How are pregnancy and endometriosis related? How does endometriosis affect fertility?

The natural desire of a woman is to find the happiness of motherhood. There are various pathological processes leading to the diagnosis of infertility. A third of the female population of the entire planet is diagnosed with endometriosis, which occurs exclusively in childbearing age.

What is endometriosis?

This is a pathology associated with an imbalance of hormones that occurs after reaching adulthood. There are several types, depending on the location of the deviation. With genital, the uterus and fallopian tubes are affected, with extragenital - pathological processes take place in other organ systems. In some cases, both types of endometriosis develop.

The deviation is characterized by the growth of the lining tissue of the uterus, the particles of the endometrium during menstruation have the ability to migrate. Transported through the lymphatic system, they settle on other organs, where they begin to increase in size.

During menstruation, these particles begin to bleed, which leads to pain and adhesions. The severity of the disease depends on the number and location of proliferating tissue fragments.

Causes of pathology

As for the provoking factors, there is no generally accepted opinion among doctors; a number of processes lead to the development. The trigger mechanism can be both a woman's chronic diseases and lifestyle features.

The risk of endometriosis increases in the following cases:

hereditary factor, genetic predisposition is the key;
frequent inflammatory processes of organs reproductive system;
difficult childbirth;
abortions, operations on the uterus (including caesarean section);
treatment of uterine erosion by cauterization;
disturbances in the work of the endocrine system;
weakened immunity;
living in an area with an unfavorable ecological situation;
anatomical features of the reproductive system;
bad habits - alcohol, smoking, excessive consumption of caffeinated products.

The psycho-emotional background of a woman also affects, regular stress leads to hormonal disorders. The chain of imbalance in the body reaches the reproductive system, provoking the onset of pathological processes.

Types and severity

The state of the reproductive organs depends on the work of the endocrine system, the hormonal background. There is a single classification of the disease, which differs in severity, as well as the localization of inflammatory processes.

Types of endometriosis:

genital - growth occurs in the internal female genital organs, in turn, the genital is divided into extraperitoneal, peritoneal, internal;
extraperitoneal - lesions are located in the vagina, affect the labia, as well as part of the cervix;
peritoneal - growth is observed in the ovaries, fallopian tubes;
internal - pathological processes do not occur in the lining of the uterus of the endometrium, but in the muscular internal - myometrium, it is in this form that it is impossible to maintain pregnancy;
the extragenital form is characterized by the transport of particles of the endometrium and growth outside the reproductive system.

There are different degrees of severity of the disease:

are formed exclusively on the surface of organs, have a single localization;
multiple lesions move deep into the uterine cavity;
cysts form on the ovaries, several foci are formed that differ in the depth of the lesion;
large adhesions are formed, pathological processes can spread to the rectum.

It is the formation of adhesions that leads to the development of infertility. Pathological processes in the uterus and the development of pregnancy can be observed only with a mild degree of the disease.

Symptoms of the disease

Exist different types and severity, the course of pregnancy with endometriosis depends on individual characteristics. Often, the pathology develops unnoticed by a woman and is detected during a routine examination by a gynecologist. When diagnosing a running form, gestation cannot be saved.

Signs of the development of endometriosis:

pain during menstruation, occurs in 50% of women with pathological growth of the endometrium;
volume spotting increases;
pain also accompanies urination and defecation;
with the localization of inflammatory foci in the vagina, intimate relationships will also cause pain and discomfort;
hemoglobin levels are sharply reduced;
long time the couple cannot conceive a child, these are the consequences of the formation of adhesions.

When pregnancy occurs, the disease does not affect the appearance of characteristic signs. If pathological processes are detected, the doctor tells the expectant mother about the risks to the fetus and gestation in general.

In the first trimester, there is a high probability of spontaneous miscarriage, fading, in later periods - the development of placental abruption. With genital external endometrosis, it is possible to save the pregnancy.

Endometriosis and pregnancy

Women are often concerned about the question - can they get pregnant with a mild degree of the disease, and also why there are problems with conception. The main difficulties are the failure of the ovaries, which leads to the difficulties of ovulation. Even if the egg has left the follicle and fertilization has occurred, there is a high risk of failure of the implantation process in the uterine cavity. With failures in the endocrine system, hormonal imbalance leads to miscarriages on early dates.

If the egg has successfully matured, conception has occurred, and the fetal egg has implanted in the uterus, there is a chance to keep the pregnancy, taking into account the severity of the disease. Pathology treatment begins after the birth of the baby

Management of pregnancy:

with hormonal disorders, drug therapy is carried out to prevent miscarriage;
after the formation of the placenta, the expectant mother is under the supervision of a doctor;
the disease does not affect the development of the fetus, the risks are associated with the occurrence of bleeding and miscarriage;
a few days before delivery, ultrasound is performed to monitor the condition of the placenta, uterus, and a planned caesarean section is possible.

With an endometrial ovarian cyst, a future mother is shown surgery. A planned operation is carried out at a period of 16-20 weeks, and does not threaten the life and formation of the fetus.

Diagnosis and treatment

At the first stage, the woman is examined, the gynecologist analyzes the patient's complaints. The most informative method today is a vaginal examination. An ultrasound of the pelvic organs is also prescribed, which allows you to determine the areas of pathological growths. Colposcopy is used, with low information content of previous diagnostic methods, laparoscopy is prescribed.

A conservative method of treatment is used to preserve gestation, in the absence of symptoms of the disease, characteristic of the initial stages. Drug therapy includes the use of gestagens, antigonadotropic compounds, combined hormonal agents. In the complex of treatment, multivitamin complexes and immunostimulants are prescribed to restore the protective properties of the body.

After the therapy, the chances of a rapid onset of pregnancy increase. In severe cases, the main method is to perform an operation to remove the foci of inflammation. After laparoscopy, 50% of women experience a long-awaited conception.

The main methods of prevention are planned examinations by a gynecologist, treatment for medical care with any discomfort from the reproductive system. If all medical recommendations are followed, the disease can be successfully overcome, a woman has a high chance of finding the happiness of motherhood.

Endometriosis is a pathological process, the essence of which is a benign growth of tissue, morphologically and functionally similar to the endometrium (this is the inner mucous membrane of the uterine cavity). The disease provokes its growth outside the uterus (in the ovaries, bladder, intestines, lungs). Most often, endometriosis is diagnosed in women of reproductive age. It is dangerous because it inhibits the work of the ovaries (which means the absence of ovulation) and provokes the appearance of cysts, neoplasms. Therefore, endometriosis and pregnancy is a rather dangerous combination.

Causes of endometriosis

Unfortunately, modern medicine cannot name the reasons for the development of this disease with full confidence. But the risk factors are precisely known:

genetic propensity;
menstrual irregularities;
at risk are nulliparous girls and women who have had one birth;
frequent abortions, diagnostic curettage of the uterus;
hormonal imbalance;
prolonged use of intrauterine contraceptives.

Also considered risk factors are dysmenorrhea, sexual intercourse and sports during menstruation, the constant use of tampons. All this complicates the free outflow of blood from the uterus during menstruation and can cause it to enter the fallopian tubes, the abdominal cavity, which contributes to the development of the pathological process.

Symptoms of endometriosis

Quite often, the disease is asymptomatic, and it is determined only by ultrasound or during laparoscopy. Most women do not even realize that their unsystematic pain in the lower abdomen or fatigue can somehow relate to the health of the reproductive system. But there are symptoms that should not be ignored. It:

chronic pain in the lower abdomen;
pain during ovulation, sexual intercourse;
painful urination during menstruation;
bowel problems and painful bowel movements;
bloody issues;
chronic weakness;
problems with conception.

The most important clinical symptoms of the disease are pelvic pain, menstrual irregularities, infertility, dysfunction of the pelvic organs.

Stages of development of endometriosis

This process occurs against the background of a violation of hormonal, immunological balances or in the case of a genetic predisposition to the disease. The frequency of endometriosis in women of reproductive age reaches 59%, and in operated women 27%.

The stages of the development of the disease depend on the depth of damage to healthy tissue. The American Fertility Society has developed its own classification of the external form of the endometrium, according to which this disease has 4 stages:

minimal (estimated at 1-5 points);
easy (6-15 points);
moderate (16-40 points);
severe (more than 40 points).

Diagnosis of endometriosis

How to treat endometriosis? First you need: diagnostics and in-depth analysis clinical picture, bimanual gynecological examination (palpation of the internal organs of the pelvis).

Bimanual gynecological examination. This research method will help the doctor evaluate the size of the uterus, its density, shape, identify seals in the retrocervical region, and the presence of tumors.
Colposcopy and cervicoscopy. These procedures will clarify the place and form of endometriosis lesions of the vaginal part of the cervix and the mucous membrane of the cervical canal (in this case, an additional examination will be carried out using a fibrohysteroscope).
ultrasound. Ultrasound is the optimal and widely available screening method for examining women with different stages of endometriosis.
The method of spiral computed tomography. It will allow you to accurately determine the nature of the pathological process, its localization, the relationship with other organs. It will also help to clarify the condition of the pelvic organs, the presence of neoplasms.
Hysteroscopy. Using a hysteroscope (optical system), you can examine the walls of the uterine cavity and assess the patient's condition. The method will help the doctor to identify and evaluate changes in the relief of the uterus, the presence of scars, crypts.
Laparoscopy. With it, you can assess the condition of the tissues and the degree of their damage. Through a small incision in the abdomen, the doctor introduces a special device with a powerful optical system, which allows you to examine all organs abdominal cavity, uterus, diagnose pathological processes.

Endometriosis and conception

Endometriosis and pregnancy during this disease have been studied by doctors for a long time. According to research by the American Fertility Society, laparoscopy data states that 20-50% of infertility cases are recorded in women suffering from endometriosis.

Although endometriosis is considered one of the causes of problems with conception, spontaneous pregnancy is possible even with a severe stage of the disease. Although usually the disease provokes anatomical changes in the mucous membrane of the uterus or other pelvic organs, which often leads to damage to the fallopian tubes, adhesions, lack of ovulation, and the formation of cysts. In addition, endometriosis has a tendency to relapse, and this negatively affects the reproductive system and conception.

Pregnancy with endometriosis of the uterus: what is the danger and how to avoid it

It is possible to get pregnant during endometriosis, although the chances of success are not very high. After the course of treatment, the most favorable period for conception lasts a year. After this time, the risk of relapse increases. Pregnancy after endometriosis is quite real, but the expectant mother needs to carefully monitor her well-being and visit the doctor regularly.

The fact is that endometriosis provokes a violation of blood circulation in the walls of the mucous membrane of the uterus, a lack of progesterone, which prevents the normal fixation of the embryo. Therefore, there is a possibility of miscarriage in the early stages. Later, a placenta that is not affected by endometriosis will form, and the risk will decrease. Taking progesterone medications and being closely monitored by your doctor will save you a lot of trouble during pregnancy with endometriosis.

Treatment of the disease by pregnancy: myth or truth?

If you have been diagnosed with this pathology, and you cannot, but want to get pregnant, then the sooner you see a doctor, the better. Treatment of endometriosis by pregnancy, contrary to popular belief, is impossible. Of course, the hormonal background of the expectant mother changes a lot, and due to the increased production of estrogen and progesterone, endometriosis foci are likely to be suppressed. But, unfortunately, there can be no talk of a complete recovery. Endometriosis and pregnancy are incompatible with each other in more than half of the cases.

Management of endometriosis before and after pregnancy

Unfortunately, so far there is no unified treatment strategy. A gynecologist in a situation of "endometriosis and pregnancy" develops an individual scheme of examination and treatment, focusing on the stage and localization of the lesion, clinical manifestations, and tolerance to hormonal drugs.

Usually, conservative treatment is used for patients of reproductive age with an asymptomatic form of the disease, infertility. In especially severe cases (when surgical and medical methods do not help), the foci of endometrial lesions are treated surgically.

In the event that the symptoms of the disease do not cause discomfort and it does not progress, then the doctor will most likely suggest that you be monitored regularly and not take drastic measures. Especially since endometriosis usually goes away after menopause. If something worries you, but the problem of the inability to conceive is not relevant, then the doctor will develop an individual drug treatment regimen for you.

Treatment options for endometriosis

One of the barriers to motherhood and health can be endometriosis. Treatment of this disease is carried out using the following methods.

Laparoscopy (surgery). How to treat endometriosis? Laparoscopy involves the destruction of adhesions and endometrioid nodes, tissue lesions that reduce the patency of the fallopian tubes. The percentage of the effectiveness of the procedure reaches 84%, especially in the case of a mild form of the disease.
Medical treatment. Drug therapy provokes the absence of ovulation and can negatively affect the embryo, so for women who want to get pregnant, it is not advisable (except for the hormone gonadotropin - it improves ovulation).

Most often, combined oral contraceptives (progesterone preparations) are recommended. The mechanism of action of drugs is that their components provoke inhibition of ovarian function, lack of ovulation and menstruation. Tissues affected by endometriosis stop bleeding, which prevents the formation of adhesions, cysts, and inflammation. The negative side is the presence of side effects.

If all methods have been exhausted, and pregnancy does not occur, there is Alternative option are assisted reproductive technologies.

Although endometriosis in almost 50% of cases provokes infertility, but this is not a sentence. With timely treatment and qualified treatment, the success rate is quite high. In addition, there is an alternative to classical treatment - assisted reproductive technologies. Medical care and self-confidence will certainly help to defeat the disease. Remember that pregnancy with endometriosis is possible!

The female reproductive system works for the sole purpose of procreation. Basically, if there are violations in the reproductive system, this is immediately reflected in the menstrual cycle. Violations in the menstrual cycle, in turn, will necessarily affect the ability to conceive. Endometriosis is a dangerous and insidious disorder that can make a woman infertile. It is diagnosed quite often, literally in every 10th woman aged 25 to 45 years. Statistics also confirm that about 40% of women have suffered from endometriosis at least once in their lives. Therefore, every woman who is worried about her health and wants to become a mother should know the symptoms of endometriosis, especially when planning a pregnancy.

Endometriosis is a very common disease. Pregnancy with endometriosis is possible, but not in all cases.

It is also sad that scientists have not yet identified the exact causes of the development of the disease. Only risk factors that increase the likelihood of a disorder are known.

What is endometriosis?

To understand whether it is possible to get pregnant with endometriosis, you need at least a little understanding of how endometriosis occurs and what it can affect during conception. The endometrium is the inner layer of the uterus. This is where the term "endometriosis" comes from. The endometrium of the uterus is divided into functional and basal. The functional layer renews its cells every month, which leave the body during menstrual bleeding. This happens when pregnancy does not occur. The basal layer begins to actively divide, preparing the "soil" for the next ovulatory cycle. If this process occurs without disturbance and fertilization of the egg occurs, then the fetal egg will implant into it without any problems and begin its growth and development.

Hormones responsible for the growth of the endometrium are progesterone and estrogen. In the first phase of the menstrual cycle, estrogens play the leading role. They "force" endometrial cells to grow and the egg to mature. After ovulation has occurred, progesterone picks up the baton, which slows down the growth rate of the endometrium so that a fertilized egg can be implanted into it. If conception does not happen, then the concentration of sex hormones in the body decreases, the superficial uterine layer is rejected and menstruation begins.

It is during menstruation that certain disorders can occur in the body of a woman, which subsequently lead to the onset of the development of endometriosis.

In endometriosis, endometrial cells are able to migrate and grow on the surface of internal organs, or implant in muscle tissue. There they do not die, but begin to divide, increasing their numbers. As a result of such a violation, foci of the uterine tissue are formed in those areas where they should not be. Despite the fact that the endometrial cells will be outside the uterus, during the next increase in hormone levels, they react to them, starting to bleed. There is nowhere for this blood to go, so the torn off tissues form cysts and adhesions. This is how endometriosis develops.

Normally, during menstruation, a woman may experience some discomfort. With endometriosis, the pain intensifies. At first, she worries the woman only during bleeding. As the pathology progresses, the pain becomes very severe and is present on an ongoing basis.

Forms and types of endometriosis

There are several forms of endometriosis. Classification is carried out according to the localization of endometrial cells:

genital;
extragenital.

Genital endometriosis

The genital form of endometriosis has several subspecies: internal, peritoneal and extraperitoneal. With internal endometriosis, cells begin to grow in the deep uterine layers. The peritoneal form of the disease is characterized by the appearance of foci of endometriosis in the organs of the reproductive system. It can be the cervix, its tubes, ovaries. If a patient is diagnosed with extraperitoneal endometriosis, then the cells will be concentrated in the vagina and in the rectovaginal septum.

The picture shows genital endometriosis.

Extragenital endometriosis

Extragenital endometriosis is a pathological proliferation of endometrial cells in organs that do not belong to the reproductive system. They can be found in the bladder, intestines, navel, respiratory system, and even in the eyes. The reasons for the growth of endometrial cells in the wrong place for them have not been established. Doctors suggest that weak immunity and hormonal imbalances become trigger factors.

Studies have shown that the risks of developing endometriosis increase in the following cases:

Frequent inflammatory processes concentrated in the organs of the reproductive system.
Difficult childbirth.
Multiple abortions.
Operation on the pelvic organs.
Abuse of alcohol and coffee.
Smoking.

Women's health is negatively affected by frequent stress and living in areas with unfavorable ecology.

Symptoms of endometriosis

When the disease has just begun to develop, the woman will not experience any pathological symptoms. From time to time, she is disturbed by painful sensations during the menstrual cycle, as well as its periodic failures. However, most women do not pay attention to such changes, so they do not rush to see a doctor.

As endometriosis progresses, the symptoms of pathology gain strength. Its main characteristics:

Pain during intercourse.
Disruptions in the menstrual cycle.
Severe pain in the lower abdomen during menstruation.
The appearance of blood between periods.
Pain during emptying of the bladder and bowels.
Blood in the urine.

If a woman is not protected, but cannot become pregnant, this will be an additional sign of endometriosis.

One more way. To understand that not everything is in order with the body, you need to regularly measure your basal body temperature and build a BT schedule. Deviations from the norm will indicate developing endometriosis.

Development of complications

The disease can develop very quickly. If a woman does not receive treatment, then endometriosis can cause complications such as:

Formation of adhesions in the pelvic organs. They provoke pain in the corresponding area, and also become an obstacle to conception.
Anemia. Anemia is the result of regular blood loss.
Reducing the ovulatory reserve that every woman has from birth.
The degeneration of overgrown endometrial cells into cancerous neoplasms.
Deterioration of the innervation of the affected organ or muscle tissue. This happens due to pressure on the nerve fibers.

If the disease is detected on time, then there will be no difficulties in its treatment. When endometriosis has a long course, a woman may stay.

Treatment of endometriosis

The choice of management tactics for a particular patient depends on her age, the degree of progression of the disease and the state of the hormonal background. After the doctor is satisfied that a woman has endometriosis, he will recommend that she either drug treatment or an operation. Sometimes you need to implement two methods at once.

Conservative therapy

Drug correction for endometriosis is reduced to taking hormonal drugs. They are prescribed for a long course. Reception medicines aimed at bringing a woman into a state of menopause. Therefore, at the time of treatment, she will have no menstruation. After completion of therapy, menstruation will appear again.

Hormonal drugs are used in the treatment of endometriosis. Only a doctor should prescribe treatment after examining the patient.

Medicines that are prescribed to patients with endometriosis:

Janine. This is a combined drug that has a contraceptive effect. Its intake helps to reduce the level of estrogen in the body.
Bysanne. This is a drug containing gestagens. It inhibits the growth of endometrial cells.
Danogen. This drug suppresses the ovulatory cycle, thereby destroying endometrial cells.
Diphereline. The drug is aimed at stopping the menstrual cycle, as it blocks the work of the ovaries.

In addition to hormonal drugs, a woman is shown taking painkillers, anti-inflammatory and antihistamines. They allow you to cope with the symptoms of the disease, as well as stimulate the immune system.

Surgery

If it was not possible to cope with endometriosis with the help of medicines, then the overgrown foci are removed surgically. The preferred method of surgical intervention is laparoscopy. This is a low-traumatic technique that allows access to the internal organs of a woman through small incisions. The doctor inserts a special instrument and a video camera into them. Burning of pathological foci of endometriosis is carried out using a laser.

So, with the help of a laser, foci of endometriosis are removed.

Laparotomy is rarely used for endometriosis. During this procedure, the surgeon cuts the peritoneum and performs the necessary manipulations. Access to areas of inflammation is carried out in an open way.

After the operation, the patient will need to take hormonal drugs. They are prescribed in order to increase the effectiveness of the intervention.

Pregnancy and uterine endometriosis

When endometrial cells penetrate into the deeper layers of the uterus, a woman is diagnosed with adenomyosis. With this disease, the fertilization of the egg by the sperm is possible. However, the fetal egg will not be able to gain a foothold, since the uterine layer will be broken.

Successful egg implantation occurs only if the woman has recently developed endometriosis. In such a situation, the embryo can find a place to attach. However, to maintain pregnancy, you will need to take hormonal drugs, or a miscarriage.

Pregnancy against the background of endometriosis is dangerous for the woman herself. If the fetal egg does not find a free site for attachment, then it migrates into the tubes, into the abdominal cavity or into the cervical canal. An ectopic pregnancy is a serious pathology that requires surgical intervention.

Doctors strongly recommend that women first get rid of endometriosis and only then start trying to conceive a child.

When the disease has a running course, then pregnancy is impossible at all. In such a situation, it will be possible to cope with the problem only with the help of.

Pregnancy with ovarian endometriosis

If areas of endometriosis occur on the ovaries, then it will not be possible to conceive a child. The chances of successful fertilization remain only if the inflammatory process is concentrated on one side.

If pregnancy has occurred

In the case when the foci of endometriosis are located outside the uterus, pregnancy can happen. Pregnancy leads to changes in the hormonal background, to a rapid increase in the level of progesterone in the body. Under the influence of this hormone, endometrial cells stop growing. However, to preserve the fetus, a woman will need to take medications. They will prevent miscarriage. When the placenta forms around the fetus, it will be under it. reliable protection. After that, endometriosis will not be able to affect the course of pregnancy.

In this short but very informative video, gynecologist K.M.N. talks about how pregnancy will proceed with endometriosis:

Until the birth, the woman will not need treatment. It is necessary only when there are cysts on the ovaries. In this case, the operation is performed for a period of 16-20 weeks.

Pregnancy after treatment

After the treatment, conception is possible. However, it is necessary to start planning pregnancy no earlier than after 2 months. During this period, the body will fully recover. If a woman underwent laparoscopy, then you can try to conceive a child earlier, but only on the condition that she did not receive hormone therapy. This rush is due to the fact that pregnancy should occur within a year. Otherwise, the disease may recur. The chances of success equate to 80%.

Write in the comments what symptoms you are experiencing. What treatment did you receive? Share tips and experience. Ask questions, our experts will be happy to answer them. Rate the article with stars below. Thanks for visiting. Be healthy!

Many women, having learned about the presence of endometriosis, ask the doctor the question: “Is pregnancy possible with uterine endometriosis?”. We will talk about this. So, endometriosis occupies a leading place among women in gynecology and in 35% of cases it ranks first in infertility, because due to its development it causes a strong adhesive process and dyshormonosis in the body, which are not capable of pregnancy.

Endometriosis - pregnancy is possible in rare cases. Most often, these are the first stages of its development, when changes and foci are single and small. In the case of bilateral damage to the ovaries and fallopian tubes, the chances of a natural pregnancy are practically absent. If, with endometriosis, at least one ovary remains unaffected, then we can talk about natural ovulation and the onset of pregnancy. When the muscular layer of the uterus is affected, it should be understood that the degree of damage can be different, we talked about this a little higher, and, accordingly, the likelihood of favorable implantation depends on the depth of the lesion of the muscle layer and its prevalence. Indeed, in the initial stages, with minimal damage to the myometrium and small sizes of foci, the chances of favorable implantation are significantly higher than with damage to the deep layers of the myometrium.

Now each of the women understands that it is possible to become pregnant with endometriosis of the uterus, but the period of gestation requires help from the doctor, because often against the background of endometriosis, pregnancy is interrupted at different times. Therefore, if you have endometriosis and you just found out about your pregnancy, you should immediately contact a specialist for help. Since the timely diagnosis of the threat of interruption requires assistance, especially if the pregnancy is desired and long-awaited.

Endometriosis and pregnancy - is it possible to get pregnant? As we said above, yes, but the chances of this are minimal, because only 30% of women, according to statistics, are able to become pregnant on their own in the presence of endometrioid heterotopias.

It should be understood that during pregnancy the progression of the disease stops, because during pregnancy the level of estrogen in the blood is minimal, and we know that the progression of the disease is associated with hyperestrogenism.

During pregnancy, progesterone is produced by the corpus luteum of pregnancy, which significantly inhibits the production of estrogen and, accordingly, the growth of the endometrium in the uterus and endometrioid heterotopias in the body.

Treatment of endometriosis by pregnancy is possible in some women, this is a fact. Indeed, during lactation, thanks to prolactin, the level of estrogen in the blood also remains minimal, which leads to atrophy of the endometrioid tissue in the uterus and endometrial cells outside it, therefore, there are chances for recovery.

Many are also interested in the question: "Is it possible to get pregnant with endometriosis of the ovaries and fallopian tubes?". The defeat of the ovaries by endometriosis is most often manifested by the presence of cysts that require prompt removal, since they very rarely resolve on their own. If pregnancy does occur, then in the postpartum period it is necessary to carry out a planned operation to remove it. As for the fallopian tubes, everything is much more complicated here, since with the growth of endometrioid heterotopias in the lumen of the tubes, they make it difficult for spermatozoa or a fertilized egg to move along them, therefore, there are often cases of ectopic pregnancy.

If there is ovulation with endometriosis, you can get pregnant, but only the issue of implantation and carrying a pregnancy requires strict control by the doctor, since the likelihood of an ectopic pregnancy or its termination at different times is very high

Pregnancy after endometriosis should be planned in order to prevent the development of complications for the health of the woman and the child. If a woman has endometriosis and conservative treatment is indicated, then after its course, the onset of pregnancy should be suspended in order to restore the woman's body, and only after three months can you try to become pregnant. If surgical treatment is indicated, then before the operation it is necessary to exclude other causes of infertility, since there is no time for this after the operation. In this case, pregnancy occurs throughout the year, so it is during this period that the probability of becoming pregnant after surgery is much higher than without it or after a year. Now we know that it is possible to get pregnant with endometriosis both without treatment and against the background of ongoing treatment. It should be understood that only a qualified, competent and experienced doctor will help you in solving this issue. And in no case should you self-medicate, as this can lead to irreversible consequences, both in terms of reproductive health and the general health of a woman.

How to get pregnant with endometriosis of the uterus - we now know. But what to do if pregnancy occurs against the background of endometriosis. Such a pregnancy is subject to strict medical supervision and in most cases involves the use of hormonal correction in order to prevent its interruption at different times. For this purpose, progesterone preparations are used, which are so necessary for the development of the fetus and the prevention of miscarriage, helping to relax muscle tone, because endometriosis itself does not affect the development of the fetus. From this it follows that the most critical moment for gestation with endometriosis is the first trimester, when the placenta is not yet functioning, therefore, it is necessary to ensure the hormonal background with the help of hormones from the outside. Further, the doctor in each case decides on the importance and necessity of using it for the prevention of interruption. We will talk about different cases and courses of pregnancy a little lower, judging by the reviews of other women who became pregnant against the background of the disease and by the reviews of doctors leading such pregnancies.

Reviews

On various forums, you can find reviews of those who became pregnant with endometriosis, how they became pregnant and the features of the course of such pregnancies. After all, each woman is individual and each organism carries certain concomitant diseases that have a direct impact on the course of the disease.

Is it possible to get pregnant with endometriosis of the uterus: doctors' reviews are quite variable, because endometriosis itself can be of several forms and stages of development, while the likelihood of pregnancy in a natural way is only in the first stages of the disease, when the damage to the muscular layer of the uterus is insignificant.

This is due to the fact that with deep and extensive lesions in the uterus, implantation of the fetal egg becomes impossible due to improper contraction of the muscle layer. One more main problem in infertility with endometriosis is a dishormonal balance in the body, in which there is elevated level estrogen and low progesterone.

Endometriosis: is it possible to get pregnant - the reviews of women who have been treating this disease for a long time are not always positive, because most of them did not seek medical help in time, and, therefore, the development of the disease already does not correspond to the first stage. Many women, having learned about the presence of endometriosis in them, and the indications for its surgical treatment, for a long time are still thinking about the appropriateness of treatment. At the same time, many often self-treat with means traditional medicine, which in this case is strictly prohibited, because timely treatment or surgery is a success in conceiving and carrying a long-awaited pregnancy.

Pregnancy with endometriosis of the uterus: reviews say that in 35% of cases pregnancy can occur on its own, but its further course requires strict control and observation by the doctor and, if necessary, correction. Very often, in the presence of endometriosis, surgical treatment is necessary. In this case, the laparoscopic technique is best. Its essence lies not only in the fact that with the help of several punctures of the abdominal cavity it is possible to identify all the foci of endometriosis and their spread, but also to simultaneously remove or cauterize them, which will significantly increase the likelihood of pregnancy after. If endometriosis is expressed strongly enough, then the adhesive process will be widespread. Here, too, laparoscopic surgery will allow the dissection of all adhesions and their removal. This modern technique is not only a unique tool for diagnosing endometriosis, but also the best in its treatment. After all, endometrioid ovarian cysts can be removed by this method so carefully that the ovarian tissue remains functioning and producing hormones and follicles with eggs, which is aimed at preserving the woman's ovarian reserve.

With endometriosis, you can get pregnant - the reviews of most women say this with confidence, and only a few of them indicate that pregnancy occurred after surgery or artificial menopause. So, endometriosis and pregnancy: we have learned the reviews of women and doctors, therefore, the conclusion suggests itself that, given the different forms and stages of the disease, it is necessary to immediately seek qualified medical help at the first signs of it or with infertility. And only then the chances of an onset and carrying a pregnancy will increase significantly, and the onset of pregnancy will become a real event in your life.

Video: Endometriosis and pregnancy

Endometriosis remains one of the most common and at the same time difficult to diagnose female diseases. Until now, the medical community has not come to a consensus about the causes that provoke this pathology. Such uncertainty also scares women who have been given such an unpleasant diagnosis when planning a pregnancy, because endometriosis can significantly complicate conception or even cause infertility. It is not surprising that many are interested in what are the signs of the disease and the methods of its treatment.

What is endometriosis

So, we are talking about the growth of the endometrium (inner uterine membrane) outside the uterus - where it normally does not exist. First of all, the pathological process affects the uterus itself and adjacent organs: the ovaries, fallopian tubes. Sometimes endometrioid cells are also found in distant organs - the lungs or even the nasal cavity.

Since the endometrium is sensitive to hormones, in the distant areas covered with this mucous membrane, the same processes occur as in normal tissue:

In response to the release of estrogen at the beginning of the menstrual cycle, the endometrium actively increases and thickens both inside and outside the uterus.
In the second half of the cycle, another hormone, progesterone, acts on the tissue. Under its influence, the overgrown layer of the endometrium begins to break down and be rejected - menstruation occurs. In the affected areas, the cells cannot come out naturally, so hemorrhages and inflammation occur.

Repeating from time to time, such processes lead to the appearance of adhesive scars, cysts.. Such seals in the organs and tissues of the small pelvis, ovaries disrupt their functioning, which is fraught with serious problems with conception and gestation.

In terms of frequency of occurrence, endometriosis is in 3rd place among all gynecological diseases. More common are only inflammatory diseases of the genital organs and tumor formations in the muscle tissue of the uterus (fibroids). However, the latent course of endometriosis and the difficulty in staging accurate diagnosis suggests that the disease is much more common.

Women 25–40 years old are at risk for the occurrence of this disease. Much less often, endometriosis is found in girls before the menstrual cycle and is extremely rare in women in menopause.

Why does it occur

There is no consensus among obstetricians and gynecologists about the causes of this pathology.

Congenital disorders, cauterization of erosion and other developmental theories

The development of endometriosis is explained by several theories, but none of them is considered absolutely proven.

The most common is the implantation theory. Studies have shown that endometrioid particles enter the internal organs through the fallopian tubes with blood released during menstruation.
According to the traumatic theory, the formation of lesions in the peritoneum occurs as a result of surgical operations on the uterus, such as:
- abortion intervention,
- cauterization of erosive areas of the mucous membrane,
- C-section.
- traumatic childbirth.
The embryonic theory implies that endometrioid foci in distant tissues are formed as a result of impaired embryonic development.
This theory confirms the facts of the discovery of the disease in girls who have not yet had menstruation.
Some experts believe that endometrial particles move through the blood or lymph vessels.
This theory explains the detection of pathological foci in organs distant from the uterus - the lungs, the nasal cavity, and even the tissues of the eyes.

Risk factors

An important role in the development of pathology is played by hormonal disorders. So, with a decrease in the amount of progesterone in the body and an excess of estrogen, an excessive growth of the inner lining of the uterus occurs. Particles of the endometrium are introduced with menstrual blood into neighboring organs, forming affected areas.

Another important factor is immune dysfunction.. Normally, the body defends itself from foreign agents, including formations that are not characteristic of a particular organ or tissue. With insufficient functioning of the protective system, endometrial cells freely take root almost anywhere.

In addition, scientists have identified a number of factors that provoke the occurrence and further development endometriosis:

early onset of menstrual bleeding;
hereditary predisposition;
gynecological diseases;
inflammatory processes in the internal organs located next to the uterus;
late start of sexual life;
late first birth;
physical inactivity (muscle weakness);
excessive physical activity;
thyroid disease;
bad habits;
unfavorable ecological situation;
anomalies in the structure of the uterus.

Typical and specific symptoms

The clinical picture of the disease is largely due to the specific localization of pathological foci of the endometrium and general condition woman's health. In some cases, the disease is asymptomatic, especially at the initial stage.. In this case, it is possible to detect endometriosis only at a regular preventive examination or by contacting a gynecologist due to difficulties in conceiving a child.

As the pathological process develops, the following characteristic signs appear:

Pain in the pelvic region. This symptom is observed in 16-24% of patients. The pain syndrome is constantly present, having a clear localization or, conversely, a diffuse character.
Cyclic pain associated with menstruation. They occur in half of the patients. A particularly strong pain syndrome is observed in the first three days of menstruation and is associated with factors such as:
- spasms of the uterine vessels;
- outpouring of blood from the affected foci into the peritoneum;
- increased pressure and blood flow to the cyst.
Unpleasant and even painful sensations during sex. More often they appear when lesions occur in the vaginal epithelium and on the ligaments of the uterus.
Changes in the normal course of the monthly cycle:
- prolonged and too "strong" menstruation;
- weak discharge Brown color before and after menstruation;
- short periods;
- bleeding in the middle of the cycle.
Problems with conception and childbearing. This symptom is observed in 25-40% of affected women. Possible reasons infertility become ovarian dysfunction, low immunity and impaired ovulation.

In addition to the characteristic signs of endometriosis, in some cases there are also such specific symptoms as:

spotting in stool and urine;
violation of defecation;
hemoptysis;
bleeding from the navel;
bloody tears.

These signs are rare (or extremely rare) and depend on the localization of the areas affected by the endometrium in the female body.

Diagnosis: laparoscopy and other procedures and tests

If the doctor suspects a woman has endometriosis, then he first of all analyzes the complaints and anamnestic data. At the same time, the specialist is interested in such important points as:

the beginning of menstruation and the features of their course;
the timing of the onset of painful sensations, their localization;
whether pain increases before menstruation, during bowel movements;
transferred gynecological diseases, surgical interventions, uterine injuries;
whether maternal relatives had endometriosis.

After making a preliminary diagnosis, the doctor conducts a further examination of the patient, which includes the following diagnostic procedures:

Gynecological examination, which involves mandatory two-handed palpation of the vagina. This is necessary to determine the size of the uterus, its cervical region, ovaries, the condition of the uterine ligaments and appendages. The procedure is uninformative, but it allows the doctor to make an assumption about the presence of areas affected by endometriosis in the internal genital organs.
Ultrasound of the pelvic area, which is advisable to perform before the next menstruation. Research helps to discover:
- enlargement of the uterus;
- pathological thickening of the uterus and other internal organs;
- large foci of damaged tissue.
Computed tomography and MRI (magnetic resonance imaging) are performed to identify the affected areas, their size, location and relationship with other nearby organs.
This method is considered very informative - the accuracy is about 96%.
Another informative and reliable diagnostic procedure is endoscopy. With the help of a special narrow tube with a video camera, which is inserted into the cavities of the internal organs, it is possible to obtain a clear image of the mucous membrane and detect tissue areas affected by endometriosis. Options for endoscopic diagnostic methods:
- hysteroscopy - examination of the uterus;
- colposcopy - examination of the vaginal mucosa and uterine cervix;
- laparoscopy - examination of the abdominal cavity;
- colonoscopy - examination of the rectum;
- cystoscopy - the study of the bladder.
Hysterosalpingography involves the introduction of a contrast agent into the uterine cavity, followed by x-ray examination. With the growth of the endometrium, the pictures show:
- intrauterine adhesions;
- areas of experimental fluid poured into the peritoneum;
- an increase in the size of the uterus.
Blood test for the presence of cancer markers (CA-125). With the growth of the endometrium, their number increases significantly, but such results do not necessarily indicate endometriosis. High levels of the CA-125 marker may indicate ovarian cancer, inflammation of the appendages.
Laparoscopy is the most informative diagnostic method. This is a sparing surgical intervention that allows you to examine the peritoneum with a magnifying device through a small puncture in the wall of the organ. In addition to detecting foci of the disease, laparoscopy allows you to remove a piece of the affected tissue for an accurate diagnosis.

Disease classification

Endometriosis is an ailment that has only a chronic form, since the acute phase of the course of the disease is practically absent. The disease is classified most often by the location of the foci of the overgrown endometrium.

Table: adenomyosis, retrocervical, ovarian endometriosis and other variants of localization of the lesion

Kinds	Subspecies	Localization of affected areas
Genital	Internal (adenomyosis)	Endometrial lesions grow in the uterus itself, penetrating deep into the mucous membrane, myometrium (muscle tissue) and even into the perimetrium (serous, outer layer).
	peritoneal	The endometrium penetrates and grows in other genital organs: ovaries; vagina; fallopian tubes; uterine cervix (retrocervical).
	extraperitoneal	The affected areas are localized in the external genitalia, in the vagina, rectovaginal septum.
extragenital		Foci of the endometrium are localized in organs that are not related to the female reproductive system: intestines; navel; lungs; bladder; eyes.

Identification of types of adenomyosis depending on the nature of the lesion: focal, diffuse endometriosis and others

In addition, adenomyosis, depending on the depth of damage to the muscular membrane of the uterus, is divided into 4 types:

focal - endometrioid particles penetrate into the uppermost layers of the uterus, forming peculiar local foci;
nodular - mucosal particles are located in the myometrium in nodules. These formations are cavities that are filled with blood;
diffuse - epithelial particles are introduced into the myometrium without the formation of clear foci and nodules;
diffuse-nodular - a mixed type of adenomyosis, in which the location of randomly scattered nodules in the myometrium is characteristic.

Experts have developed a typology of endometriosis, which takes into account the localization and depth of penetration of endometrial particles.

Table: degrees of endometriosis of the uterus and ovaries

Type of disease	Degree	The nature of the lesion
Adenomyosis	I	The affected areas are observed only directly on the mucous membrane of the body of the uterus.
	II	The pathological process descends to the middle of the muscular layer of the uterus.
	III	Endometriosis covered the entire muscle layer, the serous membrane of the uterus was also affected.
	IV	The parental peritoneum of the small pelvis is affected, the process covers the outer shells of neighboring organs.
ovarian endometriosis	I	There are small lesions on the surface of the ovaries.
	II	An endometrioid cyst (5-6 cm) appears on one ovary, the affected areas appear on the peritoneum of the small pelvis, adhesions form in the area of the appendages.
	III	Cysts are located on both ovaries, foci of endometriosis are located on the outer shell of the uterus, fallopian tubes, and the pelvic peritoneum.
	IV	Large diameter cysts are also located on both ovaries. Surrounding organs are also affected - the bladder, intestines.

Is natural pregnancy possible with chronic endometriosis and why it may not occur

Women with endometriosis are at risk for developing secondary infertility. Difficulties with conception in the genital and extragenital form of the disease are observed in 25–40% of patients. Experts explain the decline in reproductive function by the following reasons:

The formation of adhesions in the fallopian tubes significantly complicates their patency, as a result of which the passage of the egg through the tube and its fertilization are disrupted.
The high content of prostaglandins (biologically active substances) in the body leads to disruption of the transport function of the fallopian tubes due to constant microspasms.
Disturbances in the hormonal background and the immune system with endometriosis can interfere with normal ovulation, the process of fertilization and attachment of the egg to the uterine wall.
Endometrioid cysts on the ovaries disrupt the process of ovulation and, accordingly, reduce the likelihood of conception. If pregnancy occurs, then there is a high risk of miscarriage or premature birth.

In some patients with endometriosis, the regularity and cyclicity of uterine bleeding persists, but the maturation of the egg does not occur. This condition is called an anovulatory cycle and also causes infertility.

Thus, the growth of the endometrium significantly reduces the reproductive capacity of a woman. But with timely and adequate therapy, the likelihood of conception and the birth of a healthy child increases.

With a severe degree of growth of the endometrium, which completely covers the fallopian tubes, the method of in vitro fertilization (IVF) is actively used. It helps to get pregnant and carry a baby even to those women who have had their fallopian tubes removed.

Treatment of endometriosis when planning pregnancy

The main objectives of the treatment of endometriosis when planning pregnancy are:

reduction of unpleasant or painful symptoms;
restoration of the ability to conceive;
prevention of the spread of the pathological process;
prevention of relapse.

There are two main ways to treat endometriosis - medical and surgical.. When choosing treatment tactics, doctors take into account the degree of the disease and the prevalence of the pathological process, the age of the woman and the presence of concomitant somatic diseases.

The use of medicines

Conservative treatment of pathological growth of the endometrium, first of all, includes the use of hormonal medications that must be taken for a long time (at least six months). Hormone therapy helps to normalize the production of estrogen and stabilize the functioning of the ovaries. In addition, hormonal agents reduce inflammation in endometriotic lesions.

Since endometriosis is considered a multisystem disease, patients are often prescribed other groups of medications:

anti-inflammatory;
antiallergic;
painkillers
immunomodulatory.

Table: Duphaston, Bysanne, Buserelin-depot and other drugs often prescribed for endometriosis

Drug group	Name of specific drugs	Effect	Contraindications	Application during pregnancy
Combined oral contraceptives	Diana-35; Regulon; Logest.	Equalization of hormonal balance by reducing the production of estrogen	The presence of thrombosis; diabetes; migraine; liver failure; pancreatitis; vaginal bleeding of unknown origin;	Forbidden
Gestagens	Bysanne; Orgametril; Norcalut.	The drugs are synthetic analogues of progesterones. Active substances inhibit the growth of the endometrium.	Intolerance to components; acute thrombophlebitis; diseases of the heart and arteries; diabetes; severe liver disease; bleeding from the vagina of unknown origin.	Prohibited (with the exception of Duphaston)
Antigonadotropic drugs	Danazol; Danogen;	Inhibit the production of gonadotropic hormones; inhibit the onset of ovulation; lead to the death of endometrial cells.	Severe diseases of the liver and kidneys; severe heart disease; bleeding from the vagina of unknown origin; mammary cancer; hypersensitivity to components.	Contraindicated
Gonadotropin-releasing hormone agonists	Diphereline; Decapeptyl.	Neutralize the work of the ovaries, lowering the production of estrogen. Stops menstruation and growth of the endometrium.	Breast-feeding; hypersensitivity to the components of the drug.	Contraindicated

Photo gallery: hormonal remedies for endometriosis, including for pregnant women

Jeanine is a drug of the group hormonal contraceptives Dufaston is practically the only hormonal drug prescribed for pregnant women to treat endometriosis. Danol is indicated for the treatment of symptoms of endometriosis
Buserelin-depot - a drug for the treatment of endometriosis and infertility

Removal of lesions surgically

If conservative methods of treating endometriosis have not brought significant results, dysfunction of the uterine appendages is observed, specialists prescribe an operative method for removing the affected foci. In modern medicine, the following methods of surgical intervention are used in the treatment of endometriosis:

laparoscopy - a microsurgical operation in which the doctor makes a small puncture or incision, and the affected areas are cauterized with a laser or special power tools;
Laparotomy is a more serious operation in which the patient's abdominal wall is cut for the purpose of further surgical manipulations.

After removal of endometriotic lesions, drug treatment is usually prescribed to consolidate the result. Many doctors consider the combination of conservative and surgical techniques to be the most effective way treatment of endometriosis.

Hirudotherapy

As part of the complex therapy of endometriosis, such a not quite traditional method as hirudotherapy, or treatment with medicinal leeches, is also used. The effectiveness of this technique lies in the following factors:

leeches are placed on strictly defined points, which allows you to remove swelling and improve blood circulation in the pelvic organs;
the saliva of these annelids contains many useful substances that dissolve adhesions and prevent the formation of blood clots.

The therapeutic course usually consists of 10 procedures. If necessary, it is repeated after 2-3 months.

When to plan pregnancy after treatment

The planning time for conception depends on how the female body recovers after hormone therapy or surgery. However, experts advise not to delay pregnancy, since in some cases endometriosis may return. If, after the treatment, it is not possible to conceive, the woman passes comprehensive examination. Its goal is to exclude other likely factors of infertility.

How does pregnancy affect the disease

During the period of bearing a child, the hormonal background changes. The amount of estrogen decreases, and the concentration of progesterone, on the contrary, increases significantly. Progesterone not only helps maintain pregnancy, but also stops the growth of the endometrium.. Therefore, pregnancy with endometriosis can be said to be useful, it helps the body cope with the disease.

Possible negative consequences of the disease and therapy that helps to save the child

Yet some risks remain. During pregnancy, accompanied by endometriosis, the following complications are possible:

miscarriage in the early stages;
fetoplacental insufficiency;
low placentation (the fertilized egg is attached to the lower part of the uterus);
premature birth.

To avoid these side effects, treatment hormonal drugs containing progesterone continues.

Specific treatment, and even more so surgical intervention, endometriosis during pregnancy does not require.

Prevention

There are no special measures for the prevention of endometriosis, since the exact causes of this pathology have not yet been established. However, following simple rules will help a woman reduce, as far as possible, the likelihood of its occurrence or relapse. Among them:

regular visits to the gynecological or examination room;
obligatory observation by a specialist after abortive and other surgical interventions on the uterus;
timely treatment of acute and chronic diseases of the genital organs;
the use of oral hormonal contraceptives according to indications;
reducing the intensity of physical activity during menstruation (this will help prevent possible penetration of blood into the abdominal cavity);
a healthy lifestyle that includes bad habits, weight control, support for the normal functioning of the immune system.