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Cited by 86Endometriosis Research and TreatmentCOVID-19 and Mental HealthPsychosomatic Disorders and Their Treatments

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

Open access
Leonardi, Mathew, Horne, Andrew W, Vincent, Katy, Sinclair, Justin, Sherman, Kerry A, Ciccia, Donna, Condous, George, Johnson, Neil P +1 more·2020·Human Reproduction Open
DOI 10.1093/hropen/hoaa028PMC PMC7263080
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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. © 2020 BioMed Central Ltd.. All rights reserved.

AI snapshot

Written from the paper’s full text.

TL;DR

This expert-opinion review outlines self-management options for endometriosis symptoms when COVID-19 disrupted usual medical and surgical care. It groups strategies into those that target the pain problem directly and those that target emotional responses, while stressing that endometriosis-specific evidence remains limited.

Key findings

  • The authors recommend considering self-management alongside medical therapy, or as an alternative, during pandemic-related isolation; strategies include education, work/study adjustments, social connection, sleep, exercise, yoga, pelvic physiotherapy, diet, heat, medicinal cannabis, relaxation/mindfulness, acceptance-based therapy, and cultivating a positive attitude.
  • Cited evidence includes a yoga RCT showing reduced chronic pelvic pain and improved quality of life; a melatonin RCT using 10 mg daily for 8 weeks showing better sleep, less pain, and lower analgesic use; and a small observational study where 1800 mg daily N-acetylcysteine for 3 months was linked to a greater chance of cancelling planned laparoscopy.
  • Survey data cited include 35% of 372 Australian women using yoga/Pilates, 47% using meditation/breathing, 18% of diet users reducing endometriosis medication by 50% or more, and 1 in 10 respondents using cannabis, with 56% of cannabis users reducing pharmaceutical use by 50% or more.
  • The review notes that exercise worsened pelvic pain, flare-ups, or fatigue in about one-third of surveyed Australian women, and that heat patches showed moderate benefit in primary dysmenorrhea but no endometriosis-specific RCTs exist.

Methods

  • Design: narrative review and expert-opinion guidance, not a systematic review or primary study.
  • Data or sample: no new patient cohort; the paper draws on previously published literature, including RCTs, surveys, systematic reviews, and expert opinion.
  • Main analysis: the authors organize self-management approaches into problem-focused and emotion-focused categories and provide recommendations for telephone or video consultations and independent patient use.

Limitations

  • Stated: the endometriosis literature on these strategies is scarce and often of lower methodological quality, with many strategies lacking RCTs in endometriosis populations.
  • Stated: some strategies carry greater risk or require professional guidance, such as pelvic floor exercises and cannabis, while others such as diet, sleep, and mindfulness are considered lower risk.
  • Stated: access barriers include electricity, devices, internet, food, and exercise equipment, which the authors say are beyond the article’s scope.
  • Evident: no systematic search strategy, evidence grading, or formal risk-of-benefit framework is described, so recommendations rely heavily on expert judgment and indirect evidence.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/hropen/hoaa028

Cites

84 of 84 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

31 of 90 cited sources checked · 19 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Adopting active, engagement coping strategies (problem-solving, information-seeking, acceptance, seeking support, planning) makes one more likely to effectively cope with ongoing stresses of living with endometriosis.

    “If one adopts active, engagement coping strategies (Kvillemo and Bränström, 2014), such as problem-solving, information-seeking, acceptance, seeking support and planning, one is more likely to effectively cope with the ongoing stresses of living with endometriosis.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kvillemo and Bränström, 2014 source

      The Discussion (page not available in our copy) reports that engagement coping was generally associated with better psychological and physical states in women with breast cancer, particularly for strategies such as acceptance. It also says planning was unrelated to those outcomes. The paper does not establish that adopting the listed strategies causes more effective coping, or that its breast-cancer findings apply to endometriosis. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Premisecitation

    Learning more about endometriosis independently has been useful for some individuals.

    “Learning more about endometriosis independently has been useful for some individuals (Roomaney and Kagee, 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Roomaney and Kagee, 2016 source
  • Premisecitation

    Exercise is increasingly recommended to manage a range of chronic pain conditions, including primary dysmenorrhea and endometriosis.

    “Exercise is increasingly being recommended to manage a range of chronic pain conditions (Geneen et al., 2017), including primary dysmenorrhea (Armour et al., 2019a) and endometriosis (Awad et al., 2017; Mira et al., 2018).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Geneen et al., 2017 source
      Experimental — accuracy not yet measured
    • cites Armour et al., 2019a

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Awad et al., 2017 source
  • Premisecitation

    Disengagement coping strategies (denial, substance use, self-blame) are likely to heighten feelings of being out of control and distressed.

    “On the other hand, disengagement coping strategies that focus attention away from thoughts and feelings about endometriosis, such as denial, substance use and self-blame, are likely to heighten feelings of being out of control and being distressed (Dijkstra and Homan, 2016).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Dijkstra and Homan, 2016 source

      The Discussion (page unavailable) reports that passive reaction, palliative reaction, and avoidance were associated with lower perceived control and well-being, supporting the claim’s general point about disengagement coping. The paper does not establish that finding for people with endometriosis or for the cited set of strategies—denial, substance use, and self-blame. Its mention of denial/self-criticism describes a separate study, not its own results. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    A focused systematic review on endometriosis and physical exercise found inconclusive results from only six studies.

    “Conversely, a focused systematic review on endometriosis and physical exercise found inconclusive results from only six studies (Bonocher et al., 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bonocher et al., 2014 source
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Premisecitation

    Women with endometriosis who engage in positive, problem-focused coping strategies report lower stress levels and less depressive symptoms, resulting in less non-cyclical pelvic pain and dysmenorrhea compared to those with maladaptive coping strategies.

    “Women with endometriosis who engage in positive, problem-focused coping strategies report lower stress levels and less depressive symptoms, which results in less non-cyclical pelvic pain and dysmenorrhea compared to those with maladaptive coping strategies (Donatti et al., 2017).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Donatti et al., 2017 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Overall quality of sleep was poorer in those reporting more severe pain, poorer functional quality of life on EHP-30, and more depression symptoms.

    “Arion et al. (2020) found that overall quality of sleep was poorer in those also reporting more severe pain, poorer functional quality of life on the Endometriosis Health Profile-30 questionnaire, and more depression symptoms.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Arion et al., 2020 source

      The Abstract reports that poorer sleep quality was associated with poorer functional quality of life on the EHP-30 and more depressive symptoms. It also reports an association with painful bladder syndrome, but does not establish the claimed association with more severe pain generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The importance of integrating self-management strategies into the biopsychological approach to endometriosis is not novel.

    “The importance of integrating self-management strategies into the broad biopsychological approach to endometriosis is not novel (Buggio et al., 2017) nor will it be exclusively relevant during this time.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Buggio et al., 2017 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients may be given an endometriosis diagnosis following clinical assessment, imaging, or surgery.

    “Patients may be given a diagnosis following clinical assessment (Agarwal et al., 2019), imaging (Nisenblat et al., 2016) or surgery (Wykes et al., 2004).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Agarwal et al., 2019 source
    • cites Nisenblat et al., 2016 source

      The Authors’ conclusions say imaging can help identify particular forms of endometriosis: transvaginal ultrasound may aid assessment of endometrioma, and MRI showed potential as a replacement test for it, though evidence was scant. They also say no evaluated imaging modality was accurate enough to replace surgery for diagnosing overall pelvic endometriosis. The citation therefore supports diagnosis following imaging only in a narrower, qualified sense. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Wykes et al., 2004 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The International Society of Ultrasound in Obstetrics and Gynecology recommended postponing ultrasound evaluation of non-acute pelvic pain.

    “In addition, the International Society of Ultrasound in Obstetrics and Gynecology has recommended postponing ultrasound evaluation of non-acute pelvic pain (Bourne et al., 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bourne et al., 2020 source

      The Details Recommended action section advises no routine scan during the pandemic for early-pregnancy patients with light bleeding and pain that is not troublesome. That supports postponement for a limited group, but our copy does not extend this recommendation to non-acute pelvic pain generally; it calls for a scan within 24 hours for pelvic pain in early pregnancy when no previous scan has been done. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Online sleep programs based on CBT for insomnia are available and may benefit women with significant sleep disruption.

    “Online sleep programs based on sound scientific approaches (cognitive behavioral therapy (CBT) for insomnia (Horsch et al., 2017)) are also available and may be of benefit to those women with significant sleep disruption.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Horsch et al., 2017 source

      The Introduction describes Internet-delivered CBT for insomnia, and the Discussion reports improved insomnia severity with a mobile CBT-I app. But the Limitations and Future Work section says the app was tested in a relatively mildly affected sample and that its efficacy had not been demonstrated in people with severe insomnia. The paper therefore does not establish a benefit for women with significant sleep disruption specifically. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    At 6-year follow-up, 9 of 10 women still used mindfulness and other mental techniques, and 7 of these 9 reported great or very great benefit.

    “Six years later, 9 out of the 10 women were still using the mindfulness-techniques and other mental techniques learned during the original study, and seven of these nine women experienced benefits from these techniques to a great or very great extent (Hansen et al., 2017).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hansen et al., 2017 source

  • May combine two claims.

    Premisecitation

    Resveratrol may reduce endometriosis-related pain, but human clinical trial results are mixed.

    “Resveratrol, commonly found in significant quantities in grapes, wine and berries, may also assist in the reduction of endometriosis-related pain, however, the results from clinical trials in humans are mixed (Dull et al., 2019).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Dull et al., 2019 source

  • May combine two claims.

    Premisecitation

    Several strategies addressing the negative psychological effects of endometriosis exist and may help patients.

    “Consequently, several strategies that address the negative psychological effects of living with endometriosis exist and may be helpful for patients (Roomaney and Kagee, 2016).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Roomaney and Kagee, 2016 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Endometriosis education in schools has recently been introduced in some countries to raise awareness early and standardize messaging, but this has not been successfully attempted with adults.

    “Endometriosis education in schools has recently been introduced in some countries to raise awareness early and standardize messaging (Bush et al., 2017), but this has not been successfully attempted with adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bush et al., 2017 source

  • May combine two claims.

    Premisecitation

    One RCT found that 10 mg daily melatonin improved quality of sleep, reduced pain scores, and reduced analgesia use.

    “However, one randomized controlled trial (RCT) implemented an administration of 10 mg of daily melatonin, which was found to improve the quality of sleep, reduce pain scores and reduce analgesia use (Schwertner et al., 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Schwertner et al., 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The World Endometriosis Society has long espoused the value of endometriosis support groups in providing a forum for mutual sharing and quality of life improvement through teaching coping mechanisms.

    “The World Endometriosis Society has long espoused the value of endometriosis support groups in providing a valuable forum for mutual sharing of experiences and quality of life improvement through teaching coping mechanisms (Johnson and Hummelshoj, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johnson and Hummelshoj, 2013 source

  • May combine two claims.

    Premisecitation

    Visceral pain comorbidities such as bowel or bladder conditions can worsen chronic pain conditions and vice versa.

    “There is increasing evidence that visceral pain comorbidities (e.g. bowel or bladder conditions) can exacerbate chronic pain conditions and vice-versa (Costantini et al., 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Costantini et al., 2017 source

  • May combine two claims.

    Premisecitation

    In primary dysmenorrhea, adhesive heat patches on the lower abdomen give moderate pain-intensity improvement compared with placebo patches, placebo pills, or no treatment, and small to moderate improvement compared with ibuprofen.

    “Heat therapy has been shown to be effective in primary dysmenorrhea, where heat therapy using adhesive heat patches on the lower abdomen showed a moderate improvement in pain intensity compared to placebo patches, placebo pills or no treatment and a small to moderate improvement compared to ibuprofen (Armour et al., 2019c).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Armour et al., 2019c

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In a study of 10 participants, mindfulness significantly improved pain level, well-being, and daily functioning.

    “While only 10 participants were recruited, they found significant improvements in participants’ pain level, well-being and ability to function in daily life after the first study (Kold et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kold et al., 2012 source

  • May combine two claims.

    Premisecitation

    An RCT found that yoga was associated with a reduction in chronic pelvic pain and improvement in quality of life in women with endometriosis.

    “An RCT by Gonçalves et al. (2017) found that yoga was associated with a reduction in levels of chronic pelvic pain and an improvement in the quality of life in women with endometriosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gonçalves et al., 2017 source

  • May combine two claims.

    Premisecitation

    Heat is commonly used and rated as effective for endometriosis-related pain.

    “Despite this, heat is commonly used and rated as effective for endometriosis-related pain (Armour et al., 2019b).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Armour et al., 2019b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In some cases, pelvic floor muscles are already hypertonic or non-relaxed, so relaxation and coordination are needed rather than strengthening.

    “In some cases, the pelvic floor muscles can already be hypertonic or non-relaxed, requiring relaxation and coordination of pelvic floor muscles rather than strengthening (Faubion et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Faubion et al., 2012 source

  • May combine two claims.

    Premisecitation

    In a cannabis-using cohort, women self-reported significant improvements in sleep, nausea, gastrointestinal upset, anxiety, and depression, and 56% reduced pharmaceutical use by at least 50%.

    “Furthermore, significant improvements in sleep, nausea, gastrointestinal upset, anxiety and depression were self-reported, along with 56% of women in the cannabis-using cohort being able to reduce their pharmaceutical usage by 50% or more (Sinclair et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sinclair et al., 2020 source

  • May combine two claims.

    Premisecitation

    In a survey of Australian women with confirmed endometriosis, 1 in 10 used cannabis for symptom management, and cannabis was rated the highest self-management strategy for pain among those assessed.

    “A recent survey of Australian women with confirmed endometriosis noted that 1 in 10 respondents was utilizing cannabis, for symptom management, with cannabis rated as the highest self-management strategy for the pain of all those assessed (Armour et al., 2019b).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Armour et al., 2019b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Self-management strategies may be effective in combating negative physical or psychological effects triggered by COVID-19 restrictions.

    “In combination with medical therapies or as an alternative, we encourage patients to consider self-management strategies that may be effective in combating the negative physical or psychological effects triggered by COVID-19 restrictions.”
    • Also stated in: § Abstract · hedged
      “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.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The COVID-19 pandemic and required self-isolation have substantially disrupted endometriosis care worldwide.
    • Rests on an assumption: Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and quality of life improvement.
    • Rests on an assumption: Many patients with endometriosis have not been counseled on or advised to use self-management strategies.

  • May combine two claims.

    Premisecitation

    In a small RCT, melatonin 10 mg per day for 8 weeks improved non-cyclical pelvic pain and dysmenorrhea and reduced analgesic use.

    “Similarly, a small RCT of melatonin (10 mg per day) for 8 weeks improved non-cyclical pelvic pain and dysmenorrhea while reducing analgesic consumption (Schwertner et al., 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Schwertner et al., 2013 source

  • May combine two claims.

    Premisecitation

    The British Pain Society guidelines on adult pain management include and encourage this category of treatment.

    “Moreover, this category of treatment is included and encouraged by The British Pain Society (2013) guidelines on pain management for adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites The British Pain Society, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The British Pain Society considers a physiotherapist an essential member of the multidisciplinary team for patients with chronic pain.

    “The British Pain Society (2013) considers a physiotherapist an essential member of the multidisciplinary team for patients with chronic pain.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites British Pain Society, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Not all individuals have access to or knowledge of online resources.

    “Not all individuals may have access or the knowledge to navigate online resources.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Some individuals may have difficulty accessing food for diet trials or exercise equipment for at-home exercises.

    “Some individuals may also experience difficulty accessing other necessities such as food to fulfill new diet trials or exercise equipment to complete at-home exercises.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACT is an evidence-based psychotherapy that aims to increase psychological flexibility.

    “ACT is a form of evidence-based psychotherapy that aims to increase psychological flexibility (Wetherell et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wetherell et al., 2011 source

  • May combine two claims.

    Premisenone given

    The literature on self-management strategies for endometriosis is scarce and/or limited by lower methodological quality.

    “In relation to endometriosis, the literature on these self-management strategies is scarce and/or limited by lower methodological quality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Many problem-focused strategies require electricity, technological devices, and internet access.

    “For many of the problem-focused strategies, access to electricity, technological devices and the internet is required.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACT aims to help patients recognize internal and external triggers and equip them with useful thoughts and behaviors.

    “In other words, the goal is to give patients the knowledge to recognize internal and external triggering events or experiences (e.g. pain) and equipping them with appropriate and useful thoughts and behaviors (Kuba and Weißflog, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kuba and Weißflog, 2017 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACT aims to provide skills such as accepting automatic thoughts and defusing from thinking.

    “- accept automatic thoughts, sensations and urges; - defuse from thinking (i.e. observe thoughts without believing them or following their directions);”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al., 2012 source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Pelvic floor exercises and cannabis carry greater risks or require guidance from healthcare providers.

    “For other strategies (e.g. pelvic floor exercises, cannabis), the risks are greater or they require guidance by healthcare providers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An ongoing RCT includes ACT-based therapy as an intervention.

    “there is an ongoing RCT that includes therapy based on ACT as intervention (Forman et al., 2016)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Forman et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    For diet, sleep, and mindfulness, possible adverse events are unlikely or mild enough that benefits would outweigh risks.

    “For some (e.g. diet, sleep, mindfulness), the likelihood and severity of possible adverse events are low enough that the potential benefits would outweigh the risk.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    The COVID-19 pandemic and required self-isolation have substantially disrupted endometriosis care worldwide.

    “The care of patients with endometriosis has been complicated by the coronavirus disease 2019 (COVID-19) pandemic.”
    “The coronavirus disease 2019 (COVID-19) pandemic, and the resultant required self-isolation, is having a huge impact on the care of patients with endometriosis worldwide.”

  • The paper relies on this without support.

    Many outpatient endometriosis appointments have been canceled or postponed.

    “Similarly, many outpatient appointments for endometriosis with family physicians, gynecologists, fertility specialists and/or other allied healthcare professionals (e.g. physiotherapists, psychologists, dieticians) have been canceled or postponed.”

  • The paper relies on this without support.

    Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and quality of life improvement.

    “Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and improvement in their quality of life.”

  • The paper relies on this without support.

    Patients with endometriosis may be more prone to negative psychological effects from COVID-19 restrictions than others.

    “which patients with endometriosis may be more prone to already.”

  • The paper relies on this without support.

    Many patients with endometriosis have not been counseled on or advised to use self-management strategies.

    “Some patients may already be using these strategies during normal times, but many will not have been counseled on them or advised to use them.”

  • The paper relies on this without support.

    Yoga therapy in forms of asanas, pranayama, and relaxation decreases pain intensity and improves quality of life for women with chronic pelvic pain.

    “Similarly, yoga therapy in the forms of asanas, pranayama and relaxation has been shown to decrease pain intensity and improve the quality of life for women with chronic pelvic pain.”

  • The paper relies on this without support.

    Sleep plays an important role in regulating quality of life and social, emotional, and physical well-being.

    “Sleep plays an important role in regulating an individual’s quality of life and social, emotional and physical well-being.”

  • The paper relies on this without support.

    Sleep can modulate physical and mental health.

    “because sleep can modulate physical and mental health.”

  • The paper relies on this without support.

    Mindfulness activities may be helpful in falling asleep.

    “Mindfulness activities may be helpful in falling asleep.”

  • The paper relies on this without support.

    Encouragement from healthcare providers to implement self-management strategies improves patients' confidence in those strategies.

    “Encouragement from healthcare providers to implement other self-management strategies should improve the confidence patients have in those strategies.”

  • The paper relies on this without support.

    The literature on sleep dysfunction in women with endometriosis is limited.

    “Thus far, the literature on sleep dysfunction in women with endometriosis is limited.”

  • The paper relies on this without support.

    Social isolation is mandated broadly globally due to COVID-19.

    “While social isolation is being mandated broadly globally due to COVID-19”

  • The paper relies on this without support.

    A frequent strategy for endometriosis sufferers is to schedule social events during more reliable periods of decreased or no pain.

    “A frequent strategy for those suffering from endometriosis is to schedule social events during more reliable periods of decreased or no pain.”

  • The paper relies on this without support.

    Working from home or attending school virtually has become a new normal for many individuals.

    “Working from home (WFH) or attending school virtually has become a new normal for many individuals.”

  • The paper relies on this without support.

    Many patients learn of endometriosis at consultation as a possible explanation for their symptoms.

    “Many patients learn of the word ‘endometriosis’ at the time of consultation with their healthcare provider as a possible explanation for their symptoms.”

  • The paper relies on this without support.

    Information patients receive about endometriosis may be inconsistent and ambiguous.

    “Depending on how they receive a diagnosis and by whom they are diagnosed, the information they receive may be inconsistent and ambiguous.”

  • The paper relies on this without support.

    Education about endometriosis often focuses on visible aspects rather than invisible downstream effects.

    “The tangible nature of endometriosis means that education is often focused on what can be seen (i.e. endometriosis deposits, endometriomas) rather than on the invisible downstream effects like chronic pelvic pain and central sensitization.”

  • The paper relies on this without support.

    Dietary factors with anti-inflammatory effects (green tea, resveratrol, fish oil, soy isoflavones) reduce endometriosis disease progression in mouse models, as measured by lesion size.

    “- dietary factors (e.g. green tea, resveratrol, fish oil, soy isoflavones) with known anti-inflammatory effects have been shown to mitigate disease progression, assessed as lesion size in mouse models;”

  • The paper relies on this without support.

    An anti-inflammatory diet may lower the risk of advanced endometriosis stage and/or reduce pain symptoms in affected patients.

    “- there may be a decreased risk for advanced endometriosis stage and/or reduction in pain symptoms in afflicted patients who use an anti-inflammatory diet;”

  • The paper relies on this without support.

    Health anxiety that interferes with daily life can be heightened in people with pre-existing chronic conditions such as endometriosis.

    “Health anxiety that interferes with everyday life can be heightened in individuals with pre-existing chronic conditions, such as endometriosis.”

  • The paper relies on this without support.

    Mindfulness meditation is not a natural skill for most people and must be learned and practiced.

    “Performing mindfulness meditation is not a skill most people naturally have so it must be learned and practiced.”

  • The paper relies on this without support.

    Telehealth options in many jurisdictions provide high-quality psychological support using CBT and ACT that can effectively manage health-related negative emotions.

    “There are telehealth options in many jurisdictions providing high-quality psychological support, using therapeutic techniques such as CBT (focusing on identifying and changing unhelpful thought patterns, and thereby changing behaviors) and ACT (discussed below) that can be effective at managing health-related negative emotions.”

  • The paper relies on this without support.

    ACT and CBT are not designed as self-help approaches and should be used only with a trained health professional.

    “As with CBT, it is important to stress that these therapies are not designed as self-help approaches, and should be utilized only in consultation with a trained health professional (e.g. psychologist).”
23 of 23

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Non-medication description conflicts with medicinal cannabis recommendation

    Minor

    The discussion describes the strategies covered as non-medication, but an earlier section recommends considering medicinal cannabis as one of those strategies.

1 of 1

Cites

Flagged first, then by citations

5 of the 89 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Geneen, 2017, Physical activity and exercise for chronic pain in adults, J Sociol, 1:135
  2. Kuba, 2017, Acceptance and commitment therapy in the treatment of chronic disease, Psychother Psychosom Medizinische Psychol, 67, 525
  3. 2013, Guidelines for Pain Management Programmes for Adults

Cited by

Sorted by citations

Related

Authors
Leonardi, M., Horne, A. W., Vincent, K., Sinclair, J., Sherman, K. A., Ciccia, D., Condous, G., Johnson, N. P., & Armour, M.
Affiliations
  • The University of Sydney (AU)
  • MRC Centre for Reproductive Health (GB)
  • John Radcliffe Hospital (GB)
  • Western Sydney University (AU)
  • Macquarie University (AU)
  • Endometriosis Australia (AU)
  • University of Auckland (NZ)
Corresponding author
Leonardi, Mathew
ORCID
Venue
Human Reproduction Open
Publisher
Oxford University Press (OUP)
Published
2020
Volume
2020
Issue
2
Pages
hoaa028-hoaa028
ISSN
2399-3529 (ISSN-L)
DOI
10.1093/hropen/hoaa028
PMC
PMC7263080
OpenAlex
W3024786223
Cited by
83
References
89
Citations by year
2026: 5 · 2025: 12 · 2024: 12 · 2023: 12 · 2022: 20 · 2021: 19 · 2020: 3
FWCI
11.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Reproduction Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, cc-by)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
Funders
Medical Research Council (MR/N022556/1)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
endometriosis, self-management, COVID-19 pandemic, analgesia, quality of life, problem-focused coping, emotion-focused coping, psychological impact, teleconsultation, healthcare access restrictions, biopsychosocial care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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