or shopping or doing house chores. This distracts you and prevents you from getting the most out of your visit.
  • Put your visit on your calendar to remind you to answer the phone when your doctor calls, because sometimes patients forget.
  • Prepare for your visit by reviewing your history, by having your records available, writing down your questions and completing any survey that the doctor’s office may have sent you ahead of time.
  • Make sure that you know the length of your visit. Your doctor has to stay on time to make it to other telehealth visits, and they have less schedule flexibility when they’re doing telehealth. If you can’t discuss everything you need to discuss in that allotted time, don’t hesitate to ask for another appointment.
  • Make sure your provider is using a secure telehealth portal to do telemedicine. You really can’t just do telemedicine with an unsecured portal.

What can I do if my healthcare provider does not offer telehealth?

Well, the good news is that nowadays that’s actually quite rare. But if your provider does not have telehealth, then it may be because they are still seeing patients face-to-face. And in that case, then just make sure that their office has implemented good COVID-19 precautions to ensure patient safety. If your provider is not seeing patients under safe conditions, you really should consider seeking a consultation from another provider. Some providers have chosen not to do telemedicine due to financial reasons. And if this is the case with your provider, you can ask whether they have the ability to see patients using telehealth independent of your insurance billings – this may result in more cost to you, though. Others may not use telehealth because of their schedule. So, see if they are willing to do a telehealth visit at an unusual time, like first thing in the morning or last thing—as the last appointment in the afternoon.

Will doctors continue to offer telehealth in a post-COVID-19 world?

Yeah, many providers are already realizing the benefits of telehealth, and many patients are already used to digital convenience in just about every other part of their lives, so I think it seems likely that everyone will continue to embrace telemedicine for a variety of healthcare encounters. However, there is uncertainty that’s related to post-COVID telehealth, and it all depends on, well, first, whether insurance companies will pay or continue to pay for virtual care consultations. And, second, if the patient demand for virtual care remains high. Telehealth is thought to be less expensive and more convenient for patients while maintaining the same high quality of care. However, this has not been proven by scientific research. For women veterans, this is a special case. So, for women veterans where providing virtual care has been successful, even prior to COVID-19, the federal government was using telemedicine. So, for now, the federal government is planning to continue telehealth with a goal of having at least 25 to 50 percent of all medical care be provided in this manner. So, hopefully, other insurances will follow.

Are there any limitations to telehealth that I need to be aware of?

Yes, but very few in my opinion. If you have symptoms that are concerning such as abnormal bleeding, infectious vaginal discharge, or any other unusual symptoms, your provider may need to do a pelvic exam. Your symptoms can often be managed or monitored via telemedicine without requiring a physical exam or an in-person visit. But some providers may choose to see you face to face. Other providers may choose to prescribe medication through telehealth.

There are other instances: sometimes when a woman is preparing for surgery, a pre-operative exam may be needed. You may also need to be seen in-person during pregnancy, because pre-natal care, where the doctor needs to do a check on the baby, still requires a face-to-face visit.

What if I am quarantined and I can’t get medication?

That’s a very good question. First, contact your healthcare provider and they will be able to order the medication so that it’s shipped to you from a pharmacy directly. Sometimes you can call your pharmacy and they will contact your provider for approval to ship you the medications. Even medications that you would normally get over the counter can be ordered by your provider and sent to you from the pharmacy.

The other alternative is to call the pharmacy, pay for the medication, and have a friend or a relative pick it up and drop it off at your doorstep.

Many pharmacies have a drive through option, where you can pick up your medications without getting out of your car. Also, check with your local retail pharmacy, they may offer a prescription delivery service at no additional charge.

And, lastly, there are many online pharmacies where you can purchase over-the-counter medications and have them shipped to you. This will also work with prescriptions from your doctor, but please make sure that you do your research and make sure that you are using a reputable pharmacy.

The COVID-19 situation has increased my stress and anxiety. What can I do to improve my situation?

First, you are not alone! This is the case for many persons, some of whom have chronic diseases and others who have no medical conditions at all. It’s important to note that the increase in stress, anxiety, and depression is a normal consequence of uncertainty, social isolation, and societal unrest. So, don’t feel bad for feeling this way, especially because there are things that you can do that can help. One of the factors that contributes to excess stress is uncertainty and misinformation about the virus. And social media and the news often don’t help by spreading this type of misinformation. So, here are some things that I think can help:

  1. First of all, do not rely on social media for information about COVID-19. Instead look for information from reliable sources such as the CDC, the National Institutes of Health, and the World Health Organization.
  2. Practice meditation, mindfulness, relaxation techniques regularly. Try to start and end your day with these types of practices. Sleep is extremely important both in stress and pain control, so try to get at least 7-8 hours of sleep a day. If you have trouble sleeping, this is a good time to start a sleep meditation and develop a good sleep routine.
  3. Set up a virtual mental health evaluation. Many clinical psychologists are doing telemedicine, so don’t wait until your symptoms are much worse, seek help very early even if it is through a virtual platform.
  4. Stay active! Even a 20 min walk a day can help. And this is really also a great time to discover outdoor activities, since being outdoors seems to be safer.
  5. Find a support group online, many new groups are popping up. Sometimes just like—just joining a group and talking helps, so it’s important to connect with others.
  6. Try to avoid alcohol, because it tends to interfere with sleep and can make mental health problems worse.

Dr. Lamvu, thank you so much for taking the time to help answer some important questions that many women with endometriosis may be asking during these uncertain times.

Thank you very much. It was my pleasure.

When you join MyEndometriosisTeam, you become part of a community of more than 100,000 women facing endometriosis together. Members share their experiences, offer tips, celebrate good days, and support each other through bad days while living with this chronic condition.

Do you have any additional questions Dr. Lamvu did not address? How has the COVID-19 pandemic affected your endometriosis treatment? Comment below or post on MyEndometriosisTeam.

Georgine Lamvu, M.D., M.P.H. received her undergraduate and medical degrees from Duke University, and she completed her residency in obstetrics and gynecology at the University of North Carolina at Chapel Hill. Learn more about her here.
Marie Freeberg, MTM comes from a background in biomedical engineering and translational medicine, focusing on bringing solutions from research bench to patient bedside faster. Learn more about her here.

A MyEndometriosisTeam Member said:

Hola Marlene
Siento escuchar eso es muy difícil necesita ser tratada rapido busque en intenet un ginecólogo o dígale a su médico primario que la remita a algún ginecólogo que sea bueno

posted 9 months ago


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