Endometriosis is a condition you’ve probably heard of before — affecting 10% of women around the world [1][5]. Even though it is common and recognised, there is a lot of misinformation out there.
Many women with endometriosis, or endo, worry that they will struggle with fertility and pregnancy. Let us put your mind at rest; women with endometriosis can get pregnant and many of them will do so naturally. Here’s everything you need to know about endometriosis and pregnancy.
What is endometriosis?
To put it simply, endometriosis is a condition where the cells that make up your uterine lining grow in places they shouldn’t. Common places to find this rebellious tissue include the fallopian tubes, ovaries and tissues lining the pelvis [1][7].
Even though the tissue is not where it belongs, it still functions in a normal way. This means it reacts to cues from the ovaries — like bleeding during your menstrual cycle. This can cause inflammation and scarring and even sometimes cause other organs to stick together [7].
There are 4 stages of endometriosis: stage 1 is mild, stages 2 and 3 are moderate, and stage 4 is considered severe [7].
What causes endometriosis?
Unfortunately, we don’t know yet what causes endometriosis. Though many theories are being investigated, such as [5][7]:
- Retrograde menstruation: Period blood flows backwards into the fallopian tubes and pelvis instead of exiting the body. If the cells stick to the other organs, they may begin to grow there.
- Metaplasia: When normal tissue morphs into abnormal tissue, such as the pelvic lining becoming endometriosis
- Genetic links: A family history of endometriosis makes it up to 10 times more likely that you will experience it too
What symptoms should you look out for?
Not all women with endometriosis will experience symptoms. But, if they do, these are the common ones to look out for [5]:
- Painful periods
- Pain during sex
- Pelvic pain
- Bloating
- Fatigue
- Pain when passing urine or bowel movements, especially on your period
All of these symptoms could be caused by something else. So, it’s important that you investigate with your doctor for a true diagnosis.
The first step is often an ultrasound which can pick up moderate to severe endometriosis. Another option is laparoscopic surgery, which is not always recommended for endometriosis diagnosis as it is invasive.
What are the treatments for endometriosis?
Endometriosis is a chronic condition. This means there is no cure, but there are lots of treatment options available to help you manage endo.
Drug therapies
For women who are not trying to conceive, hormonal therapies can be useful. These include oral contraceptives, an IUD and gonadotropin-releasing hormone analogues (GnRHa).
All of these are believed to suppress endometrial growths, which helps to reduce severe endometriosis [3].
Natural therapies
Many women prefer to try natural therapies to manage their endometriosis symptoms — like diet, psychology and visiting a pelvic floor physio. More research is needed to prove how effective these treatments are, but they are rarely harmful [3].
Surgery
Surgery is surprisingly common for people with endometriosis. That’s because it’s proven to be quite effective. A keyhole surgery (or laparoscopy) will remove the endometriosis tissue, which can help improve symptoms and even the quality of life for patients [3].
The idea is to get most of the tissue in one go, which should mean fewer surgeries or a process you only have to go through once. Once removed, it’s even possible that the endo tissue will not return [3].
You might not need treatment at all
It’s actually okay to leave some endometriosis alone. Treatments are recommended if you’re experiencing severe pain or having trouble with fertility.
Otherwise, and especially with mild disease, you can let it be. This is a conversation to have with your doctor or specialist who can help you weigh up all the benefits and risks for appropriate treatment [6].
How does endometriosis affect fertility?
Here’s some good news: only 30% of women with endo are expected to have fertility issues. For the women that do, treatments like surgery and IVF can be super helpful [1][7].
In fact, a lot of women only find out they have endometriosis when they start investigating infertility. Others will have already had children by the time they are diagnosed [1], [7].
We don’t know for sure why endometriosis sometimes impacts fertility. But, there are a few theories being explored [1][5]:
- Chemicals released by the endometriosis cells might interfere with conception, harm sperm cells or prevent the formation of a healthy embryo
- You may have lower-quality eggs which are harder to fertilise
- You might find sex painful, so you have less of it
- In moderate and severe cases, fallopian tube scarring may be preventing sperm from reaching the egg or blocking the egg from travelling
Whether you’re ready for kids or not, you can start to explore your options by getting a fertility test. This involves a blood test followed by a GP consult that gives you insight about your ovarian reserve, the potential success of egg freezing and IVF, possible signs of PCOS as well as your menopause timing, reproductive timeline and more.
What are the chances of falling pregnant with endometriosis?
Ready for some more good news? The chances of falling pregnant with endometriosis are pretty high. Most women with endometriosis are able to fall pregnant without any medical help [2].
What if you struggle to fall pregnant with endometriosis?
We know it’s scary when you face fertility problems, but all is not lost! Laparoscopy is a fairly effective way for women with endometriosis to help their fertility — especially in cases of mild disease [6]. Another option is in vitro fertilisation (IVF) [1].
You might also want to try counselling if your fertility journey is making you feel angry or depressed. A counsellor can help you handle the ups and downs — from unsuccessful treatments to the difficulty of watching others go through pregnancy [2].
Does endometriosis improve with pregnancy?
There’s an old myth out there that pregnancy can actually cure endometriosis. Unfortunately, this isn't true. Pregnancy does not cure endo, but it might make your endometriosis symptoms go away (at least for a bit) [2].
Without periods to aggravate the endometrial growths, a lot of women find their endometriosis symptoms improve. The pregnancy hormones may also help relieve endometriosis [2].
This lack of symptoms might continue after giving birth and while breastfeeding. But, often they will return when your period starts back up again [4].
What does pregnancy with endometriosis feel like?
It’s hard to say for sure because everyone is different, but many women do have an uncomplicated pregnancy with endometriosis [4].
Studies have shown that lesions can become inactive during pregnancy, which means endometriosis pain is limited. These studies may have been impacted by the fact lots of women have had a laparoscopy to improve fertility, which is also known to reduce pain [4].
Some women do still experience pain throughout pregnancy. It’s important to look into any symptoms you might have. It may not be related to endometriosis at all, in which case you need a proper diagnosis with your doctor [4].
Is pregnancy with endometriosis high risk?
Endometriosis in pregnancy has been linked to a higher risk of complications, but that’s not the whole story. A systematic review of many studies found some gaps in the research.
First, a lot of the studies have small sample sizes. This makes it harder to apply results to a general population [8].
Second, the studies often recruited from fertility clinics. This means they are not collecting data from women with endometriosis who did conceive naturally. Since many women are actually diagnosed with endometriosis during fertility treatments, there’s possibly a whole sector of women with endo who are not part of the statistics [8].
In a lot of cases, extra monitoring is enough to support pregnant women with endo. Some of the risk factors you might monitor for include [4][8]:
- Placenta praevia
- Ectopic pregnancy
- Premature birth
- Miscarriage
The bottom line is: endometriosis does not definitely mean increased risk in pregnancy. Working with your doctor and health team, you can monitor for risk factors and have a healthy baby.
Can endometriosis cause miscarriage?
It’s estimated that a miscarriage will occur in 20-25% of all pregnancies [4]. Knowing the facts doesn’t make it any less difficult, but it does remind us that miscarriages are unfortunately common.
And, research hasn't proven if having endo can increase your chance of miscarriage or not. Most women with endometriosis do have normal, uncomplicated pregnancies. Early monitoring, like your first ultrasound, is always recommended to minimise pregnancy complications [4].
Remember that support is available, no matter what you are going through. Talk to family, friends and health professionals throughout your pregnancy journey.
How to get pregnant naturally with endometriosis
Women with endo aren’t so different to the rest. The advice for getting pregnant naturally involves all the usual suspects, like timed intercourse and weight management. Here’s what you should know.
Consider surgery to remove lesions
Surgical treatments for endometriosis, like laparoscopy, are believed to assist with fertility and pregnancy. The pregnancy rate after laparoscopic surgery is around 42% [1].
So, if you’re committed to a natural conception, it might be worth chatting with your doctor about whether surgery is a viable treatment option for you.
Have sex in your fertile window
You can have sex as many times as you like (we encourage it), but the baby-making only happens for a short time each month.
To get pregnant, you need to be getting jiggy with it during your fertile window, which is 3-5 days before ovulation and the day of ovulation itself [9].
Build healthy habits from the start
Your body is a temple, as they say — and you should treat it with respect. Preparing to invite a baby into your womb means prepping with some healthy lifestyle habits too. Lifestyle recommendations include [9]:
- Try to reduce stress
- Set a regular exercise routine
- Quit smoking
- Stop drinking alcohol
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