March is Endometriosis Awareness Month. Endometriosis is a disease that causes the same kinds of cells, or "tissue", that line the uterus to also grow outside of the uterus on nearby organs, usually within the pelvis. Because these cells grow and shrink corresponding to the menstrual cycle, endometriosis often causes significant pain beyond typical period symptoms. Endometriosis can also cause little or no pain, which means it can go undiagnosed until there is a problem, like trying to get pregnant. While there is no cure for endometriosis, there are many treatments to cope. 

People with endometriosis can become pregnant, and can have a healthy pregnancy, birth, and baby. People who have endometriosis can also experience difficulty getting pregnant as well as complications with pregnancy and birth. If you have endometriosis, it's impossible to predict what you might experience when you try to conceive and during pregnancy. The more informed you are about endometriosis, the more prepared and supported you can be as you go through this stage in your life. 

Endometriosis and Fertility

About one-third of people with endometriosis will experience difficulty becoming pregnant. This could be due to the inflammation that endometriosis causes in and around the uterus, or because of endometrium-like tissue that grows outside the uterus, blocking the fallopian tubes or the ovaries. Some people with endometriosis become pregnant without any issues.

For people with endometriosis experiencing fertility issues, it's important to work with a doctor who specializes in endometriosis, as well as a fertility specialist. (Check out these tips for finding an endometriosis specialist.) It's important to determine if your infertility is being caused by the endometriosis (it is one of the top causes of infertility) or by another related or unrelated issue. An endometriosis specialist can help you treat your endometriosis first to see if that allows you to get pregnant. A fertility specialist can rule out other causes of infertility. Treatment for endometriosis often can be the solution to getting pregnant after experiencing infertility caused by the disease. 

Pregnancy and Endometriosis

There are additional risk factors when you have endometriosis and become pregnant, though many people with endometriosis have safe and healthy pregnancies. It's important to become familiar with the risks so you know what to look for. As with any medical complication, it's important to get the medical, physical, emotional, and mental health support you need.

In pregnancy, endometriosis increases the possibility of:

• Miscarriage (about 13% higher than normal risk of miscarriage)
• High blood pressure ("hypertension")
• Preeclampsia (a condition marked by 
• Preterm (early) birth (about 1.5 times more likely to give birth before 37 weeks)
• Low birth weight or size for baby 
• Placenta previa (placenta grows over the opening of the cervix)

It's also possible you may not experience any complications during your pregnancy with endometriosis. Either way, the best health outcomes happen when you work closely with your prenatal care providers as well as your endometriosis specialist during pregnancy.

The good news is that many people with endometriosis experience reduced pain during their pregnancy due to the pause in menstruation and because pregnancy increases progesterone, which is believed to stop, reduce, or even shrink the growth of endometrial cells. Some people may begin to experience pain toward the end of pregnancy. Unfortunately for most, endometriosis pain will return after pregnancy. Breastfeeding / chest feeding, however, may slow the return of endometriosis and its painful side affects. 

Learning the facts about endometriosis and pregnancy, and working with an endometriosis specialist will give you the best chance of becoming pregnant and having a healthy pregnancy. Endometriosis is a chronic condition that can cause significant challenges. Getting professional support will help you manage the condition and improve your quality of life during pre-pregnancy, pregnancy, birth, breastfeeding, and beyond. 

Resources

Endometriosis Foundation of America

Endometriosis.org

Endometriosis Association

Office on Women's Health

Published: March 01, 2021

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