Endometriosis and pregnancy: What’s the connection?

During pregnancy, your uterus becomes a home for your growing baby. This home is lined with an important tissue called endometrium, which is crucial to your baby's healthy development. But if this tissue grows in other parts of your body, it's known as endometriosis—and it can cause a wide range of problems before and during pregnancy.

"If you're one of the 10 percent of women who suffer from endometriosis, you may already be familiar with some of the common symptoms, like painful periods and painful sexual intercourse," says Jordan S. Klebanoff, MD, a minimally invasive gynecologic surgeon at Lankenau Medical Center with advanced training in endometriosis care. "On the other hand, maybe you don't have any pain with your periods or with sex—but you have been trying to get pregnant and it's just not working. That could also be related endometriosis."

Whether you have symptoms or are having trouble getting pregnant, here's what you should know about endometriosis and how it affects your ability to get and stay pregnant.

What is endometriosis?

Endometriosis is a disease where the tissue that's supposed to grow only in your uterus grows in another part of your body—generally somewhere else in your abdomen and pelvis. During your menstrual cycles, these endometriosis patches get inflamed (swell up). Aside from causing pain, this repeated inflammation causes scar tissue to build up on and between your internal organs.

The most common spots for endometriosis are your reproductive organs, like your ovaries (which produce eggs), fallopian tubes (the narrow tubes leading from the ovaries to the uterus) and your intestines and bladder.

Many women with endometriosis experience:

• Chronic (ongoing) pelvic pain
• Painful periods
• Pain with sexual intercourse
• Heavy menstrual bleeding
• Intestinal or bowel disfunction (like constipation or diarrhea)
• Changes in their urinary habits

"Rarely, however, you may not experience any symptoms. Sometimes, you might only learn that you have endometriosis when you have trouble getting pregnant," says Dr. Klebanoff.

Getting pregnant with endometriosis

The exact relationship between endometriosis and ability to get pregnant isn't known. About 20 to 30 percent of women who have endometriosis have trouble getting pregnant. These numbers might seem scary, but many women go on to have successful pregnancies—especially if you seek treatment for your endometriosis.

In general, your best option to get pregnant naturally with endometriosis is a laparoscopic surgery to remove this disease. In this surgery, your provider makes small (less than one centimeter) incisions and uses a narrow tube to scrape away patches of endometriosis and scar tissue.

Depending on your stage of endometriosis, this surgery can make it easier to get pregnant without any additional help.

Other options to improve your chances of pregnancy include artificial insemination (also known as intrauterine insemination or an IUI) and in vitro fertilization (IVF). Ask your provider which treatment option would be best for you, since every case of endometriosis is different.

How can endometriosis affect pregnancy?

Most women with endometriosis who become pregnant go on to have healthy pregnancies. In fact, the hormones that go along with pregnancy can cause endometriosis—and the pain that goes with it—to diminish.

In some cases, though, endometriosis is associated with an increased likelihood of pregnancy complications. Your provider will keep watch for these complications at your regular prenatal visits, and the earlier you catch them, the better the outcomes.

Some pregnancy complications of endometriosis can include:

Ectopic pregnancies

In an ectopic pregnancy, the embryo (cluster of cells that will become the baby) implants somewhere other than the uterus—usually the fallopian tube. Ectopic pregnancies always require treatment by a healthcare provider. They can't be carried to term and are life-threatening.

Women with endometriosis have a greater risk of ectopic pregnancy. This is because scar tissue build-up in the fallopian tubes can block or slow the embryo from reaching the uterus.

Pregnancy loss

A pregnancy that is lost before 13 weeks is considered a miscarriage, or an early pregnancy loss. Certain hormones linked to endometriosis make miscarriage more likely.

If a pregnancy is lost after 20 weeks, it is considered a stillbirth. Women with endometriosis also have an increased risk of stillbirth.

Regardless of the length of your pregnancy, pregnancy loss can be devastating. Communicating with your provider and having a support system in place can help you through this difficult time.

Placental problems

Endometriosis makes it more likely for your placenta (the organ connecting you to your baby) to block or partially block your cervix (the lower part of the womb that the baby passes through in a vaginal delivery). This is called placenta previa.

When your placenta lies at this low part of the uterus, there's an increased risk of severe bleeding and preterm labor/birth. Your provider will need to closely monitor your placenta's location throughout your pregnancy.

"Almost all women who have a placenta previa will need to deliver via cesarean section (or c-section). In a c-section, your baby is delivered in an operating room by surgical incisions to open the abdomen and uterus," says Dr. Klebanoff.

Your risk for placental abruption (when the placenta separates from the uterus prematurely) is also increased by endometriosis. Placental abruption can be a cause of bleeding during the second half of your pregnancy and is a medical emergency.

What can endometriosis mean for me?

Depending on where it is and how bad it is, endometriosis might make it harder to get pregnant. If you have endometriosis, sharing your pregnancy plans with your provider can allow you to come up with a plan, together, to get—and stay—pregnant.

Remember that most women who have endometriosis end up having successful pregnancies. What's more, there are options that can boost your chances of getting pregnant.

Though women with endometriosis are more likely to experience pregnancy complications, regular appointments with your provider can ensure that your pregnancy is healthy and complication-free.

Understanding the relationship between endometriosis and pregnancy means that you and your provider can work together to make the best choices for your health and pregnancy goals.

Next steps:

Make an appointment with Jordan S. Klebanoff, MD
Learn more about the Advanced Gynecology Program at Main Line Health
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