2023-12-18 17:25:48
In 40% of cases, endometriosis is responsible for fertility problems. The latter are explained in particular by an inflammatory state of the reproductive system, adhesions which can compress or block the fallopian tubes or even by the presence of cysts on the ovaries. It is then difficult to believe that with such anomalies, a pregnancy could be successful. But against all odds, pregnancy and childbirth go smoothly for the majority of women affected by the disease. Appropriate medical monitoring is nevertheless recommended throughout the pregnancy.
Endometriosis: how does pregnancy go?
Usually, pregnancy is associated with a clear reduction or even disappearance of endometriosis symptoms, especially in the second and third trimesters. Sometimes women who suffer from endometriosis adhesions before pregnancy report more intense ligament pain than during a pregnancy without endometriosis. Dr. Omnrane Ben Rejeb, gynecologist.
Symptoms often reduced
As a reminder, endometriosis is usually responsible for pain sometimes throughout the body during periods. Indeed, the disease is characterized by the presence of tissues similar to the uterine lining outside the uterus. However, during pregnancy, the cycles stop, which is why women who have endometriosis see thetheir symptoms decrease.
Persistent pain in early pregnancy
It is not uncommon for pain to still be present, especially at the start of pregnancy. This is particularly the case, when the fetus grows, it then compresses endometriosis lesions so far asymptomatic. Let us add that it happens that the uterus, by increasing in volume, pulls on adhesions (fibrous scar tissue likely to appear particularly after surgical treatment). When these lesions and adhesions are found on the ligaments, we are talking about ligament pain.
Can endometriosis cause miscarriages?
The miscarriage is defined by a spontaneous termination of pregnancy in the first three months of gestation. There is no evidence that there is an increased risk of miscarriage in cases of endometriosis. However, a 2016 INSERM study found a 10% increased risk of miscarriage in women suffering from endometriosis.
According to the government’s santé.fr website, “it is possible that this risk is particularly increased in women who suffer from adenomyosis.” L’adenomyosis is a particular form of endometriosis which is characterized by the abnormal presence of endometrial tissue in the muscle wall of the uterus. This form of endometriosis is particularly painful.
Endometriosis and pregnancy: what medical follow-up?
Generally speaking, women with endometriosis do not have any complications during their pregnancy. However, it is considered that stricter medical monitoring than for women without endometriosis remains necessary. This is all the more true in cases of adenomyosis, a particular type of endometriosis at risk of complications during pregnancy. In fact, this form of endometriosis can increase the risks of:
- previous cake (abnormal implantation of the placenta on or near the internal os of the cervix. Placenta previa causes painless vaginal bleeding after 20 weeks of pregnancy);
- pre-eclampsia (characterized by high blood pressure and high protein in the urine);
- miscarriage ;
- antenatal hemorrhages (source 4) ;
- placental abruption of the uterine wall;
- infections et chronic maternal conditions which may affect the fetus.
In the event that a health professional (such as your gynecologist or midwife) judges that your pregnancy is at risk, you should benefit from specific monitoring with more consultations, analyzes and ultrasounds than follow-up. classic pregnancy.
However, each follow-up is individualized depending on the difficulties encountered by the mother-to-be, for example if you have had pre-eclampsia, you will have your blood pressure checked more regularly.
Endometriosis: how does childbirth go? And after ?
Generally childbirth is without difficulty in cases of endometriosis. Nevertheless, the use of cesarean delivery is commonplace and even more so in cases of adenomyosis, a particular type of endometriosis. In this situation the risk of cesarean section is multiplied by 20 compared to a woman who does not have endometriosis (source 3).
After childbirth, a risk of hemorrhage was observed (source 4). In addition, the postpartum period is sometimes difficult for some emotionally. The quality of life is degraded.
Pregnancy does not cure illness
The symptoms (which most often disappear during gestation) are likely to reappear after delivery. Note that for some women, breastfeeding can delay the return of endometriosis symptoms.
Endometriosis: an increased risk of premature birth?
According to a recent 2022 study, endometriosis appears not to be associated with a risk of premature birth. Monitoring a pregnancy in the event of endometriosis therefore does not justify modifying the usual monitoring protocols to prevent the risk of premature delivery (source 2).
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