What management options are available during the COVID-19
pandemic?
We encourage individuals in need of help to seek a clinical assessment
with their general practitioners (GP), gynaecologists, physiotherapists,
and/or complementary medical providers through telehealth avenues.
Referral to a gynaecologist with expertise in endometriosis may also be
appropriate to offset the new diagnostic and therapeutic challenges
faced during this time. Those with an established diagnosis who are
seeking help, regardless of their intentions to pursue surgical
management, should discuss with their clinician the potential to modify
their current medication regimen. Some with suspected endometriosis may
accept a clinical diagnosis in the absence of imaging or laparoscopy and
empirical medical therapy can be initiated.8
Caution in the use of non-steroidal anti-inflammatory drugs (NSAIDs),
commonly used for endometriosis-related pain, is being advised, because
increase in angiotensin-converting enzyme 2 (ACE2) may predispose to
infection with COVID-19.9 Those at low-risk of
exposure may consider the benefits of NSAIDs outweigh potential risk,
deciding to continue use when needed. Conversely, those at higher-risk
for acquisition (e.g. continuing to attend work outside of their home or
having household members whom are high-risk), may benefit from using
NSAIDs. Beyond traditional medical therapies, problem-focused
interventions such as education, modifying work/school/social life,
taking advantage of virtual and telephone support provided by national
endometriosis organisations, improving sleep hygiene, low-intensity
physical activity (including pelvic exercises, yoga), dietary changes,
application of heat, and medical cannabis should be considered, either
with the assistance of a healthcare provider via telehealth or
independently by patients themselves. Similarly, emotion-focused
strategies, which include relaxation/mindfulness, acceptance of chronic
illness (e.g. via Acceptance and Commitment Therapy with the help of a
clinical psychologist through telehealth), reducing catastrophising, and
improving a balance toward positive attitude can be considered. These
strategies are not unique to the COVID-19 pandemic and are recognised as
an integral part of the usual multidisciplinary treatment of
endometriosis.
Patients should be aware that, if they experience acute exacerbations of
their chronic pain, they may warrant urgent medical assessment, as such
cases, especially those with suspected endometrioma or severe acute
recalcitrant exacerbation of pain, may require urgent surgery. However,
most pain exacerbations are not life- or organ-threatening and with
appropriate counselling and support, a face-to-face consultation in the
emergency department may be avoided. Some GPs may find it challenging to
confidently reassure patients that they are safe to avoid an emergency
department visit, so urgent telehealth consultation with a gynaecologist
or pain specialist may be helpful.