Often a woman finds out that she is sick with endometriosis only if she couldn’t get pregnant for a long period of time. Pathology is usually detected after the gynecological examination. Doctors immediately suspect the presence of the pathology, if they are addressed by women who have problems with conception. Endometriosis is the second most common cause of infertility in women. About one third of women unable to conceive a baby are also sick with this disease. So, does a sick woman have chances to conceive a baby? Are endometriosis and pregnancy compatible? These questions bother many women. Let’s try to find the answers out.
What Is Endometriosis?
Endometriosis is the abnormal growth of endometrial cells outside the uterus. It is a condition in which the layer of tissue that normally covers the inside of the uterus grows outside of it. Endometriosis is a pathological proliferation of the endometrium. And the endometrium is a layer of tissue lining the inner surface of the uterus, the mucous membrane of its body. It is necessary for the attachment of a fertilized egg to the uterus. To make the blastocyst attach, function and develop, every month the endometrium prepares for this important event. In its epithelium, the number of glands and blood vessels increases, which in the future, if conception does occur, will become the beginning of uteroplacental blood flow, because they “grow” Into the forming placenta. Later it will carry out fetal nutrition with oxygen and nutrients.
It may seem that more endometrium is better for pregnancy. But in reality it’s not like this. Endometrial overgrowth and the spread of its tissues to the surface of other internal organs is a serious obstacle to the onset and maintenance of pregnancy, and in general for the health of women. The biggest difficulty is that endometriosis is diagnosed, as a rule, not at the initial stage of its development. It happens because it is very difficult to find the disease out on your own.
Why Does Endometriosis Develop?
In medicine, there have been cases when the pathological growth of the endometrium has been detected in young girls and in women of mature age, long after the climacteric period. But nevertheless, in general, the disease develops in girls and women of reproductive age. To date, medicine cannot fully comprehend the mechanisms of development of endometriosis. Still, scientists have come to the conclusion that this pathology develops because of disorders in various systems of the body of a woman. Factors predisposing to endometriosis also play a huge role: hormonal failures, immune disorders, stress, poor ecology, hereditary predisposition, anatomical features in the structure of the fallopian tubes, the number of pregnancies in the past, miscarriages or abortions.
Causes of Endometriosis
- There is no exact scientific information about why endometriosis develops. Most doctors explain the disease with heredity.
- There is also a theory that endometriosis is caused by hormonal imbalance in the body of a woman.
- Another point of view is implantation. The onset of endometriosis development is associated with the fact that the rejected endometrial particles remain on the organs and are a consequence of the disease.
- Malnutrition, infection of the genitals, and stress play no less important role. The causes of the disease can be C-section, abortion, difficult births and even diathermocoagulation of the cervix.
At the initial stage, the symptoms of endometriosis are almost not manifested. A woman usually is not capable of suspecting the pathology. If she does not undergo regular gynecological examinations with a prophylactic goal, then most likely she will turn to a gynecologist after painful signs or difficulties with conception of the child that arise as endometriosis develops.
If, despite endometriosis, the pregnancy has occurred (this is also not uncommon), the symptoms of the disease may gradually disappear or decrease. But the woman has more chances to detect signs of endometriosis before pregnancy. The following symptoms may point at the development of the pathological process of growth of the endometrium in the internal organs:
- irregular period;
- discharge from the mammary glands;
- pain during menstruation and regardless of it – in the lower abdomen, in the back or lower back;
- pain and discomfort (and sometimes spotting) during or after sexual contact (if endometriosis affects the cervix);
- abundant spotting during menstruation;
- spotting – both during menstruation, and in the intervals between them.
As you can see, the symptoms are not specific. It means that they can be characteristic not only for endometriosis and pregnancy, but also for a number of other female diseases and disorders. That is why independent diagnostics of endometriosis is very difficult.
If the endometriosis has spread to other internal organs, then they will also feel soreness, as with menstruation, because the endometrium will also regenerate every month. Pelvic pain is the most characteristic sign of endometriosis. Approximately 70% of women who experience it have this disease.
Uterus Endometriosis and Pregnancy: Chances of Conception
Why is the growth of endometriosis tissue an obstacle to the conception of a child? There are several explanations for this.
Endometriosis is the formation of the uterine epithelium in places where it should not normally be. As a result, internal organs begin to function worse, and first of all the uterus. Because of pathological changes in its mucosa a fertilized egg cannot gain a foothold on the surface of the uterus.
Against the background of the development of endometriosis, the ovaries (which may also be affected by endometriosis tissue) start function worse. Ovulation may become irregular, or even “false”. That means that changes characteristic of this period take place, but the egg does not mature. And usually a woman does not even know about it.
Endometriosis of the Fallopian Tubes
But the biggest obstacle to conception is most often created by endometriosis, which spread in the fallopian tubes:
- first, it makes meeting of the egg and sperm impossible, because they cannot penetrate into the tubes;
- secondly, even if conception occurred, it is very difficult for the blastocyst to move along the lining of the endometrial tubes;
- Thirdly, as a result of endometriosis on the fallopian tubes, scars and adhesions are often formed. The tubes become impassable or unable to push the fetal egg higher. The development of an ectopic pregnancy is also possible in this case;
- And, fourthly, the ovule that has reached the uterus, in spite of all the barriers, cannot attach itself to the expanded epithelium.
Often, endometriosis in the fallopian tubes produces cysts (formations from the endometriosis tissue). It is clear that they prevent the movement of the fetal eggs through the tubes. It happens that the cysts disappear on their own. Still, the general condition does not get much better. At their former place, scars are formed, which also worsen the patency of the fallopian tubes. Cysts can “migrate”, disappearing and appearing every time in another place, because of what endometriosis is also called a “flying” disease.
Endometriosis and Pregnancy
A woman can get pregnant even if she is sick with endometriosis. Also, it should be noted that for the baby, endometriosis does not pose any danger in terms of impact on the development processes. However, this disease can cause a miscarriage, especially in the early stages of pregnancy. Therefore, a pregnant woman with endometriosis should be especially careful in the first trimester. With the onset of full-fledged functioning of the placenta, which actively produces hormones and is devoid of formations of endometriosis, all risks associated with possible rejection of the fetus will drop dramatically.
In general, pregnancy during endometriosis may even be “useful”. Changes occurring in the body of the future mother during this period lead to the fact that the processes of endometriosis stop, and often even turn back. All thanks to hormones. In the body of a pregnant woman, progesterone hormone is actively produced, which suppresses the production of estrogen. The signs of endometriosis in pregnancy, as we have already said, either decrease or disappear altogether. This continues throughout the lactation period.
Endometriosis and Pregnancy: Treatment
However, pregnancy and endometriosis don’t coexist in the majority of cases. It’s not worth it just hoping for the best. It is better to start treatment. Moreover, if a woman has cysts, then they will certainly not disappear even during pregnancy. Endometriosis and pregnancy are compatible only if there are no cysts.
So, if a woman has been diagnosed with endometriosis, she should know what to do. Treatment here is a must. Depending on the age of the woman, the state of her health, the hormonal background, the degree and severity of the disease, the localization of the cysts, the presence or absence of scarring, the treatment of endometriosis can be performed in several ways, but more often complex therapy is provided: medicinal (hormonal, anti-inflammatory, immunomodulatory) and surgical.
The greatest danger, as we have already noted, are endometriosis cysts – formations from clusters of endometriosis tissue. They block the normal patency of the fallopian tubes and contribute to tissue scarring after their disappearance.
Therefore, first of all, when confirming the diagnosis of endometriosis or in case of difficulties with conception of a child, a woman should check the patency of the fallopian tubes. If it is not damaged, then hormonal and anti-inflammatory therapy is usually enough. In this case, hormone-containing drugs that inhibit the production and stop the process of development of endometriosis are prescribed. Menstruation for the period of treatment ceases under the influence of drugs. Ovulation does not occur. The ovaries temporarily stop performing their functions. Then, after a period of rest, hormonal drugs are abolished sharply. The ovaries are actively “included” in the work. As a result, there is a high probability of pregnancy after the endometriosis.
Obstruction of the Fallopian Tubes
With diagnosed obstruction of the fallopian tubes, surgical treatment is required, because it is impossible to remove the foci of endometriosis in another way. During the procedure of examination of the uterine tube cavity with the help of a laparoscope, the foci of endometriosis accumulations are immediately removed, as well as scars.
This is enough to create the necessary conditions for conception and implantation of the fetal egg, if endometriosis was the only cause of infertility. But, unfortunately, cases where conception by a natural way is impossible is not uncommon. In addition, endometriosis tissue may not be removed completely and resume its activity, or a new one may develop. Therefore, it is better not to delay pregnancy after the treatment.