Endometriosis, fertility, and pregnancy often become inextricably linked. When you have endometriosis, they can present both challenges and a potential solution to managing symptoms.
This blog will explore how endometriosis affects individuals before and after pregnancy, including when symptoms are most likely to recur, how to manage postpartum endometriosis and potential treatment options.
Here is what we are covering:
Challenges of getting pregnant with endometriosis
How pregnancy affects endometriosis
Endometriosis after pregnancy
Endometriosis and the lack of a cure
Managing endo as a new parent
Challenges of getting pregnant with endometriosis
Up to 30% to 50% of women with endometriosis may experience infertility.
Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.
One of the most significant challenges of endometriosis is the impact it can have on fertility.
Studies show that those assigned female at birth with endometriosis have a higher risk of infertility than those without the condition.
This is because endometriosis can cause damage to the reproductive organs and disrupt the menstrual cycle.
Endometriosis can lead to the formation of scar tissue and adhesions, which can block or damage the fallopian tubes.
This can make it difficult or impossible for the sperm to reach the egg or for the fertilized egg to travel to the uterus for implantation.
Endometriosis can also affect the quality of the eggs, making it harder for them to be fertilized.
Endometriosis can also cause hormonal imbalances, which can affect ovulation.
Women with endometriosis may have irregular periods, which can make it difficult to predict when ovulation will occur.
This can make it challenging to time intercourse properly for conception.
Can pregnancy help alleviate endo symptoms?
Pregnancy has been touted by clinicians as a ‘natural cure’ for endometriosis since the early 20th century.
Into the 1950s and 1960s, pregnancy was commonly recommended by doctors as a ‘treatment’ for endometriosis.
This evidence was based mostly on case reports of women whose endometriosis improved during pregnancy.
The problem with case reports is that they aren’t thorough, expansive, nor are they inclusive and thus don’t necessarily reflect what happens to most people.
Today, pregnancy as a treatment for endometriosis does not appear in current international guidelines for the management of endometriosis.
Can pregnancy provide temporary relief for endometriosis symptoms?
Pregnancy may temporarily halt the painful periods and heavy menstrual bleeding that are often characteristic of endometriosis. It might provide some other relief as well.
Some people benefit from the increased levels of progesterone during pregnancy.
It’s thought that this hormone suppresses and perhaps even shrinks endometrial growths.
Progestin, a synthetic form of progesterone, is often used to treat those with endometriosis.
Other people, however, will find no improvement. You may even find that your symptoms worsen during pregnancy.
That’s because, as the uterus expands to accommodate the growing fetus, it can pull and stretch misplaced tissue. That can cause discomfort.
An increase in estrogen can also feed endometrial growths.
Can pregnancy improve endometriosis symptoms in the long term?
Scientists believe that endometriosis symptoms may temporarily improve during pregnancy and while breastfeeding.
That’s because during pregnancy, ovulation is inhibited, so the hormonal changes that typically cause pain during an average menstrual cycle don't occur.
Similarly, the hormonal changes that allow for breastfeeding can also inhibit ovulation.
Unfortunately, symptoms often return once hormone levels return to pre-pregnancy levels and the menstrual cycles resumes.
The condition occurs when endometrial tissue grows outside of the uterus.
During a typical menstrual cycle, the endometrial lining of the uterus responds to hormonal signals, which causes the tissue to shed and bleed.
However, when endometrial tissue grows outside of the uterus, the extra tissue has nowhere to go.
This can cause pelvic pain, cramping, a sensation of fullness or pressure in the abdomen, and changes in bowel and bladder function.
During pregnancy and breastfeeding, hormone levels shift, and menstrual cycles usually stop.
Without the hormonal signals to grow and shed endometrial tissue, endometriosis symptoms are often reduced.
Menstruation typically begins between six to eight weeks after giving birth in those who aren't breastfeeding.
Others find that their periods return sooner, often when they start introducing supplemental feedings in addition to breastmilk.
As a result, pregnancy and breastfeeding may only serve as temporary relief from endometriosis.
Can endometriosis return after pregnancy?
Some find their endometriosis symptoms improve or go away after giving birth.
But for many, endometriosis symptoms come back after they stop breast-feeding and their period returns.
It's important to continue with medical care for your endometriosis after your baby is born.
Managing endo as a new parent
It can be difficult to manage the pain and symptoms associated with endometriosis while juggling new parenthood.
If you have recently given birth and are dealing with endometriosis, it's especially important to rest when you can, eat a healthy diet, and engage in gentle exercise as directed by a healthcare provider.
It can also be helpful to discuss your symptoms with a healthcare provider, care navigator, partner or friend.
Alternative treatments to managing endo as a new parent
Research is still emerging regarding non-medical treatments for endometriosis.
Some individuals find relief by:
Eating a healthy diet high in vegetables, flaxseed, and omega-3 fatty acids
Exercising regularly
Taking a warm bath
Other alternative and complementary therapies, including acupuncture, may help reduce period-related pain, although the research is unclear.
Medical options for managing endo as a new parent
Prescription pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs): Pain medications may include opioids or NSAIDs such as Advil (ibuprofen) and Aleve (naproxen). There is a risk of addiction to opioid pain medications, and long-term use of these medications may not be appropriate for everyone.
Hormone therapies: Hormone therapies, including hormonal birth control, change hormone levels involved in menstruation, and some birth control may stop periods altogether. While many forms of birth control are safe for long-term use, some may cause unwanted side effects. Some research also suggests that endometriosis symptoms recur in 50% of individuals after two years of treatment. They are also not appropriate if you are trying to get pregnant.
Laparoscopic surgery: This technique uses small abdominal incisions, a camera, and surgical instruments to evaluate and remove extra endometrial tissue from inside the abdominal cavity. Unfortunately, the tissue often regrows in 40% to 50% of those treated within five years.
Hysterectomy: Complete removal of the uterus and other reproductive organs may improve symptoms, but it is not an option for those who wish to get pregnant.
The takeaway
Endometriosis is a chronic condition, and researchers are still unclear about how and why the disease progresses.
However, pregnancy and breastfeeding appear to reduce symptoms in many individuals, and some people may experience long-term resolution in their pain and heavy bleeding after pregnancy.
However, the disease follows a unique path in every individual, and it's impossible to know what will occur in any given person.