If you are one of the 10 percent of women with endometriosis, you may have had a hard time getting pregnant.  About 30 percent of women with endometriosis have trouble getting pregnant. In fact, infertility may be the first sign of endometriosis.  Now that you are pregnant, what do you need to know about endometriosis during pregnancy?
Does Endometriosis Get Better or Worse?
If you have already done some net searching on this, you might be confused. Many older sources might tell you endometriosis usually gets better during pregnancy. You may have even heard that pregnancy is a cure for endometriosis. Years ago, many women were advised to get pregnant as a treatment for endometriosis. More recent sources will reflect more recent research, and tell you that endometriosis may not get better and does not go away during pregnancy. This is what you need to know: [2,3,4]
It might get better. When you have endometriosis, you have tissue that normally is inside your uterus growing outside your uterus. It could be on the outside surface of your uterus, on your bladder, bowel, or on your ovary. When you have your period, this tissue swells and bleeds. That causes the pain of endometriosis. [2,4]
When your become pregnant, your periods stop. You also produce more of the female hormone progesterone, which helps reduce the growth of endometrial tissue. In fact, progesterone is a treatment you may have had for endometrioses. So it is not surprising that some women have less symptoms during pregnancy. [2,4]
It might get worse. Even though your are not having periods and you are making more progesterone, you are making more estrogen. Estrogen can stimulate endometrial tissue. Also, as your belly grows it can stretch or put pressure on endometrial tissue and cause more symptoms. So, not surprisingly, some women feel worse. [2,4]
You may have more symptoms or less. It could go either way. What is more certain is that even if you feel better, it is very unlikely your endometriosis will go away. Once your period starts up again, so will your endometriosis. Breast-feeding might delay that, but eventually you should be working with your doctor again on a treatment plan. [2,3]
Does Endometriosis Affect Pregnancy?
Internet surfing might be confusing on this also. Older sources may warn you about an increased risk of preterm birth, miscarriage, or Cesarean section. More recent reviews of studies including large numbers of pregnant women with endometriosis show that these risks are very low. In fact, the latest recommendations are that your pregnancy should be managed the same as any other pregnancy. No need for increased monitoring. [2,4]
There may be a very small increased risk for two complications that your obstetrical care provider should be alert for. One is high blood pressure of pregnancy – called pre-eclampsia – the other is a condition called placenta previa. [2,4]
Pre-eclampsia causes swelling, headache, belly pain, or changes in vision. These would be symptoms to let your provider know about. Placenta previa is when your placenta grows over the bottom of your uterus instead of the top. As your uterus grows during the second half of pregnancy, bleeding from the placenta can occur and appear as bright red vaginal bleeding. Placenta Previa usually leads to Cesarean section. [2,4]
Managing Endometriosis During Pregnancy
Once you are pregnant, there are no safe treatments for endometriosis. If you have symptoms, you can manage them with an over-the-counter pain reliever recommended by your provider. Stretching exercise, like yoga or tai chi can help. A heating pad or a warm bath is also good. A high-fiber diet can reduce bowel symptoms. 
Bottom line: Your symptoms may get better or you may have some flares, but your pregnancy should be fine. After pregnancy, expect your symptoms to go back to the way they were before pregnancy. [1-4]
- Medical News Today, What to know about endometriosis during pregnancy, https://www.medicalnewstoday.com/articles/322516.php
- Jean Hailes for Women’s Health, Endometriosis, fertility & Pregnancy, https://jeanhailes.org.au/health-a-z/endometriosis/fertility
- Human Reproduction Update, The effect of pregnancy on endometriosis-facts or fiction, https://academic.oup.com/humupd/article-abstract/24/3/290/4859612?redirectedFrom=fulltext
- Human Reproduction Update, A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes, https://academic.oup.com/humupd/article/22/1/70/2457880