For many women with endometriosis, the journey to pregnancy can be challenging. Endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus, often causes pain, inflammation, and can even affect fertility. However, even after conception, endometriosis may increase the likelihood of pregnancy-related complications. While many women with endometriosis go on to have healthy pregnancies, it’s essential to understand the potential risks and take proactive steps to ensure the best outcomes.

How Does Endometriosis Impact Pregnancy?

Endometriosis affects reproductive health in several ways, from altering the uterine environment to creating scar tissue that can interfere with implantation. These factors don’t just impact fertility—they can also contribute to complications during pregnancy.

Here’s how endometriosis may increase the risk of pregnancy complications:

• Higher Risk of Preterm Labor: Studies show that women with endometriosis are more likely to experience preterm labor, defined as giving birth before 37 weeks. This may be due to inflammation and structural changes in the uterus caused by endometriosis.
• Increased Likelihood of Miscarriage: Early pregnancy loss is more common in women with endometriosis, possibly due to impaired implantation or hormonal imbalances.
• Placental Abnormalities: Endometriosis may impact how the placenta implants and functions, increasing the risk of conditions like placenta previa (when the placenta covers the cervix) or placental abruption (when the placenta detaches from the uterine wall).
• Risk of Preeclampsia: Women with endometriosis may be at a slightly higher risk for developing preeclampsia, a condition characterized by high blood pressure and damage to organs like the liver and kidneys.
• Pelvic Pain and Discomfort: While some women experience relief from endometriosis pain during pregnancy due to hormonal changes, others may continue to experience discomfort due to adhesions and inflammation. 

Why Does Endometriosis Increase These Risks?

The exact mechanisms are still being studied, but researchers believe that endometriosis may affect pregnancy outcomes due to:

• Inflammation and Immune Response: Persistent inflammation can create a less favorable environment for implantation and fetal development.
• Structural Changes in the Uterus: Adhesions, scarring, and altered uterine architecture can interfere with normal placental attachment and fetal growth.
• Hormonal Imbalances: Abnormal progesterone signaling may impact the uterus’s ability to support a pregnancy.

What to Watch for During Pregnancy If You Have Endometriosis

If you’re pregnant and have a history of endometriosis, being informed and proactive can make a significant difference. Here’s what to keep an eye on:

• Signs of Preterm Labor: Report any regular contractions, pelvic pressure, or changes in vaginal discharge before 37 weeks.
• Persistent or Severe Pelvic Pain: While mild discomfort can be normal, ongoing or sharp pain should be evaluated by your provider.
• Abnormal Bleeding: Spotting can be common in early pregnancy, but heavier bleeding may signal a problem and should be assessed.
• Changes in Fetal Movement: A decrease in fetal activity after 24 weeks may indicate fetal distress and should be reported immediately. 

Proactive Steps to Reduce Risks During Pregnancy

While you can’t entirely eliminate the risk of complications, there are steps you can take to promote a healthier pregnancy:

• Schedule Regular Prenatal Check-Ups: Frequent monitoring allows your provider to track fetal growth and identify any potential concerns early.
• Consider High-Risk Pregnancy Care: Depending on the severity of your endometriosis, your provider may refer you to a maternal-fetal medicine specialist for closer monitoring.
• Stay Hydrated and Eat a Balanced Diet: Proper hydration and nutrition can support a healthy pregnancy and reduce inflammation.
• Manage Pain Safely: If you continue to experience pelvic pain, talk to your provider about safe pain management options during pregnancy.
• Monitor for Hypertension: Since preeclampsia is a potential risk, keeping an eye on your blood pressure is essential.

Will Endometriosis Affect Delivery?

For some women with endometriosis, vaginal delivery is possible without complications. However, in cases where severe adhesions or structural abnormalities exist, a cesarean delivery (C-section) may be recommended for the safety of both mother and baby.

When to Seek Immediate Care

If you experience any of the following symptoms, contact your healthcare provider right away:

• Severe abdominal or pelvic pain that doesn’t improve.
• Heavy vaginal bleeding.
• Sudden swelling, severe headaches, or changes in vision (possible signs of preeclampsia).
• Signs of preterm labor, such as regular contractions or fluid leakage.

Looking Ahead: Hope and Support for a Healthy Pregnancy

While endometriosis can add complexity to pregnancy, it’s important to remember that many women with the condition go on to deliver healthy babies. Staying informed, advocating for your care, and working closely with your healthcare provider can help you navigate this journey with confidence. You’re not alone—and with the right support, a healthy pregnancy is absolutely possible.

Source:
Breintoft K, Pinnerup R, Henriksen TB, Rytter D, Uldbjerg N, Forman A, Arendt LH. Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. J Clin Med. 2021 Feb 9;10(4):667. doi: 10.3390/jcm10040667. PMID: 33572322; PMCID: PMC7916165.