Will Pregnancy Cure Endometriosis?

A fertility expert unveils the pros and cons of getting pregnant with endometriosis.

Endometriosis is characterized by painful periods and heavy menstrual bleeding. It is a chronic disease which happens when tissue similar to the lining of the uterus grows outside the uterus. Worldwide., approximately 10 per cent of reproductive age women and girls are living with endometriosis, according to WHO. Currently, there is no cure for endometriosis and treatments (medicines or, in some cases, surgery) are focused on controlling symptoms. While endometriosis may make it harder to get pregnant, pregnancy is known to have beneficial effects on endometriosis.

Can Pregnancy Cure Endometriosis? Pregnancy may help temporarily reduce endometriosis symptoms, but it cannot cure the disease, says Dr. Mamatha C.V., Consultant Fertility, and IVF, Rainbow Children’s Hospital, Hebbal, Bengaluru. The expert sheds light on the benefits and risks of getting pregnant with endometriosis. Read on…

Pregnancy with endometriosis

Pregnancy provides immense benefits in the endometriosis symptoms, especially in the last trimester of pregnancy. Some ladies experience worsening symptoms during the first trimester.

Beneficial effects are due to the progesterone effect. Progesterone suppresses the growth and development of endometriotic lesions because of no menstruation causing the lesion to be inactive. Symptoms may worsen in early pregnancy due to a rapid increase in the size of the uterus which will cause pulling and stretching of the tissues and also adhesions, which are already scarred by endometriotic lesions.

Increased levels of estrogen produced during pregnancy may stimulate the growth of endometriotic lesions which may worsen the symptoms. The majority of the ladies’ beneficial effects of pregnancy are only temporary. Many women will experience a recurrence of the disease once resuming their menstruation or after a few years.

Many women are able to lengthen the remission of their endometriosis symptoms after pregnancy due to breastfeeding. Regular breastfeeding inhibits the release of estrogen by ovaries which suppresses the ovulation and growth and development of endometriosis.

Pregnancy does not cure endometriosis

The myth that pregnancy can cure endometriosis is disappearing. In reality, pregnancy is like hormonal drug treatment. Pregnancy may temporarily suppress the symptoms of endometriosis but will not cure it. Symptoms will recur after birth.

In the past few years, pregnancy is considered a therapeutic period of relief of painful symptoms due to endometriosis.

Beneficial effects of pregnancy on endometriosis

The regression of endometriotic lesions during pregnancy was first recognized in 1921. After that, all the doctors recommended women conceive in order to reduce the advancement of the symptoms. Lack of symptoms before menarche and after menopause additionally supported this theory that pregnancy was helpful. Progesterone induces endometrial atrophy and regression in endometriotic lesions which shows cyclical changes such as endometrial growth and luteal phase transformation in the entire menstrual cycle.

Progesterone levels are greatly increased in pregnancy which is in favor of the regression of endometriotic lesions, using this the theory of pseudo-pregnancy is established. Progesterone is established for therapeutic treatment against endometriosis and continues to be part of therapeutic strategy even today.

The impact of endometriosis on pregnancy

Endometriosis can cause severe complications in the event of pregnancy such as rupture of lesions leading to intra-abdominal bleeding. Hence learning the effect of pregnancy on the development of endometriosis is critical to ensure the benefits and adverse effects in counseling women with endometriosis. This is specifically important as the co-occurrence of endometriosis and pregnancy becomes more dominant due to the rise in success rates of the latest assisted reproductive technologies.

Knowing the effects of endometriosis is challenging. Use of transvaginal scan which leads to high detection rates of endometriosis in pregnancy, ultrasound evaluation of ovaries is not a part of routine antenatal tests and USG does not allow dependable checking of non-ovarian endometriotic lesions. Retrospective studies are often biased as symptomatic lesions are more likely to be evaluated and reported than lesions that do not have symptoms.

Endometriotic lesions during pregnancy have been the subject of systematic studies, with a particular focus on the post-pregnancy years. Additionally, studies are mixed in regards to times and methods of examination (clinical USG, MRI, laparoscopic surgeries, and histopathological examination), different types of endometriotic lesions investigated (lesions in ovary, non-ovarian lesions, exact locations), information of lesions collected (size, number, and structure) other limitations and logical approach. Lastly, most of the data studies are small and old. Often the data is extracted retrospectively from databases designed for different purposes.

Not only is the data on endometriotic lesions during pregnancy sparse, factors potentially influencing the development of endometriosis are even more difficult to evaluate. Few studies that are available support regression more often in the second or third than in the first trimester or the lactation period.

HPE studies of endometriotic lesions during pregnancy show that they may grow aggressively during this time. Which makes the differentiation from malignant tumors difficult. The expansion of endometriotic lesions and suspicious sono-morphological appearance is the reason for surgery during pregnancy. Such changes are due to decidualization. This has reported up to seventy-seven percent of chocolate cysts and similar endometriosis in other sites which is tough to diagnose and monitor during pregnancy. Decidualization lesions have a reduced ability to spread and it is the first step towards regression, this hypothetically has a benefit on endometriosis.

Conclusion

Pregnancy supports reducing the symptoms of the disease but only pregnancy cannot cure the disease. At the same time, endometriosis-related pain will lead to surgical intervention during pregnancy.