• Most people with endometriosis are recommended to be vaccinated against COVID-19.
• The COVID-19 vaccines are considered safe, effective, and low-risk for most people with endometriosis.
• Your doctor is the best person to help you understand your potential risks versus the potential benefits of the COVID-19 vaccines.

Ever since the U.S. Food and Drug Administration (FDA) authorized the first COVID-19 vaccines for emergency use in December 2020, people living with endometriosis have had questions about whether these inoculations will be safe and effective for them.

On February 27, the FDA approved the Johnson & Johnson COVID-19 vaccine, providing a third option to the Pfizer and Moderna COVID-19 vaccines. The Johnson & Johnson vaccine requires a single dose and works in a different way than the first two vaccines. Although the FDA paused the use of the Johnson & Johnson vaccine on April 13, the FDA and the Centers for Disease Control and Prevention (CDC) lifted that pause on April 23.

Many MyEndometriosisTeam members have shared questions about whether the vaccine is safe. One noted, “I cannot help but fear this vaccination because of too many unknown factors.” Another said, “Are COVID-19 vaccines safe for people with endometriosis?”

To help address these concerns, MyEndometriosisTeam sat down with Dr. Nicholas Fogelson. Dr. Fogelson is a gynecologic surgeon and the founder of Northwest Endometriosis and Pelvic Surgery in Portland, Oregon.

The COVID-19 vaccines are so new that there is not yet any specific data on results or side effects in people with endometriosis. How can we know whether they are safe and effective for this population?

The data on the COVID-19 vaccines came from very large studies with many thousands of people, so no doubt there were people of both genders and there were probably people with endometriosis — but no one has specifically studied the vaccine’s impact on people with endometriosis. However, within the framework of those studies, the vaccines were not only found to be effective, but they were deemed largely safe.

I think what's really important to remember is the fact that, a lot of times, there is an overemphasis on the unknown negatives and an underemphasis on the known positives. Some people are very worried about whether the vaccine is some danger to them, and not concerned enough about what benefit they would be missing out on by not taking it.

We have no specific reason to believe that the COVID vaccine is more dangerous in someone who has endometriosis than anyone else. Nor do we believe it's dangerous in really anybody. And we have a very strong reason to believe that it's very beneficial for prevention of illness from COVID and prevention of transmission of COVID in the community as well. So, for my patients and for anyone listening, I would strongly recommend you get vaccinated, whether you have endometriosis or not.

Can medications to treat endometriosis cause interactions or impact the effectiveness of the vaccination? For instance, hormone therapy, contraceptives, or gonadotropin-releasing hormone (GnRH) agonists and antagonists?

There's no reason to believe that hormone-containing medications would impact the effectiveness of the vaccine or vice versa. The one thing that might impact the effectiveness of the vaccine is taking anti-inflammatories leading up to taking the vaccine, or during the first 24 hours afterward.

There’s actually some research showing that if you take nonsteroidal anti-inflammatory drugs (NSAIDs) — like ibuprofen — six hours before or for the first 24 hours or so after getting a vaccine, that you may blunt the immune response somewhat because NSAIDs are decreasing inflammation in the body. And part of how vaccines work is that they create an inflammation that the immune system is responding to.

The Centers for Disease Control and Prevention say not to take NSAIDs routinely to prevent side effects from vaccines, as these medications may blunt the immune response, but if you feel really bad, it's OK to take them. In the end, I don't think it matters that much, but that's the one thing that you could say might have some impact. But as far as hormonal therapies, there's no reason to believe it would matter.

Do you recommend people with endometriosis time the vaccines around surgical procedures, or should they just get the shot when they can?

I would definitely encourage them to get immunized, particularly because if they get COVID, it's going to prompt cancellation of their surgery for some time.

Our practice has actually had several patients who we had to cancel just a few days before surgery because they came down with COVID, some of whom had traveled from out of state as well. Not only would vaccination have prevented a COVID infection in these patients, but it would also have prevented their surgeries from being canceled.

I would get a COVID-19 vaccination as soon as you can, but I wouldn't plan on getting it right before you have surgery because there’s a chance you may feel bad for a day or two following the vaccination. In addition, we generally don't operate on anyone that has a fever, and if you have a small fever from the vaccination, they’ll probably cancel the surgery for that. But in general, I would get it.

What’s the most important thing for people with endometriosis to know about the COVID-19 vaccines?

The most important thing is that just about everyone should get vaccinated whether they have endometriosis or not. If anything, the fact that you have endometriosis may put you at greater risk of getting sicker, so you're really incentivized to want to not get COVID.

Most people who are young and healthy will do well with COVID, but obviously not everyone does. There are some young people that get COVID and get tremendously sick, and there are some that even die. And clearly it is more dangerous the older you are, and the more other comorbidities you may have. So it's to your benefit to become immune to COVID, and not only is it a benefit to you, but of course it's a benefit to all of the population.

Once we hit 60 percent to 80 percent of the population being relatively immune to COVID transmission, then the disease is probably going to dry up, but the more people who are susceptible to becoming infected and transmitted to others, the longer the infection will continue in the population. So I would strongly encourage people to get vaccinations for their own benefit, their family’s benefit, and for the benefit of society in general.

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