Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic

Mathew Leonardi, Andrew W Horne, Katy Vincent, Justin Sinclair, Kerry A Sherman, Donna Ciccia, George Condous, Neil P Johnson, Mike Armour, Mathew Leonardi, Andrew W Horne, Katy Vincent, Justin Sinclair, Kerry A Sherman, Donna Ciccia, George Condous, Neil P Johnson, Mike Armour

Abstract

The care of patients with endometriosis has been complicated by the coronavirus disease 2019 (COVID-19) pandemic. Medical and allied healthcare appointments and surgeries are being temporarily postponed. Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and improvement in their quality of life. Anxieties may be heightened by concerns over whether endometriosis may be an underlying condition that could predispose to severe COVID-19 infection and what constitutes an appropriate indication for presentation for urgent treatment in the epidemic. Furthermore, the restrictions imposed due to COVID-19 can impose negative psychological effects, which patients with endometriosis may be more prone to already. In combination with medical therapies, or as an alternative, we encourage patients to consider self-management strategies to combat endometriosis symptoms during the COVID-19 pandemic. These self-management strategies are divided into problem-focused and emotion-focused strategies, with the former aiming to change the environment to alleviate pain, and the latter address the psychology of living with endometriosis. We put forward this guidance, which is based on evidence and expert opinion, for healthcare providers to utilize during their consultations with patients via telephone or video. Patients may also independently use this article as an educational resource. The strategies discussed are not exclusively restricted to consideration during the COVID-19 pandemic. Most have been researched before this period of time and all will continue to be a part of the biopsychological approach to endometriosis long after COVID-19 restrictions are lifted.

Keywords: COVID-19; coronavirus; counseling; endometriosis; lifestyle management; mind-body therapies; pelvic pain; psychology; self-care; self-management.

© The Author(s) 2020. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.

References

    1. AAGL – Elevating Gynecologic Surgery. COVID-19: Joint Statement on Elective Surgeries 2020. (5 April 2020, date last accessed).
    1. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS.. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019;220:354.e1–354.e12.
    1. Anthony JC, Warner LA, Kessler RC.. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 1994;2:244–268.
    1. Arion K, Orr NL, Noga H, Allaire C, Williams C, Bedaiwy MA, Yong PJ.. A quantitative analysis of sleep quality in women with endometriosis. J Women’s Heal 2020. doi:10.1089/jwh.2019.8008.
    1. Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers KJ, Steel KA, de Manincor MJ, Delshad E.. Exercise for dysmenorrhoea. Cochrane Database Syst Rev 2019. a;19:CD004142. doi:10.1002/14651858.CD004142.
    1. Armour M, Sinclair J, Chalmers KJ, Smith CA.. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC Complement Altern Med 2019. b;19:1–16. doi:10.1186/s12906-019-2431-x.
    1. Armour M, Smith CA, Steel KA, Macmillan F.. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complement Altern Med 2019. c;19:22.
    1. Awad E, Ahmed HAH, Yousef A, Abbas R.. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci 2017;29:2112–2115.
    1. Ball E, Khan KS.. Recent advances in understanding and managing chronic pelvic pain in women with special consideration to endometriosis. F1000Research 2020;9:1–8.
    1. Ball EF, Nur Shafina Muhammad Sharizan E, Franklin G, Rogozińska E.. Does mindfulness meditation improve chronic pain? A systematic review. Curr Opin Obstet Gynecol 2017;29:359–366.
    1. Bekalu MA, McCloud RF, Viswanath K.. Association of social media use with social well-being, positive mental health, and self-rated health: disentangling routine use from emotional connection to use. Heal Educ Behav 2019;46:69S–80S.
    1. Beyond Blue. Relaxation Exercises 2020.
    1. Bonocher CM, Montenegro ML, Rosa e Silva JC, Ferriani RA, Meola J.. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol 2014;12:1–5. doi:10.1186/1477-7827-12-4.
    1. Bouaziz J, Bar On A, Seidman DS, Soriano D.. The clinical significance of endocannabinoids in endometriosis pain management. Cannabis Cannabinoid Res 2017;2:72–80.
    1. Bourne T, Leonardi M, Kyriacou C, Al-Memar M, Landolfo C, Cibula D, Condous G, Metzger U, Fischerova D, Timmerman D. et al. ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2. Ultrasound Obstet Gynecol 2020. doi:10.1002/uog.22047.
    1. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ.. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912–920.
    1. Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N.. Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. Int J Womens Health 2017;9:281–293.
    1. Bush D, Brick E, East MC, Johnson N.. Endometriosis education in schools: a New Zealand model examining the impact of an education program in schools on early recognition of symptoms suggesting endometriosis. Aust New Zeal J Obstet Gynaecol 2017;57:452–457.
    1. Costantini R, Affaitati G, Wesselmann U, Czakanski P, Giamberardino MA.. Visceral pain as a triggering factor for fibromyalgia symptoms in comorbid patients. Pain 2017;158:1925–1937.
    1. De Leo V, Cagnacci A, Cappelli V, Biasioli A, Leonardi D, Seracchioli R.. Role of a natural integrator based on lipoic acid, palmitoiletanolamide and myrrh in the treatment of chronic pelvic pain and endometriosis. Minerva Ginecol 2019;71:191–195.
    1. Dijkstra MTM, Homan AC.. Engaging in rather than disengaging from stress: Effective coping and perceived control. Front Psychol 2016;7:1–12.
    1. Donatti L, Ramos DG, Andres M de P, Passman LJ, Podgaec S.. Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain. Einstein (Sao Paulo) 2017;15:65–70.
    1. Dull AM, Moga MA, Dimienescu OG, Sechel G, Burtea V, Anastasiu CV.. Therapeutic approaches of resveratrol on endometriosis via anti-inflammatory and anti-angiogenic pathways. Molecules 2019;24:1–21.
    1. Endometriosis Australia. 2020.
    1. Endometriosis New Zealand. 2020.
    1. Endometriosis UK. 2020.
    1. Evans S, Fernandez S, Olive L, Payne LA, Mikocka-Walus A. Psychological and mind-body interventions for endometriosis: a systematic review. J Psychosom Res 2019;124:1–11. doi:10.1016/j.jpsychores.2019.109756.
    1. EXPPECT. Information for Patients. 2020. a.
    1. EXPPECT. Alternative Ways of Managing Your Pain. 2020. b.
    1. Fallon K. Exercise in the time of COVID-19. Aust J Gen Pract 2020;49.
    1. Faubion SS,, Shuster LT, Bharucha AE.. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc 2012;87:187–193.
    1. Ferreira-Valente A, Garcia IQ, Rosa AM,, Pereira A, Pais-Ribeiro JL, Jensen MP.. The Portuguese 35-item survey of pain attitudes applied to Portuguese women with endometriosis. Scand J Pain 2019;19:553–563.
    1. Findeklee S, Radosa JC, Hamza A, Haj Hamoud B, Iordache I, Sklavounos P, Takacs ZF, Solomayer EF, Radosa M.. Treatment algorithm for women with endometriosis in a certified Endometriosis Unit. Minerva Ginecol 2020;72:43–49.
    1. Folkman S, Moskowitz JT.. Coping: pitfalls and promise. Annu Rev Psychol 2004;55:745–774.
    1. Forman A, Vase L, Hansen KE.. Psychological Pain Treatment in Endometriosis Identifier: NCT02761382. 2016.
    1. Fuentes-Márquez P, Cabrera-Martos I, Valenza MC.. Physiotherapy interventions for patients with chronic pelvic pain: a systematic review of the literature. Physiother Theory Pract 2019;35:1131–1138.
    1. Geneen LJ, More RA, Clarke C, Martin D, Colvin LA, Smith BH.. Physical activity and exercise for chronic pain in adults. J Sociol 2017;1:135–139.
    1. Gonçalves AV, Barros NF, Bahamondes L.. The practice of hatha yoga for the treatment of pain associated with endometriosis. J Altern Complement Med 2017;23:45–52.
    1. Griva K, Myers LB, Newman S.. Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus. Psychol Health 2000;15:733–750.
    1. Gustavsson-Lilius M, Julkunen J, Keskivaara P, Lipsanen J, Hietanen P.. Predictors of distress in cancer patients and their partners: the role of optimism in the sense of coherence construct. Psychol Health 2012;27:178–195.
    1. Hållstam A, Stålnacke BM, Svensén C, Löfgren M.. Living with painful endometriosis—a struggle for coherence. A qualitative study. Sex Reprod Healthc 2018;17:97–102.
    1. Hansen KE, Kesmodel US, Kold M, Forman A.. Long-term effects of mindfulness-based psychological intervention for coping with pain in endometriosis: a six-year follow-up on a pilot study. Nord Psychol 2017;69:100–109.
    1. Harris HR, Chavarro JE, Malspeis S, Willett WC, Missmer SA.. Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. Am J Epidemiol 2013;177:420–430.
    1. Harris HR, Eke AC, Chavarro JE, Missmer SA.. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod 2018;33:715–727.
    1. Harris R. In: Honeychurch C. (ed). ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. 2009, CA: New Harbinger Publications, Inc.
    1. Hayes SC, Strosahl KD, Wilson KG. In: Guilford Press (ed). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd edn.2012, New York, NY: Guilford Press.
    1. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME. et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med 2017;51:199–213.
    1. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L. et al. National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Heal 2015;1:40–43.
    1. Horsch CHG, Lancee J, Griffioen-Both F, Spruit S, Fitrianie S, Neerincx MA, Beun RJ, Brinkman W-P.. Mobile phone-delivered cognitive behavioral therapy for insomnia: a randomized waitlist controlled trial. J Med Internet Res 2017;19:e70.
    1. Hurt CS, Burn DJ, Hindle J, Samuel M, Wilson K, Brown RG.. Thinking positively about chronic illness: an exploration of optimism, illness perceptions and well-being in patients with Parkinson’s disease. Br J Health Psychol 2014;19:363–379.
    1. Johnson NP, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013;28:1552–1568.
    1. Killam K. How to Prevent Loneliness in a Time of Social Distancing - Scientific American. Scientific American 2020.
    1. Klimkiewicz A, Jasinska A.. The health effects of cannabis and cannabinoids. Psychiatria 2018;15:88–92.
    1. Klotz SGR, Schön M, Ketels G, Löwe B, Brünahl CA.. Physiotherapy management of patients with chronic pelvic pain (CPP): a systematic review. Physiother Theory Pract 2019;35:516–532.
    1. Kold M, Hansen T, Vedsted-Hansen H, Forman A.. Mindfulness-based psychological intervention for coping with pain in endometriosis. Nord Psychol 2012;64:2–16.
    1. Kuba K, Weißflog G.. Acceptance and commitment therapy in the treatment of chronic disease. Psychother Psychosom Medizinische Psychol 2017;67:525–536.
    1. Kvillemo P, Bränström R.. Coping with breast cancer: a meta-analysis. PLoS One 2014;9:1–26.
    1. Lazarus RS, Folkman S.. Transactional theory and research on emotions and coping. Eur J Pers 1987;1:141–169.
    1. Leonardi M, Gibbons T, Armour M, Wang R, Glanville E, Hodgson R, Cave AE, Ong J, Tong YYF, Jacobson TZ. et al. When to do surgery and when not to do surgery for endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol 2020;27:390–407.e3.
    1. Leone Roberti Maggiore U, Bizzarri N, Scala C, Tafi E, Siesto G, Alessandri F, Ferrero S.. Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case–control study. Eur J Obstet Gynecol Reprod Biol 2017;209:39–43.
    1. Lintzeris N, Driels J, Elias N, Arnold JC, McGregor IS, Allsop DJ.. Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS‐16). Med J Aust 2018;209:211–216.
    1. Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM.. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir 2012;67:499–504.
    1. Mellado BH, Falcone ACM, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido-Dos-Reis FJ. Social isolation in women with endometriosis and chronic pelvic pain. Int J Gynecol Obstet 2016;133:199–201.
    1. MindSpot Clinic. MindSpot. 2020.
    1. Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL.. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynecol Obstet 2018;143:2–9.
    1. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE.. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod 2010;25:1528–1535.
    1. Moore JS, Gibson PR, Perry RE, Burgell RE.. Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust New Zeal J Obstet Gynaecol 2017;57:201–205.
    1. Morán-Sánchez I, Adoamnei E, Sánchez-Ferrer ML, Prieto-Sánchez MT, Arense-Gonzalo JJ, Casanova-Mompeán V, Carmona-Barnosi A, Mendiola J, Torres-Cantero AM.. Is dispositional optimism associated with endometriomas and deep infiltrating endometriosis? J Psychosom Obstet Gynecol 2020. doi:10.1080/0167482X.2020.1729732.
    1. National Sleep Foundation. Sleep Guidelines and Help during the COVID-19 Pandemic 2020.
    1. Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016;2:1-293; CD009591. doi:10.1002/14651858.CD009591.
    1. Nodler JL, Harris HR, Chavarro JE, Frazier AL, Missmer SA.. Dairy consumption during adolescence and endometriosis risk. Am J Obstet Gynecol 2020;222:257.e1–257.e16.
    1. Nunes FR, Ferreira JM, Bahamondes L.. Pain threshold and sleep quality in women with endometriosis. Eur J Pain 2015;19:15–20.
    1. O’Connell K, Davis AR, Westhoff C.. Self-treatment patterns among adolescent girls with dysmenorrhea. J Pediatr Adolesc Gynecol 2006;19:285–289.
    1. Öst L-G. The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behav Res Ther 2014;61:105–121.
    1. Porpora MG, Brunelli R, Costa G, Imperiale L, Krasnowska EK, Lundeberg T, Nofroni I, Piccioni MG, Pittaluga E, Ticino A. et al. A promise in the treatment of endometriosis: an observational cohort study on ovarian endometrioma reduction by N-acetylcysteine. Evidence-based Complement Altern Med 2013;2013:1–7.
    1. Roomaney R, Kagee A.. Coping strategies employed by women with endometriosis in a public health-care setting. J Health Psychol 2016;21:2259–2268.
    1. Saguyod SJU, Kelley AS, Velarde MC, Simmen RCM.. Diet and endometriosis-revisiting the linkages to inflammation. J Endometr Pelvic Pain Disord 2018;10:51–58.
    1. Schwartz ASK, Gross E, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Eberhard M, Imesch P, Imthurn B. et al. The use of home remedies and complementary health approaches in endometriosis. Reprod Biomed Online 2019;38:260–271.
    1. Schwertner A, Conceição Dos Santos CC, Costa GD, Deitos A, De Souza A, De Souza ICC, Torres ILS, Da Cunha Filho JSL, Caumo W.. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain 2013;154:874–881.
    1. Shakya HB, Christakis NA.. Association of facebook use with compromised well-being: a longitudinal study. Am J Epidemiol 2017;185:203–211.
    1. Sinclair J, Smith CA, Abbott J, Chalmers KJ, Pate DW, Armour M.. Cannabis use, a self-management strategy among Australian women with endometriosis: results from a national online survey. J Obstet Gynaecol Canada 2020;42:256–261.
    1. Smith MT, Haythornthwaite JA.. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 2004;8:119–132.
    1. Soliman AM, Yang H, Du EX, Kelley C, Winkel C.. The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod 2016;31:712–722.
    1. The British Pain Society. Guidelines for Pain Management Programmes for Adults. 2013, London: The British Pain Society.
    1. The Endometriosis Network Canada. 2020.
    1. Usher K, Bhullar N, Jackson D.. Life in the pandemic: social isolation and mental health. J Clin Nurs 2020. doi:10.1111/jocn.15290.
    1. Volkow ND, Baler RD, Compton WM, Weiss SRB.. Adverse health effects of marijuana use. N Engl J Med 2014;370:2219–2227.
    1. Weinman J, Petrie KJ, Sharpe N, Walker S.. Causal attributions in patients and spouses following first-time myocardial infarction and subsequent lifestyle changes. Br J Health Psychol 2000;5:263–273.
    1. Wetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, Solomon BC, Lehman DH, Liu L, Lang AJ. et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain 2011;152:2098–2107.
    1. Wykes CB, Clark TJ, Khan KS.. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. Br J Obstet Gynaecol 2004;111:1204–1212.
    1. Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA.. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol 2018;219:178.e1–178.e10.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever