Does pregnancy improve endometriosis symptoms?

Endometriosis Symptoms During Pregnancy

Pregnancy does not reliably improve endometriosis symptoms, and women should not be advised that pregnancy is a strategy for managing symptoms or reducing disease progression. 1

Effects of Pregnancy on Endometriosis Symptoms

• The traditional belief that pregnancy has a positive effect on endometriosis symptoms due to ovulation blockage and hormonal changes is not supported by current evidence 1
• Development of endometriotic lesions during pregnancy is variable, with no evidence that pregnancy generally reduces the size or number of lesions 1
• While some women may experience temporary symptom relief during pregnancy, symptoms rapidly recur in the vast majority of cases after delivery 2
• Studies show that 84% of women report at least one moderate-severe pain symptom two years after delivery, indicating that any relief is typically temporary 2
• Approximately 37% of women experience clinically relevant recurrence of symptoms requiring medical or surgical treatment within two years after delivery 2

Potential Complications During Pregnancy

• Women with endometriosis may experience decidualization (structural changes) of endometriotic lesions during pregnancy, which can pose diagnostic challenges due to their atypical appearance 3
• Rare but life-threatening acute complications can occur during pregnancy, including:
  • Spontaneous hemoperitoneum
  • Bowel complications
  • Ovarian complications 3, 4
• These complications are unpredictable and may require surgical intervention 3

Pregnancy Outcomes in Women with Endometriosis

• Evidence suggests endometriosis may be associated with higher risk of:
  • Placenta previa (odds ratio from 1.67 to 15.1)
  • Preterm birth
  • Cesarean section 4, 5
• Some studies indicate possible associations with miscarriage and small for gestational age babies, though results are controversial 4, 5
• The correlation with placenta previa may be linked to abnormal frequency and amplitude of uterine contractions observed in women with endometriosis 3

Management Considerations

• Due to insufficient knowledge about the pathogenesis of endometriosis, current literature data are contradictory regarding the relationship between endometriosis and pregnancy complications 4
• There is no evidence that prophylactic surgery would prevent the potential negative impact of endometriosis on pregnancy outcomes 3
• Despite potential complications, pregnant women with endometriosis can generally be reassured about the course of their pregnancies 3
• Current evidence does not support modification of conventional pregnancy monitoring in patients with endometriosis, though physicians should be aware of the potential increased risk of placenta previa 3

Clinical Implications

• Healthcare providers should avoid advising women that pregnancy will improve endometriosis symptoms or slow disease progression 1
• Women with endometriosis who are planning pregnancy should be counseled about the potential risks of adverse pregnancy outcomes, but also reassured that most will have uncomplicated pregnancies 3, 5
• The World Endometriosis Society emphasizes that classification and management of endometriosis should focus on delivering tangible benefits to affected women, including understanding the likely impact on fertility, pain symptoms, and quality of life 6