Endometriosis and Pregnancy Risk Warnings

Traditionally we have thought that endometriosis undergoes involution and resolution in pregnancy. In a September 2019 study in Obstetrics & Gynecology it was shown that women with endometriosis tend to have more medical problems in pregnancy. But there is much to be understood and a new article in Obstetrics and Gynecology in Dec 2022 has relooked at this issue.

Endometriosis occurs in at least 5-15% of all women, and it is a condition of inflammation. Case reports have shown that ruptured appendix, perforated intestines, and rupture of endometrioma cysts of the ovary are all possible complication of endometriosis and pregnancy. Those problems are directly related to cases with scar tissue that gets stretched from the growing uterus and the pressure it causes.

It was thought that the high levels of natural progesterone made by the placenta during pregnancy might serve to suppress endometriosis. Progesterone therapy is one of the effective treatments for endometriosis.

But the new study indicating that women who have active endometriosis going into pregnancy are more likely to have severe hypertension during pregnancy.

Women who have had proven endometriosis are known to have more infertility, so they still have to be on the alert once they are successful at conception. The problems do not stop once they conceive.

Women in this data show those with endometriosis have more problems with diabetes, preeclampsia, delivering before being full term, having risk of pregnancy infections, as well as prematurely rupturing membranes, and more babies being under weight at birth.

In other studies women with endometriosis are also more likely to have a miscarriage and more likely to deliver prematurely.

No one cause has been determined, but the more we know about adenomyosis, which is endometriosis of the uterus itself, the more we have looked to problems with the placenta leading to the problems in pregnancy with the women who have had confirmed endometriosis.

Obstetricians are wary of some of the data. Many women who have had proven endometriosis are actually older when they conceive. For some women their increased age, preexisting problems, and entering pregnancy when over weight could account for some of these same problems.

It means that you need to be as healthy as possible when you enter pregnancy, so come in for a check up before discarding contraception.