• The Centers for Disease Control and Prevention (CDC) has recommended Pfizer COVID-19 vaccine booster shots for adults over 65 and other high-risk individuals.
• People who are determined to be immunocompromised are eligible to receive a third dose of the Pfizer and Moderna vaccines under the emergency use authorizations amended on Aug.12.
• Endometriosis is not expressly identified as a high-risk condition by the CDC, but individuals with the condition may be eligible for an additional vaccine dose based on other health conditions.

The Centers for Disease Control and Prevention has recommended booster shots of the Pfizer COVID-19 vaccine at least six months after a second dose for the following groups:

• People 65 and older
• Residents of long-term care facilities
• People ages 50 to 64 with underlying medical conditions that place them at high risk for severe COVID-19

The CDC recommendations state that people ages 18 to 49 with underlying medical conditions and people ages 18 to 64 who are at risk of COVID-19 exposure due to their work or living arrangements “may receive a booster shot” of the Pfizer vaccine “based on their individual benefits and risks.”

The CDC’s list of underlying medical conditions does not specifically include endometriosis. The list of underlying conditions does include pregnancy, asthma, and diabetes, among several other conditions.

President Joe Biden confirmed in a speech on Sept. 24 that eligible individuals who received their second dose of the Pfizer vaccine in March or earlier can receive a booster dose of the vaccine now, free of charge.

The CDC and U.S. Food and Drug Administration (FDA) did not release recommendations about the Moderna vaccine or the single-dose Johnson & Johnson vaccine. Both Moderna and Johnson & Johnson have submitted data on booster shots to the FDA for review.

Recommendations for Immunocompromised People

A COVID-19 vaccine booster is administered when someone developed adequate immunity after the initial vaccine doses, but that immunity has decreased over time. However, an additional dose of the vaccine may be recommended for those who did not develop an adequate immune response after the two-dose vaccination series.

The FDA amended the Pfizer and Moderna vaccines’ emergency use authorizations on Aug. 12 to allow a third vaccine dose at least 28 days after the second dose for certain immunocompromised individuals. There is not yet guidance from the FDA or CDC on additional doses for immunocompromised people who received the Johnson & Johnson vaccine.

Individuals defined as immunocompromised include people in cancer treatment, people who received a stem cell transplant in the last two years, people who are organ donor recipients and taking immunosuppressive drugs, people taking high-dose steroids or other immunosuppressive drugs, as well as those with certain other health conditions.

The CDC recommends individuals consult their doctors to determine if a third dose is appropriate for them.

COVID-19 Booster Shots and Additional Doses for People With Endometriosis

MyEndometriosisTeam sat down with Dr. Nicholas Fogelson to answer questions about booster shots and additional COVID-19 vaccine doses for people with endometriosis. He also addressed concerns some people may still have about the safety of the COVID-19 vaccines. Dr. Fogelson is a gynecologic surgeon and the founder of Northwest Endometriosis and Pelvic Surgery in Portland, Oregon.

MyEndometriosisTeam previously spoke to Dr. Fogelson about COVID-19 vaccination in April. In that conversation, Dr. Fogelson addressed questions about endometriosis medications and surgeries as they relate to vaccination.

The following conversation has been lightly edited for clarity.

Dr. Fogelson on COVID-19 Additional Doses and Booster Shots

Are people with endometriosis considered immunocompromised and therefore eligible for a third Pfizer or Moderna COVID-19 vaccine dose?

In general, people with endometriosis are not immunocompromised, assuming there are no other immune issues involved. At this point, I do not think that endo patients would meet any special qualification for an early booster.

Are there any cases in which you would recommend a person with endometriosis get an additional vaccine dose as soon as possible?

I would wait until they [qualify]. There [is] a directive from the CDC as to the recommendations on this, which I would recommend that people follow.

Dr. Fogelson on COVID-19 Vaccine Concerns

What is your response to someone concerned about the long-term safety of COVID-19 vaccines?

I understand that a lot of people still have vaccine concerns. [These individuals] are generally worried about long-term safety data on the vaccine and are not entirely comfortable with moving forward and getting vaccinated.

We have data showing the vaccines to be safe and effective. People [wanting to wait] for long-term data are [at risk of] getting COVID-19 while they wait.

So people are either going to get vaccinated or they are going to get COVID-19. Some are going to get vaccinated and they are going to get COVID-19, but at least those cases will be fairly mild and very rarely lead to any bad outcomes.

I think to some extent people who are worried about safety are really underestimating how bad COVID-19 can be, and why they should really want to avoid getting it. So while some people say there isn’t enough safety data on the vaccine, you really have to look at the other side of the coin, which is safety of getting COVID-19. It's very dangerous. You should want to avoid it. Even young, healthy people can get very very sick, especially with the delta variant.

COVID-19 can kill you, even if you are healthy, and you don’t want to get it.

Some people with endometriosis may be hesitant to be vaccinated because they’re worried about flares. Can COVID-19 vaccination cause endometriosis flares?

I’ve heard enough anecdotal evidence to think that [a COVID-19 vaccination] probably does [cause flares] in some people. I have some patients that have chosen to not be vaccinated for that reason. To me, COVID-19 seems much more serious than whatever temporary flare there may be with the vaccine. And we are talking about a one-for-one trade, because nearly every unvaccinated person will get COVID-19 eventually, if they haven’t already gotten it.

I understand and have compassion for a patient that is worried about having an endo flare. Still, I think it is in a person’s interest to get vaccinated, even if it causes a flare of endo.

Dr. Fogelson on COVID-19 Hospitalizations and Endometriosis Care

How is COVID-19 affecting health care access for people with endometriosis?

This personal decision that a person might make [to not be vaccinated] is affecting more than just that one person. Our medical system is cracking under the weight of having to care for the huge number of hospitalized COVID-19 patients.

Right now, we can’t operate in our hospitals because every nurse in the hospital is being assigned to care for COVID-19 patients. My endometriosis patients who have serious pain can’t get surgery. Nearly 100 percent of the hospitalized [COVID-19] patients have not been vaccinated, so it’s not hard to draw a straight line between a portion of the community’s decision to not get vaccinated and the current situation in our hospitals.