By Robert B. Albee, Jr., MD, Founder & The Center for Endometriosis Care
Although it used to be taught endometriosis was a disease of older career women who had delayed childbearing, this is completely unfounded. The disease can and does affect any female of reproductive age, regardless of race, socioeconomic or childbearing status. Pregnancy still figures strongly in the myths surrounding endometriosis, however. Women are often told, “you can’t get pregnant if you have endometriosis” as well as, “if you get pregnant you will cure endometriosis.” Neither statement is true.
First of all, endometriosis is a disease of fertile women. Most women with endometriosis who want to have children, have children. Secondly, pregnancy is not a cure for endometriosis.
Endometriosis and Pregnancy
During pregnancy, ovulation stops. The endometriosis implants may become less active, smaller and tender. This seems to be the result of the hormonal changes pregnancy brings. These include high levels of progesterone, the presence of HCG (human chorionic gonadatropin) and prolactin, among others. Menstruation stops, and many women with endometriosis may feel better while they are pregnant. Medical suppressive therapy is aimed at mimicking or inducing a pseudo-pregnancy and achieving similar results by blocking hormone receptors and reducing or completely eliminating menstrual flow.
In addition, an enormous psychological impact occurs. Pregnancy is something a normal, healthy woman’s body does. A woman who has suffered with endometriosis and then conceives feels that, finally, she is like other women. She feels normal for perhaps the first time since puberty. It is a liberating, positive experience.
However, the disease does not go away during pregnancy (or through use of drug therapy). After pregnancy and nursing (and sometimes before then), the symptoms return, sometimes with a vengeance. It is heartbreaking to see a new mother struggle to cope with a debilitating disease at a time that should be joyous (if exhausting).
Pregnancy Complications with Endometriosis
In terms of pregnancy risks associated with endometriosis, previous uncontrolled studies demonstrated increased incidence of spontaneous abortion in women with the disease. Subsequent data, however, have yielded contradictory results. Endometriosis has also been linked to a spectrum of pregnancy complications, originating either in the implants or in the uterus. Disorders of pregnancy associated with endometriosis include spontaneous hemoperitoneum in pregnancy (SHiP), bleeding and preterm birth. A recent cohort study also provided further evidence that subfertile women who conceive spontaneously are at increased risk of pregnancy complications, including antepartum hemorrhage, cesarean delivery, pregnancy-induced hypertension, preeclampsia and very preterm birth. [Risks of adverse pregnancy outcome in endometriosis. Fertil Steril. 05 March 2012. Brosens I, Brosens J, Fusi, Al-Sabbagh, Kuroda, Benagiano]. More recent data has implied that infertile patients with endometriosis may require additional monitoring with increased attention when they become pregnant. [Petraglia, Arcuri, de Ziegler, Chapron. Inflammation: a link between endometriosis and preterm birth. Fertil Steril. 1 June 2012.]
Though the impact of endometriosis on fertility and pregnancy remains a complex issue, increasing research efforts and technological progress will lead to more timely intervention and appropriate, multi-factorial treatments to restore quality of life and preserve or improve fertility. While the disease may present obstacles to family-building, with proper intervention and careful management many of these challenges can be overcome and offer long-term, effective management of endometriosis.
Excerpts of this article originally appeared in “Endometriosis: Q&A” by CEC Founder, Robert B. Albee, Jr., MD.
About the Authors: The Center for Endometriosis Care is a COEMIG-Designated Center of Excellence in Minimally Invasive Gynecologic Surgery which was founded over two decades ago by renowned laparoscopic excision (LAPEX) pioneer Robert B. Albee, Jr., MD, FACOG, ACGE. The Center is run under the leadership of Medical Director Ken R. Sinervo, MD, FRCSC, ACGE along with a caring, compassionate staff. We continue our efforts as architects of the legacy in gold standard endometriosis care.