Fertility & Endometriosis: What You Need To Know & How To Cope When TTC

Did you know endometriosis is the second most common gynecological condition in the UK (affecting 1 in 10 women), and yet it takes an average of 7.5 years from the onset of symptoms for women to receive the correct diagnosis? We talked about a similarly frustrating timeline when we discussed PCOS a few weeks ago (which happens to be the most common gynecological condition). It's still surprising that it can take so long for women to reach an endometriosis diagnosis and get the support they need, but that's largely because symptoms and experiences and severity can vary so widely from person to person. But that's why we need to talk about it more.

Let's start with the basics: what is endometriosis?

It's a condition that causes tissue commonly present in the lining of the womb to grow in other places -- such as the ovaries or fallopian tubes. This misplaced tissue commonly causes pain in your pelvic region, lower back, or stomach that intensifies during your periods.

Speaking of periods... women with endometriosis often have heavy and irregular flows. Now, we all experience some form of PMS but the pain associated with endometriosis is often strong enough to stop you from completing your normal daily activities, and can worsen when having sex, urinating, and during bowel movements. 

What endometriosis means for fertility

Unfortunately, this answer is not always clear cut. As with many gynecological and endocrine (hormonal) conditions that can impact your chances of conceiving, the way that endometriosis impacts fertility can vary greatly from person to person. And, like so many conditions related to women's health, it's... complex.

Generally, endometriosis is associated with a slightly longer time to conception, and this usually increases with the severity of the endometriosis. This is because increased severity is associated with greater amounts of scar tissue, and that's what causes pain. And the more scar tissue you have, the higher the chance of your egg being trapped in your ovaries or unable to move down the fallopian tube and into your uterus.

However, that doesn't mean you will struggle to conceive with an endometriosis diagnosis. Only around 50% of women with endometriosis report difficulty conceiving, and even women with the most severe form of the condition can still get pregnant and give birth to happy, healthy babies! Research has shown that most women with mild endometriosis have similar fertility rates to women without the condition.

Let's talk about treatment...

Although there is not yet a cure for endometriosis, hormonal treatments are often prescribed to slow its progression, such as the Combined Oral Contraceptive Pill. The Pill is most often used to ease pain and control symptoms, however, if you're actively trying to conceive, contraceptives won't be your best bet.

There are surgical interventions available to alleviate symptoms and possibly improve your chances to get pregnant -- and it typically involves the removal of cysts, adhesions, and nodules formed by the misplaced tissue growth associated with endometriosis.

As with all things related to your health, it's best to consult your healthcare professional on the best route to care when you're TTC and trying to manage endometriosis.

What will happen once I become pregnant?

Again, it's... hard to predict.

For some women, pregnancy temporarily alleviates the symptoms of endometriosis as it puts a stop to those painful periods and heavy menstrual bleeding.

Other women don't notice an improvement of symptoms, and sometimes symptoms worsen as the uterus expands to accommodate the growing baby, stretching misplaced scar tissue.

To add to the complexity of it, the hormonal changes that come with pregnancy can have varying impacts. Findings show that increased levels of progesterone are thought to suppress or even shrink endometrial growths (which is why the Pill is often prescribed to manage it). But on the flip side, increasing levels of estrogen seem to encourage further endometrial growths. Both hormones are important to a healthy pregnancy -- which can make it hard to effectively manage while expecting.

Will endometriosis impact my chances of carrying a pregnancy to term? 

It's important to know that most endometriosis pregnancies progress almost identically to those of women who do not suffer from the disorder. Several studies have suggested that there may be higher rates of miscarriage in women with endometriosis than those without, largely due to complications surrounding inflammation, possible structural damage to the uterus and hormonal influences. But what's important to know is that studies around endometriosis and miscarriage is often inconclusive and results vary greatly -- so more research is definitely needed.

Are there any other risk factors of endometriosis and pregnancy?

Findings suggest that women with endometriosis are 33% more likely to give birth prematurely, which is typically associated with lower birth weights for baby and a greater incidence of developmental issues.

There is also an increased risk of a condition called placenta previa where the placenta attaches to the bottom of the uterus at the opening of the cervix instead of at the top or side of the uterus. Your doctor or midwife will be monitoring for this throughout your pregnancy and will help you manage it accordingly, ensuring as safe and healthy an experience for you and baby.

What will happen after I give birth?

Whether or not pain is alleviated or aggravated over the course of your pregnancy, shortly after you’ve given birth to your baby symptoms of endometriosis typically return in line with your periods restarting.

But breastfeeding makes things interesting. Research has shown that regularly breastfeeding your newborn can lengthen the "remission period" after pregnancy as it inhibits the release of estrogen by the ovaries, suppressing ovulation and halting the development of your endometriosis. 

How can I take control of an endometriosis diagnosis?

We know that an endometriosis diagnosis can feel like a life sentence, but once you know that's what you're dealing with there are a number of ways that you can take back control of your body and ease your pain.

There are some short term methods of pain relief such as using heat pads on your stomach or taking a warm bath when symptoms are particularly bad, and some women have found acupuncture to be helpful with pain relief as well. More interestingly, research has pointed to the importance of diet and exercises in alleviating symptoms of endometriosis (which Baby2Body will of course help with!). 

Studies have suggested avoiding the trans fat in fried, processed and fast foods, as well as avoiding red meat, gluten, caffeine, and alcohol can help lessen the pain and growth of endometriosis. Instead, here are some foods to love:

• Fibrous foods such as fruit, vegetables, legumes, and whole grains

• Essential fatty acids like salmon, sardines, herring, trout, walnuts, chia, and flax seeds

• Iron rich foods such as dark leafy greens, broccoli, beans, fortified grains, nuts, and seeds

• Antioxidant rich foods found in colourful fruits and vegetables, such as oranges, berries, dark chocolate, spinach, and beets

• Consider supplementing your diet with zinc, vitamins A, C, and E -- but be sure to talk to your doc before beginning any supplementation plan, especially if you're TTC, pregnant, or breastfeeding.

When it comes to exercise, some women find high impact exercises and traditional core routines (like sit ups and crunches) to exacerbate abdominal pain, especially while on your period. If you find certain workouts heighten your pain, please be sure to skip them. We always preach listening to your body above all else!

However, we also know that regular exercise is proven to boost your moods, ease pain and inflammation, reduce stress, and improve sleep quality -- and so maintaining a regular exercise routine is so important for managing endometriosis. Yoga and bodyweight exercises that relax, lengthen and strengthen your pelvic floor, abdominal wall, and hip flexors are particularly important. The workout programs on the Baby2Body app will help you target all of these areas regularly!

Lastly, it's important to engage in frequent and careful monitoring and tracking of your symptoms. This is true if you have not been diagnosed with endometriosis but suspect you may have the condition, and it's true if you are managing endometriosis through your conception journey and during pregnancy to check for any of the possible complications. 

You can have a healthy, happy pregnancy with endometriosis

Being diagnosed with endometriosis often feels like adding another level of unpredictability to the complex and at times scary world of motherhood. But even with the risks we've discussed here, it is important to remember that there are countless examples of women with endometriosis who have been able to conceive naturally and give birth to healthy babies, and there are treatment plans that can help if you are struggling. The most important thing is to check in with your doctor to get diagnosed quickly, don't be afraid to speak up about your symptoms, and know that the entire Baby2Body community of mamas and mamas-to-be are behind you.

---