Does pregnancy alleviate endometriosis symptoms?

Does Having a Baby Help Endometriosis?

No, pregnancy does not cure or reliably improve endometriosis, and women should not be advised to become pregnant as a treatment strategy for managing their symptoms or disease progression. 1

The Evidence Against Pregnancy as Treatment

The traditional belief that pregnancy benefits endometriosis has been thoroughly challenged by modern research. While symptoms may temporarily improve during pregnancy due to hormonal changes, this relief is neither universal nor lasting:

• Symptom recurrence is the rule, not the exception: In women who had moderate-to-severe pain before pregnancy, 84% reported at least one moderate-severe pain symptom two years after delivery 2

• Clinical recurrence requiring treatment is common: 37% of women required medical or surgical treatment for symptom recurrence within two years postpartum 2

• Disease progression is not halted: There is no evidence that pregnancy reduces the size or number of endometriotic lesions in a predictable manner 1

• Decidualization can cause growth: Endometriotic lesions may actually grow and undergo structural changes during pregnancy through decidualization, creating diagnostic confusion and potential complications 1, 3

Why the Myth Persists

The outdated recommendation stems from theoretical mechanisms that don't translate to clinical benefit:

• Pregnancy does create a high-progesterone, anovulatory state that temporarily suppresses menstruation 1

• However, this is similar to hormonal medical therapy, where symptoms rapidly recur once treatment stops 2

• The hormonal, metabolic, and immune changes of pregnancy are insufficient to eradicate endometriotic tissue 1

Potential Pregnancy Complications from Endometriosis

Rather than helping endometriosis, the disease may actually complicate pregnancy:

• Increased risk of placenta previa: Odds ratios ranging from 1.67 to 15.1 have been reported across studies 3

• Possible increased risk of: spontaneous miscarriage, preterm birth, and small-for-gestational-age babies, though evidence is controversial 3, 4

• Rare but serious acute complications: spontaneous hemoperitoneum, bowel perforation, and ovarian complications can occur during pregnancy in women with endometriosis 3, 4

The Appropriate Medical Management

Instead of pregnancy, evidence-based treatments should be offered:

• First-line: NSAIDs for immediate pain relief 5, 6

• Second-line hormonal options:

  • Oral contraceptives provide effective pain relief comparable to more expensive regimens 5, 6
  • Progestins (oral norethindrone 0.35 mg daily or depot medroxyprogesterone acetate) offer similar efficacy 5, 6
  • GnRH agonists for at least three months with add-back therapy for long-term use 5, 6

• Surgical management: Provides significant pain reduction in the first six months, though 44% experience recurrence within one year 5, 6

Clinical Bottom Line

Women with endometriosis who desire pregnancy should pursue it for family-building reasons, not as a therapeutic intervention. 1 They can be reassured that pregnancy is generally safe despite the disease, but should not expect lasting symptom improvement or disease regression. Conventional pregnancy monitoring is appropriate, with awareness of slightly increased risks for certain complications like placenta previa 3