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Endometriosis and Infertility: How This Connection Affects Pregnancy

Endometriosis and Infertility: How This Connection Affects Pregnancy

By Christopher D. Cook, DO

Mar 12, 2018

Updated Nov 17, 2023

5 min read

Endometriosis and infertility

Your doctor says you have endometriosis. Along with painful periods, now you’re worrying about being able to get pregnant in the future.

Endometriosis is a condition that affects women during their menstruation and childbearing years. If you have endometriosis it means the tissue that grows inside of your uterus is also growing outside of your uterus on your ovaries, fallopian tubes, intestines, the outer wall of the uterus, or other organs in your belly.

What does endometriosis mean for you and your health?

Symptoms of endometriosis

Although endometriosis doesn’t always cause symptoms, you may experience the following:

  • Painful periods. Before and during your period you might experience pelvic pain and/or cramping. Although many women have cramping and pain during menstruation, women with endometriosis tend to have more intense pain that can worsen over time.
  • Chronic lower back/abdominal pain
  • Infertility
  • Excessive bleeding during periods or bleeding/spotting between periods
  • Pain during or after intercourse
  • Painful bowel movements or urination, especially during your period
  • Stomach issues like nausea, diarrhea, or constipation
  • Fatigue

Other conditions that cause pelvic pain have similar symptoms as endometriosis. Some of these conditions include pelvic inflammatory disease, ovarian cysts, or irritable bowel syndrome.

Causes of Endometriosis

It’s difficult to pinpoint the exact cause of endometriosis. That being said, it’s suspected that estrogen will make your endometriosis worse. Your estrogen levels are high during childbearing years, but drop when your menstrual periods stop during menopause. After menopause your symptoms should improve dramatically.

Risk factors

For most women, endometriosis develops several years after you start menstruating. Most women see relief from endometriosis during pregnancy, and it’ll go away permanently after menopause. Not sure if you’ll develop endometriosis? The following factors can put you at risk:

  • Family members with endometriosis
  • Having your menstrual periods start at an early age
  • Having medical conditions that can prevent menstrual blood from leaving the body
  • Going through menopause at an older age
  • Abnormalities in your uterus
  • Short menstrual cycles
  • Never giving birth
  • Having high levels of estrogen
  • Low body max index
  • Consuming alcohol

Treatment for Endometriosis

Home treatment

Whether your endometriosis is mild or severe, there are things you can do at home to ease your symptoms. These include:

  • Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or naproxen to ease menstrual cramping pain.
  • Heat in the form of warm baths or a heating pad. When applied to the pelvic area, heat can ease menstrual cramping and pain.
  • Exercise regularly
  • Avoid alcohol

Medical treatment

When you have endometriosis, your doctor will usually recommend medications and/or surgery. Each case of endometriosis is different, and your treatment goals may vary (for example, you may want to get pregnant or reduce your pain).

Your doctor will work with you to create an individualized treatment plan. In most cases, your doctor will start with conservative treatments before recommending surgery. Medical treatments for endometriosis may include:

  • Hormonal therapy like birth control pills, progestin-only contraceptives, or gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. Your doctor should explain the benefits and side-effects of each hormonal therapy approach.
  • Assisted reproductive technologies like in vitro fertilization can help you become pregnant.
  • Surgery to remove endometriosis, usually to ease pain or assist you in becoming pregnant. In most cases, your doctor will recommend the least invasive surgical options.
  • A hysterectomy (removing your uterus, cervix, and ovaries) may be the best option if you have a severe case of endometriosis. Because you can no longer get pregnant after a hysterectomy, this is generally considered a last resort.

Endometriosis and infertility

Can you still get pregnant if you have endometriosis? Yes, but it can be more difficult. Among women with infertility, half have endometriosis. Endometriosis can block or change the shape of your pelvis and reproductive organs and make it difficult to get pregnant. Endometriosis can also impact your endometrium, which is the layer of your uterus where fertilization happens, and make it difficult for fertilization to occur. Finally, when you have endometriosis, your body’s immune system may attack your developing embryo.

As discouraging as it is to think about how endometriosis is affecting your fertility, about 70 percent of women with mild or moderate endometriosis do end up getting pregnant within three years without treatment. Endometriosis just makes it more difficult to get pregnant.

When to talk to your doctor

If you’ve been trying to get pregnant for more than 12 months, talk to your doctor. She or he can recommend surgery to remove endometrial growths (as necessary), and treatments to help you get pregnant. You should also contact your doctor if you:

  • Have periods that have recently gone from being painless to painful
  • Have painful urination or unexplained changes in your bowel movements
  • Have pain that interferes with your daily activities