What to know about endometriosis during pregnancy

Endometriosis occurs when cells similar to those that line the uterus grow elsewhere in the body. It can cause chronic pelvic pain and a variety of other symptoms. But what is the link between endometriosis and pregnancy?

Becoming pregnant may be more difficult for women with endometriosis. However, many women with endometriosis do get pregnant and have healthy babies.

This article discusses the effect of pregnancy on endometriosis symptoms. It also considers whether or not having endometriosis during pregnancy increases the risk of complications.

How does pregnancy affect endometriosis symptoms?

Pregnant mother holding her stomach
For some women, pregnancy may relieve endometriosis symptoms.

Pregnancy has different effects on each woman with endometriosis. Some women may find that becoming pregnant relieves their endometriosis symptoms, as they will no longer be having periods.

Raised levels of the hormone progesterone during pregnancy may also improve symptoms.

Research has found that progestin, which is a synthetic version of progesterone, reduces endometriosis pain for around 90 percent of women. Progestin is a standard treatment for endometriosis.

The body’s natural progesterone may have similar effects to progestin for some women, but not everyone with endometriosis finds that their symptoms improve during pregnancy.

In fact, pregnancy can worsen some women’s endometriosis symptoms. This may be due to the growing uterus putting extra pressure or traction on existing areas of endometriosis.

Another factor that may worsen endometriosis symptoms during pregnancy is a rise in the hormone estrogen, which can encourage more endometriosis lesions to develop.

Even if pregnancy does provide relief, the symptoms of endometriosis are likely to return once a woman’s periods start again after pregnancy, although breast-feeding can delay this further.

A 2018 review states that women should not think of pregnancy as a strategy for managing or treating endometriosis. Pregnancy will not cure endometriosis.


Risks of endometriosis during pregnancy

People with endometriosis may be more likely to experience complications during pregnancy or when giving birth, although this is very rare.

Most people with endometriosis are able to have a healthy, uncomplicated pregnancy.

There are no specific monitoring tests or treatments for people who are pregnant and have endometriosis.

However, having endometriosis may slightly increase the risk of the following complications:

Pre-eclampsia

The results of a 2017 population-based study in Denmark suggest that pregnant women with endometriosis have a higher risk of pre-eclampsia.

Symptoms of pre-eclampsia include:

A woman with symptoms of pre-eclampsia during pregnancy should speak to a doctor. The doctor will also check for signs of this condition during routine pregnancy appointments.

Placenta previa

A 2016 study suggests that having endometriosis during pregnancy may significantly increase the risk of placenta previa.

Placenta previa is when the placenta lies very low in the womb, partially or fully covering the cervix. Placenta previa may endanger the baby and the woman during childbirth.

A woman with placenta previa will usually require a cesarean delivery.

The primary sign of placenta previa is bright red vaginal bleeding. Any women experiencing this should speak with a doctor.

Preterm birth

Research suggests that having endometriosis may increase the risk of preterm birth.

Also known as premature birth, this is when the baby is born after less than 37 weeks of gestation.

Cesarean delivery

According to research, having endometriosis may increase the likelihood of needing a cesarean delivery.

A cesarean delivery uses a surgical procedure in the abdominal region to remove the baby if a vaginal birth is not possible.

Doctors may perform a cesarean delivery if a vaginal birth is unsafe for the woman or baby.

Miscarriage

Having endometriosis also increases the risk of miscarriage, according to a 2017 research review.

Lower back pain, cramping, or bleeding during pregnancy may indicate a miscarriage. Women should see a doctor if they experience any of these symptoms.

Safe endometriosis treatments during pregnancy

Pregnant woman doing yoga
People may be able to reduce some endometriosis symptoms with gentle exercise.

Many people use hormonal therapies to manage endometriosis. These include progestin-only pills, combined pills containing estrogen and progestin, and intrauterine devices (IUDs). These options are not safe to use during pregnancy.

Some people also manage the condition by having keyhole surgeries, or laparoscopies, to remove endometriosis lesions. Surgery is also not possible during pregnancy.

Pregnant women with endometriosis may safely manage their symptoms by:

  • taking over-the-counter (OTC) pain relievers with the approval of a doctor or midwife
  • doing gentle exercise, yoga, or stretching to ease back pain
  • using heating pads or warm baths to ease cramps but not placing them directly on the uterus
  • eating foods rich in fiber to reduce bowel symptoms


What is endometriosis?

Experts estimate that endometriosis affects as many as 10 percent of women of childbearing age.

When a person has endometriosis, cells similar to those that line the uterus grow elsewhere in the body, including:

  • on the outside of the uterus wall
  • on the fallopian tubes
  • behind or on the ovaries
  • on the bladder
  • on the bowel and rectum

Endometriosis can also affect other parts of the body.

Endometriosis lesions respond to the menstrual cycle, meaning that this tissue also thickens and breaks down or bleeds each month. However, it cannot flow out of the vagina, so the blood remains trapped in the body and causes pain, inflammation, and other symptoms.

Endometriosis may also cause pelvic adhesions, where tissues in the pelvis stick together.


When to see a doctor

Many women with endometriosis have a safe pregnancy and birth with help from their doctor.

Although some women experience a reduction in their symptoms during pregnancy and while breast-feeding, others find that their symptoms remain the same or get worse.

It is essential to speak with a doctor about how to manage endometriosis symptoms during pregnancy, as many traditional treatment options are unsafe at this time.

Endometriosis rarely increases the risk of complications during pregnancy and childbirth, but a doctor can provide advice on the best way to manage the condition. Any women who have symptoms of a complication should speak to their doctor.

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