Approximately 1 woman in 10 is affected by endometriosis, a progressive gynecological disease that increases the risk of infertility and certain complications during pregnancy. How is endometriosis managed from conception to delivery? What are the chances of seeing your family project succeed? Here’s how it works.
What is endometriosis?
Endometriosis is a progressive gynecological disease that affects approximately 1 in 10 women and even 40% of women suffering from hypofertility and pelvic pain. It is characterized by the presence of endometrial mucosa outside the uterus. These endometrial cells can have different locations. While they are often located in the woman’s reproductive system (ovary, fallopian tubes, peritoneum, vagina, etc.), they can also affect the digestive system, the lungs or even the bladder. Depending on the depth of the lesions and the evolution of the disease, endometriosis is described in different stages ranging from minimal to severe.
How does endometriosis work?
First of all, we need to take a look at the female cycle. In a woman who is not a carrier, these cells naturally present in the uterus evolve with the level of estrogen. When the level increases during the menstrual cycle, these cells grow. When it decreases, the endometrial tissue gradually disintegrates.
This is the time of menstruation: the mucous membrane is evacuated from the cervix via the vagina. In women affected by endometriosis, these cells, which are not in the uterus, cannot be evacuated. A chronic inflammation then appears and can intensify over cycles and years. In more severe cases of endometriosis, cysts may appear in the ovaries in particular, as well as adhesions between the different organs affected.
What are the most common symptoms?
Although endometriosis is sometimes asymptomatic (which makes it difficult to diagnose), this inflammation is accompanied by symptoms that can vary depending on the location of the endometrial cells.
The signs that may indicate endometriosis are:
- intense abdominal pain (like menstrual pain, except that it is not always relieved by a painkiller)
- digestive and/or urinary problems (constipation, diarrhea, pain or difficulty with urination or bowel movements, etc.)
- a feeling of great and constant fatigue;
- pain during sexual relations (dyspareunia);
- bleeding, …
Is pregnancy possible with endometriosis?
Although spontaneous pregnancy is possible, especially when the endometriosis is minimal, this condition can also lead to difficulty conceiving a child, or even infertility. According to the Endofound, 30 to 40% of women with endometriosis have a fertility problem. Another figure that speaks volumes about this disease: 20 to 50% of infertile women suffer from endometriosis.
How can this link between endometriosis and infertility be explained? Various possibilities have been put forward by health professionals:
- chronic inflammation could disrupt the interaction between the spermatozoa and the oocyte;
- adhesions or occlusion of the tube, when present, could again slow down or prevent fertilization;
- the formation of endometriotic cysts in the ovary could prevent the follicles from developing properly.
How is infertility managed in the case of endometriosis?
Once you have been diagnosed with endometriosis, your doctor may refer you to medically assisted reproduction if he or she considers it necessary. Depending on the degree and type of endometriosis you have and the particularities of your couple, the medical team following you may recommend
- ovarian stimulation, with or without intrauterine insemination (IUI);
- IVF, sometimes preceded by pre-treatment with estrogen-progestin contraception (the pill) or GnRH agonists.
Please note: the health authorities do not systematically recommend surgical treatment of endometriosis to improve the chances of pregnancy. However, your practitioner may consider it in the case of IVF failure and if your endometriosis is moderate to severe. In the case of management within the framework of a medical assistance for procreation (MPA) program, the chances of pregnancy per IVF cycle for women with endometriosis are more or less similar to those of other women receiving similar treatment, i.e. approximately 1 in 4.
Pregnancy: a break from endometriosis?
It is sometimes believed that pregnancy cures endometriosis. The reality is more complex. In fact, hormonal impregnation, particularly in terms of oestrogen, changes during pregnancy.
As a result, the symptoms of endometriosis can worsen during the first trimester, then subside or even disappear until after the birth. However, the signs of endometriosis generally resume when menstruation resumes. The disease is therefore only dormant during gestation.
Endometriosis and pregnancy: increased risk of complications?
Moreover, endometriosis could favour the appearance of certain complications during pregnancy. In particular, there is an increased risk of :
- early miscarriage (+10%) ;
- prematurity and very premature birth;
- placenta previa
- delivery by caesarean section. The cause: a nodule or the aftermath of a previous surgery that makes the delivery more complicated.
However, it is important to remember that not all pregnancies in women with endometriosis are pathological and that they can result in a vaginal delivery and a healthy pregnancy. If you have any questions about the progress of your pregnancy, do not hesitate to contact your doctor who will recommend a follow-up adapted to your case.