Endometriosis when pregnant: How does this condition affect pregnancy?

 Key takeaways

• Although endometriosis increases the risk of infertility, pregnancy is achievable in most cases.
• Pregnancy may reduce the symptoms of endometriosis. Nevertheless, this may not be the case for everyone with the condition.
• Having endometriosis when pregnant is associated with certain complications, such as miscarriage and preterm delivery. But the majority of women with endometriosis still have healthy pregnancies and deliveries with proper medical care, research says.

Endometriosis is a gynecological condition that affects approximately 1 in 10 people with uteruses. Some experience severe symptoms, while for others, they're mild.

About 1 in every 2 women with endometriosis has infertility challenges compared to those without endometriosis. Studies have also shown that out of 100% of women with infertility, 25% have endometriosis.

There have also been associated risks of pregnancy complications with endometriosis. However, with proper treatment, pregnancy is achievable in most cases, and the majority have healthy pregnancies and deliveries.

 Does endometriosis reduce pregnancy chances?

One of the complications of endometriosis is infertility. Endometriosis may reduce the chances of a woman getting pregnant. 

This, however, depends on the severity of a person's condition. The more advanced the stage of endometriosis, the lesser the chances of getting pregnant, says Dr. Adewole Adebayo, a consultant gynecologist at Federal Medical Center, Lokoja, Kogi State, Nigeria.

Nonetheless, pregnancy is still achievable for people with endometriosis.  Women with endometriosis can get pregnant naturally, but for those who cannot achieve it naturally, there are available Assisted Reproductive Technologies (ART) like IVF (In vitro fertilization), through which pregnancy may be made possible, Dr. Adebayo said.

 How does endometriosis reduce pregnancy chances?

Endometriosis causes infertility in some ways, which can be mechanical or biochemical. 

In the biochemical cause of infertility, the inflammation caused by endometriosis releases toxic chemicals into the bloodstream. These chemicals can affect the quality of the sperm or ovum (a woman's egg), making the ovum and/or sperm unfavorable for fertilization. They can also affect the embryo after fertilization.

For mechanical causes, adhesions (scar tissues) resulting from the presence of endometriotic tissues or surgical interventions may block the fallopian tubes, preventing the passage of the ovum to the uterus or the sperm from meeting the ovum.

Additionally, endometriosis can prevent ovulation in situations where the tissues are found in the ovary, Dr. Adebayo said.

 Can you have endometriosis symptoms while pregnant?

Pregnancy quietens endometriosis symptoms, says Dr. Adebayo, meaning that endometriosis symptoms may reduce when you get pregnant. This may be attributed to the increased level of progesterone and decreased estrogen level during pregnancy, thereby halting the growth of endometriotic tissues.

While this is so, some people still experience endometriosis symptoms, especially in early pregnancy. This may be linked to the fact that for some people, the endometriotic tissues seem to have disappeared, while for others, there's increased endometriotic tissue growth.

 Endometriosis in early pregnancy

Most endometriosis symptoms experienced by some people occur in the early stages of pregnancy (first trimester). Symptoms may improve as pregnancy progresses. This may be a result of the rapid growth of the uterus, thereby putting pressure on the inflamed or scarred areas affected by endometriosis.

Also, some women may be at risk of ectopic pregnancy (a pregnancy where the embryo implants in places other than the uterine cavity) due to the blockage of the fallopian tubes by endometriotic tissues. They may also have a higher risk of miscarriage due to malformations of the placenta, causing it to detach before the baby is viable.

These increased or sustained symptoms/complications, however, are rare. Most people with endometriosis who achieve pregnancy have healthy pregnancies without endometriosis symptoms. 

 Can endometriosis affect pregnancy?

Endometriosis does not, in most cases, cause problems during pregnancy. However, there are controversial findings on the outcome of pregnancy among women with endometriosis.

Endometriosis has been linked to a higher rate of pregnancy complications in women with endometriosis compared to those without endometriosis. While this is so, the incidence of these complications is rare.

 Endometriosis pregnancy complications: How it can affect pregnancy

Endometriosis can put those diagnosed with it at risk of some pregnancy complications, such as:

 1. Placenta previa

Placenta previa is the abnormal placement of the placenta. Normally, the placenta is situated in the upper segment of the uterine cavity. In placenta previa, the placenta is found in places close to the cervix or over the cervical opening. 

A 2021 review study found that people with endometriosis have a higher risk of having placenta previa.

Also, placenta previa places a woman at risk of vaginal bleeding during pregnancy.

 2. Placenta abruptio

Here, the placenta separates before the pregnancy has reached term. This may result from placenta previa or placenta malformation.

 3. Miscarriage

Miscarriage is a pregnancy loss before 20 weeks gestation. People with endometriosis are at a higher risk of miscarriage compared to women without endometriosis. Research has shown about 80% increased risk.

This may be a result of poor implantation of the embryo in the layers of the uterus caused by the presence of inflammatory biochemicals.

 4. Ectopic pregnancy

A 2019 study found that there's an increased risk of ectopic pregnancy among women with endometriosis.

Most cases of ectopic pregnancy occur in the fallopian tube and can lead to rupture of the tube. 

Also, ectopic pregnancy can lead to bleeding, in most cases, internal bleeding.

 5. Preterm delivery

Preterm delivery is any birth that occurs before 37 weeks gestation.Studies have linked a greater risk of preterm delivery to endometriosis.

The exact reason for this is unknown, but some believe it may be due to increased uterine contractions caused by inflammation in people with endometriosis.

 6. Preeclampsia

Preeclampsia is a condition where there's increased blood pressure and the presence of protein in urine in pregnant people. 

There's an associated risk of developing preeclampsia among pregnant individuals with endometriosis.

 7. Cesarean delivery

This is the surgical delivery of babies. Studies have shown an increased risk of cesarean delivery among people with endometriosis. However, there's limited study on whether it's is elective or emergency cesarean section these women are predisposed to.

 Other endometriosis complications

Other possible complications of endometriosis, which can affect pregnant people, include:

• Bowel perforation
• Uterine rupture
• Rupture of endometriosis cysts
• Spontaneous hemoperitoneum (blood in the peritoneal cavity)
• Intra-abdominal bleeding

 Endometriosis vs. pregnancy symptoms: Are there similarities?

Endometriosis is primarily characterized by chronic pain, especially during menstruation and sexual intercourse. In pregnancy, this is not the case.

People with endometriosis who may begin to experience an 'endo belly' (protruding belly) may think they're pregnant. In this case, a pregnancy test is advised for confirmation.

Endometriosis and pregnancy are two different situations. Research has shown that endometriosis is one of the causes of infertility. So, there are no similarities in their symptoms, says Dr Adebayo.

 When to see a gynecologist

After withdrawal from hormonal therapy, most women get pregnant naturally within twelve months. If, after 6–12 months, pregnancy does not occur, It's best to visit a gynecologist for proper assessment and assistance.

There are medical options available to help women achieve pregnancy. Your doctor will explain the pros and cons of each and may advise you on the one that is best for you.

Also, if the pregnancy is achieved, you may be placed on proper monitoring to ensure you deliver a healthy baby. And, if, along your pregnancy journey, you experience symptoms such as cramping, pelvic pain, or bleeding, or you feel something is wrong, ensure to see your doctor. 

 Wrap-up

The increased risk of infertility among women with endometriosis puts them on the edge when it comes to pregnancy and its outcome. However, research has shown that women with endometriosis can get pregnant and have healthy pregnancies.

Although there are pregnancy complications linked to having endometriosis, appropriate medical care can help people with endometriosis have healthy babies.

Each pregnancy is unique. The outcome of one pregnancy cannot be used to ascertain another's outcome. Therefore, ensure that you always keep to your hospital appointments and treatments during pregnancy.