Endometriosis and pregnancy: What is the outlook for affected women?

Published Jun 16, 2021 • By Aurélien De Biagi

Endometriosis is a little-known gynecological condition that affects one in ten women. The main complication of this condition is infertility, which affects 30 to 40% of women living with endometriosis.

What is endometriosis and its symptoms? How is it treated? What are the fertility options for women with endometriosis looking to become pregnant?

We explain it all in our article!

Endometriosis and pregnancy: What is the outlook for affected women?

What is endometriosis?

Endometriosis is a common but still little known gynecological condition. It affects approximately one in ten women. Endometriosis is an estrogen-dependent condition, which means that it depends on the level of hormones (in this case estrogen). It therefore appears in women of childbearing age, sometimes as early as adolescence, and regresses at menopause. 

This condition is characterized by the presence of endometrial tissue (endometrium) outside the uterus. During menstruation, the endometrium is shed due to the effect of hormones. However, in the case of endometriosis, the endometrium is not properly expelled - it migrates into neighboring organs such as the ovaries, vagina, fallopian tubes, rectum, colon, bladder, etc. In rare cases, more distant organs are involved, such as the lungs or the brain.

What are the symptoms of endometriosis?

Endometriosis can be completely asymptomatic. However, when it is not asymptomatic, the main symptom is pain. This pain may occur in the pelvic (lower abdomen), lumbar (lower back) or abdominal area and may be present at all times. Though, in most cases, the pain coincides with the menstrual cycle. The intensity of the pain is not, however, correlated with the size of the lesions, since it may due to the lesions themselves (mainly the depth of the lesions in the affected organs) but may also be due to the inflammation caused or the nerve damage. 

The pain is often debilitating and limits a woman in her daily activities. It is often exacerbated during menstruation, which is referred to as dysmenorrhea (painful menstruation). In addition, pain during sexual intercourse (dyspareunia) can occur.

Other symptoms can be observed, such as:

  • Dysuria (pain during urination)
  • Hematuria (blood in the urine)
  • Blood in the stool
  • Pain during bowel movement

How does endometriosis progress?

Endometriosis develops during a woman's reproductive years (from adolescence to menopause). During this time, new lesions are formed, causing bleeding and leaving fibrous scar tissue.

The most common complication of endometriosis is infertility. Infertility usually occurs as a result of lesions in the fallopian tubes, ovaries or peritoneum (membrane surrounding the organs in the abdomen and pelvis). Endometriosis is often diagnosed during fertility testing.

What are the treatment options for endometriosis?

There are two main treatment options for women with endometriosis: surgery and hormone therapy.

Hormone therapy

In addition to painkillers, medications to reduce the amount of estrogen in the blood may be prescribed. 

For example, an estrogen-progestin treatment (contraceptive pill), danazol (suppresses ovulation and induces hypoestrogenism or estrogen deficiency), or a hormonal IUD delivering levonorgestrel or progestin (Mirena®, for example) can be used. These hormonal treatments can stop the progression of lesions, but they do not allow them to be complete eliminated.

Surgical treatment

In case hormone therapy is not effective, surgery is possible. A distinction is made between conservative surgery (which aims to preserve the affected organs) and radical surgery (removal of the uterus and/or ovaries). Surgery remains the only treatment capable of permanently removing the lesions.

First, surgery is used to assess the extent and nature of the lesions. Subsequently, the lesions are destroyed (by coagulation or laser vaporization) or removed. Most often the operation is performed under laparoscopy in order to limit complications and postoperative effects.

Once the procedure is completed, hormonal treatment is started if there is no desire to become pregnant.

Endometriosis and pregnancy: What is the outlook for women looking to become pregnant?

In more than half of cases, endometriosis does not cause infertility. However, this complication occurs in approximately 40% of women with this condition. If there is a desire for pregnancy, there are several possible options.

The first option is surgery. If conservative surgery is possible, then removal of the lesions allows the patient to have a natural pregnancy. It should be noted, however, that depending on the extent and nature of the lesions, the delivery may be performed by cesarean section.

Fertility treatment (using assisted reproductive technology (ART)) is another option. ART involves a number of procedures, the most common of which is in vitro fertilization (IVF). Following hormonal stimulation, the patient's ovocytes (eggs) are retrieved. One of them will be fertilized, in vitro (in a lab), by a sperm cell from the father. The remaining ovocytes are cryogenically preserved. Once the ovocyte is fertilized, the resulting embryo will be transferred to the mother's uterus. Before the age of 35, the probability of success with this technique is around 25%. However, this probability decreases with age. At the age of 38, the probability is only around 12%.

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avatar Aurélien De Biagi

Author: Aurélien De Biagi, Health Writer, Pharmacy Student

Aurélien is a fifth year PharmD student at the University of Lorraine in France and writes health articles for Carenity. He is particularly interested in the neuropsychiatric and cardiovascular fields.

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