Does getting pregnant mean someone doesn't have endometriosis?

Pregnancy Does Not Rule Out Endometriosis

Pregnancy does not mean someone doesn't have endometriosis, as women with endometriosis can and do become pregnant, and the condition persists during and after pregnancy. 1, 2

Understanding Endometriosis and Pregnancy

• Endometriosis is an inflammatory disease characterized by endometrial-like tissue outside the uterus, affecting approximately 2-10% of women of childbearing age 3
• The gold standard for diagnosis of endometriosis remains laparoscopy, which allows for both diagnosis and staging of the condition 4
• While endometriosis is associated with infertility, many women with endometriosis can still conceive naturally or with fertility treatments 4
• Endometriosis affects at least one-third of women with infertility, but the exact mechanism linking endometriosis to reduced fertility is not fully understood 4

Endometriosis During and After Pregnancy

• Pregnancy was traditionally thought to have a positive effect on endometriosis symptoms due to ovulation suppression and hormonal changes, but recent evidence challenges this assumption 1
• Studies show that endometriotic lesions can undergo various changes during pregnancy, including decidualization (a pregnancy-related change in tissue structure), but these changes don't necessarily mean the disease is eliminated 2
• The development of endometriosis during pregnancy is variable, and there is no evidence that pregnancy can be expected to generally reduce the size and number of endometriotic lesions 1
• After delivery, symptoms of endometriosis often recur, with 84% of women reporting at least one moderate-severe pain symptom two years after delivery 5

Clinical Implications

• Women should not be advised that pregnancy is a treatment strategy for endometriosis, as available data show fewer beneficial effects than previously reported 1
• Approximately 37% of women with endometriosis experience clinically relevant recurrence of symptoms requiring medical or surgical treatment within two years after delivery 5
• Complications of endometriosis during pregnancy are rare, but can include serious conditions such as spontaneous hemoperitoneum, and bowel and ovarian complications 2
• There is some evidence suggesting an association between endometriosis and pregnancy complications including spontaneous miscarriage, preterm birth, and placenta previa 2

Diagnostic Considerations

• Endometriosis can be difficult to diagnose during pregnancy due to changes in the appearance of lesions caused by the hormonal environment 2
• Transvaginal ultrasound and MRI can be useful in diagnosing some forms of endometriosis, particularly adenomyosis, but small endometrial implants are not well detected on imaging 4, 6
• The diagnosis of endometriosis requires a high index of suspicion, especially in women with chronic pelvic pain, dysmenorrhea, or infertility 4

Management Approach

• Management of endometriosis focuses on pain relief, fertility preservation, and preventing disease progression 3
• Surgical intervention may be required for both diagnosis and treatment of endometriosis 3
• Current evidence does not support any modification of conventional monitoring of pregnancy in patients with known endometriosis 2
• Women with endometriosis who become pregnant can generally be reassured about the course of their pregnancy, though physicians should be aware of the potential increased risk of placenta previa 2