Does giving birth reduce the spread and symptoms of endometriosis?

Giving Birth Does Not Reliably Reduce Endometriosis Symptoms or Progression

Pregnancy does not consistently reduce the spread or symptoms of endometriosis, and women should not be advised that becoming pregnant is a strategy for managing the disease.

Evidence on Pregnancy and Endometriosis

• Contrary to traditional beliefs, pregnancy does not reliably improve endometriosis symptoms or reduce disease progression 1
• A systematic review found limited evidence of beneficial effects of pregnancy on endometriosis, with fewer benefits than previously reported 1
• While some women may experience temporary symptom relief during pregnancy, symptoms rapidly recur in the majority of cases after delivery 2

Symptom Recurrence After Pregnancy

• Studies show that 84% of women report at least one moderate-severe pain symptom two years after delivery 2
• Approximately 37% of women experience clinically relevant recurrence of symptoms requiring medical or surgical treatment within two years postpartum 2
• Up to 44% of women experience symptom recurrence within one year after endometriosis treatment, including pregnancy 3

Changes in Endometriotic Lesions During Pregnancy

• The development of endometriosis during pregnancy is variable, and there is no evidence that pregnancy consistently reduces the size or number of endometriotic lesions 1
• Endometriotic lesions may undergo structural changes during pregnancy due to decidualization (hormone-induced changes), but this does not necessarily mean improvement of the condition 1, 4
• Growth of lesions during pregnancy may occur, posing diagnostic challenges due to their atypical appearance 4

Pregnancy Complications in Women with Endometriosis

• Women with endometriosis have an increased risk of pregnancy complications, including:
  • Placenta previa (odds ratio 1.67-15.1) 4
  • Potential increased risk of spontaneous miscarriage, preterm birth, and small for gestational age babies 4, 5
• Rare but serious acute complications can occur during pregnancy in women with endometriosis, such as spontaneous hemoperitoneum, bowel and ovarian complications 4

Management Considerations

• First-line treatments for endometriosis symptoms include NSAIDs for pain relief 6
• Hormonal therapies such as oral contraceptives and progestins are effective second-line options 6
• GnRH agonists provide significant pain relief for chronic pelvic pain associated with endometriosis 6
• Surgical management may be necessary for severe endometriosis when medical treatment alone is insufficient 6

Important Considerations

• The depth of endometriosis lesions correlates with severity of symptoms, though the pain has little relationship to the type of lesions seen by laparoscopy 6, 3
• Endometriosis is a chronic, inflammatory condition affecting approximately 2-10% of women of reproductive age worldwide 3, 7
• Current evidence does not support advising women that pregnancy will improve their endometriosis symptoms or disease progression 1
• Women with known endometriosis who become pregnant should be monitored according to conventional pregnancy protocols, with awareness of the potential increased risk of placenta previa 4