Endometriosis is a condition where the tissue that normally lines the inside of the uterus, called endometrium, grows outside of the uterus. According to a
Endometriosis can be associated with chronic pelvic pain, heavy periods, and infertility. While there’s no cure for the condition, various treatment strategies are available to help reduce symptoms and prevent progression of the disease.
Treatment for endometriosis is often done with the goal of preserving fertility. Even if having a baby isn’t on your radar yet, there may be things to consider if you want to get pregnant in the future.
Hormonal birth control is commonly used to prevent pregnancy, whether you have endometriosis or not. It’s available in the form of a pill, shot, ring, patch, or intrauterine device (IUD).
Hormonal birth control works by altering your hormone levels to prevent ovulation. Ovulation is when an egg is released from your ovaries. If no egg is released, it can’t be fertilized by sperm.
This type of contraception can also help manage endometriosis symptoms and preserve fertility.
Hormonal birth control helps reduce hormone levels, including estrogen, which stimulate the growth of endometriosis. By lowering estrogen levels, hormonal birth control can help alleviate bothersome symptoms and minimize disease progression that could lead to future fertility issues.
Hormonal birth control is also used to lighten or skip periods. This can help reduce endometriosis pain.
A laparoscopy is a surgical procedure where a small telescopic camera is placed into the abdomen. It’s the gold standard for diagnosing endometriosis, though endometriotic implants can be treated and removed with this technique.
A laparoscopy can show the extent of the endometriosis and the amount of lesions and scar tissue. The more endometriosis that is present, the more likely it will affect fertility.
Endometriosis can impact fertility in several ways:
- Scar tissue or adhesions can cause anatomic distortion and affect the function of the fallopian tubes and ovaries.
- Endometriomas, or ovarian cysts of endometriosis, can impact egg quality and ovulation.
- Increased inflammation can impact fertility.
- Endometriosis can decrease implantation rates in the uterus.
Treating endometriosis can help with fertility. Here are some treatment options that may be used for infertility related to endometriosis:
- Laparoscopic surgery. Adhesions and scar tissues can change the structure of reproductive organs. With this procedure, anatomy can be restored and affected tissue can be removed or treated. For some people, this can improve fertility.
- Medications. Hormonal birth control is often used before trying to get pregnant. Medications can help prevent disease progression and manage symptoms. If you’re trying to get pregnant,
medicationscan be used to stimulate egg growth and ovulation if needed.
- Assisted reproductive technology (ART). Options may include intrauterine insemination (IUI) or in vitro fertilization (IVF). IVF may be needed with more severe disease. There are several factors that need to be considered when deciding whether ART is the right choice for someone.
Limited research is available on how pregnancy affects endometriosis, and findings are mixed.
A 2018 review of studies showed that 15 to 50 percent of lesions went away and 34 to 64.7 percent got smaller with pregnancy. However, the review also found that between 8.8 and 39 percent of lesions got bigger during pregnancy. Findings also showed that about 25 percent of lesions didn’t change during pregnancy.
So the effects of pregnancy on people living with endometriosis can vary greatly. For some, not having periods can mean getting a break from symptoms. For others, there may be no change in symptoms, or symptoms may increase during pregnancy.
Pain during pregnancy is more common when certain areas are affected by endometriosis. Lesions in the umbilical area (belly button) or rectum are more likely to cause pain. As the uterus expands during pregnancy, there can be extra pressure on these areas.
Endometriosis may increase the odds of placenta previa in pregnancy. Placenta previa is when the placenta is very close to the cervix or covers the cervix.
If it’s early in pregnancy, there’s time for the placenta to move away from the cervix. If the placenta still covers the cervix in later pregnancy, you may need extra monitoring. Most cases of placental previa lead to a planned cesarean delivery, also known as a C-section.
However, complications from endometriosis during pregnancy are rare. There may be no need for extra monitoring during pregnancy if you have endometriosis.
Birthing methods may play a role in future endometriosis symptoms after pregnancy.
Research suggests that vaginal births are associated with lower rates of endometriosis recurrence. Many people experience a break from their symptoms for a bit after a vaginal delivery.
If you breastfeed or chestfeed, this can further delay the return of your period, which can help alleviate symptoms.
The postpartum period can be overwhelming and exhausting. Don’t forget to take care of yourself too. Be sure to follow up with your own healthcare team and discuss future plans for managing your endometriosis.
Endometriosis commonly affects people in their reproductive years. It can cause pain, heavier periods, and sometimes, fertility challenges.
There’s no cure for endometriosis, but treatment can help manage symptoms and preserve fertility. Treatment approaches may change if a person is trying to conceive or is considering getting pregnant in the future.