For those of you who followed our discussions about endometriosis (see below for personal stories), the following information might be of interest. It appears that vaginal parturition (birth) may decrease the symptoms of this debilitating disease that affects up to 50% of women. Endometriosis causes dysmenorrhea (menstrual cramps), lower back pain, and infertility. 40% to 60% of women with dysmenorrhea have endometriosis. It is not yet clear how, but the first clinical consequence of endometriosis is infertility. Interestingly, pregnancy may reduce the recurrence of endometriosis and dysmenorrhea. Italian researchers analyzed the data from clinical studies of over a thousand women with severe dysmenorrhea (aged 18–35 years). Women were diagnosed for endometriosis by laparoscopy, which is a standard procedure for such cases. The pain associated with dysmenorrhea was rated on a scale from 0 to 10.
Vaginal childbirth to reduce endometriosis pain: the research
Authors were trying to answer a primary question regarding the medical management of endometriosis: how to control its recurrence. Their study clearly demonstrates the positive role of vaginal delivery in reducing pain associated with dysmenorrheal and endometriosis recurrence. It also suggests a mechanism by which vaginal delivery exerts this positive effect. They have shown that enlargement of the uterine internal ostium (IOS) was related to pain relief and a reduction in the recurrence of endometriosis. It is known that retrograde bleeding in endometriosis is a recurrence due to cumulative episodes of endometrial debris transported throughout the tubes. In this study, women who were surgically treated for endometriosis and had vaginal parturition, experienced a longer pain-free interval than women who underwent cesarean section. Medical treatment designed to interfere with ovulation generally provides effective pain relief, but the recurrence rate after the cessation of therapy is high, and this type of treatment will not resolve infertility or cure endometriosis.
The recurrence rate of endometriosis was significantly lower in women who had vaginal parturition than in nulliparous (has not yet given birth) women and those who delivered by cesarean section. Parity seemed to have a key role in establishing the recurrence rate of endometriosis. In fact, the incidence of endometriosis recurrence in women who had vaginal parturition was significantly lower than the recurrence rate detected in all of the remaining women in the study.
How vaginal childbirth reduces endometriosis pain
Pregnancy with parturition may also decrease dysmenorrhea by enlarging the uterine IOS, which, in turn, may facilitate endometrial discharge through the cervix rather than the uterine IOS tubes into the pelvis. A decrease of dysmenorrhea was not observed in women who underwent cesarean section; this data is related to the absence of IOS enlargement in women who delivered vaginally. Retrograde bleeding occurs in a large number of women, but the debris that flows through the tubes implants in the pelvic organs and peritoneum in only some cases. The proposed dynamic of debris displacement may explain the protective role of vaginal parturition associated IOS enlargement in the reduction of endometriosis recurrence as described in the present study.
Vaginal parturition has many advantages both for mother and child. Decrease in the severity of endometriosis is yet another factor to consider the natural childbirth.
Personal Stories of Endometriosis
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