Endometriosis After Pregnancy: Recurrence and Coping

Some individuals find that their endometriosis symptoms resolve during pregnancy and breastfeeding due to a shift in hormones. These symptoms often return after pregnancy, however.

This article will explore how endometriosis affects individuals after pregnancy, including when symptoms are most likely to recur, how to manage postpartum endometriosis, and potential treatment options.

When Does Endometriosis Return After Pregnancy?

Endometriosis symptoms may temporarily improve during pregnancy and while breastfeeding. During pregnancy, ovulation is inhibited, so the hormonal changes that cause endometriosis don't occur.

Similarly, the hormonal changes that allow for breastfeeding can also inhibit ovulation. Symptoms often return once hormone levels return to pre-pregnancy levels and menstrual cycles resume.

The condition occurs when endometrial tissue grows outside of the uterus. During a typical menstrual cycle, the endometrial lining of the uterus responds to hormonal signals, which causes the tissue to shed and bleed.

However, when endometrial tissue grows outside of the uterus, the extra tissue has nowhere to go. This can cause pelvic pain, cramping, a sensation of fullness or pressure in the abdomen, and changes in bowel and bladder function.

During pregnancy and breastfeeding, hormone levels shift, and menstrual cycles usually stop. Without the hormonal signals to grow and shed endometrial tissue, endometriosis symptoms are often reduced.

Menstruation typically begins between six to eight weeks after giving birth in individuals who aren't breastfeeding. Exclusive breastfeeding (the baby receives only breast milk) can delay the return of menstruation, and some individuals do not get their periods until they stop breastfeeding.

Others find that their periods return sooner, often when they start introducing supplemental feedings in addition to breastmilk.

As a result, pregnancy and breastfeeding may only serve as temporary relief from endometriosis.

Misconceptions About Pregnancy and Endo

Unfortunately, pregnancy and lactation cannot cure endometriosis.

While symptoms may improve during pregnancy and breastfeeding, it's not universally true. Some individuals experience fewer symptoms during this period, while others do not see a change in their endometriosis. A few even see worsening symptoms.

Endometriosis may also increase the risk of pregnancy complications, including placenta previa (a low-lying placenta that blocks the cervix). However, many individuals who become pregnant while diagnosed with endometriosis will go on to have a normal pregnancy and delivery.

Breastfeeding May Reduce Symptoms Longer

Breastfeeding may help reduce endometriosis symptoms. Endometriosis is related to estrogen levels, and breastfeeding lowers estrogen levels. As a result, breastfeeding individuals may experience fewer endometriosis symptoms while exclusively breastfeeding.

Effect of Endometriosis on Future Pregnancies

Endometriosis may make it more difficult to get pregnant and stay pregnant. It is associated with an increased risk of pregnancy complications, but these are rare and should not be a reason to avoid pregnancy if you have endometriosis.

The research on whether pregnancy and lactation affect the recurrence of endometriosis is sparse. The few available studies are small, older, or look at records from databases created for other studies. No definitive answers can be drawn from this research.

Coping With Endometriosis As a New Parent

It can be difficult to manage the pain and symptoms associated with endometriosis while juggling new parenthood.

If you have recently given birth and are dealing with endometriosis, it's especially important to rest when you can, eat a healthy diet, and engage in gentle exercise as directed by a healthcare provider.

It can also be helpful to discuss your symptoms with a healthcare provider, partner, friend, or local support group.

If you have concerns about your symptoms or questions about planning future pregnancies, it's best to speak to a healthcare provider as soon as possible. Treatment options are available that can reduce symptoms or improve the chances of getting pregnant again.

Non-Drug Treatments

Research is still emerging regarding non-medical treatments for endometriosis.

Some individuals find relief by:

• Eating a healthy diet high in vegetables, flaxseed, and omega-3 fatty acids
• Exercising regularly
• Sitting in a sitz bath or taking a warm bath

Other alternative and complementary therapies, including acupuncture, may help reduce period-related pain, although the research is unclear. To ensure safety, it's best to speak with a healthcare provider before trying complementary therapies.

Medical Treatments

The main medical treatment options for endometriosis include:

• Prescription pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs): Pain medications may include opioids or NSAIDs such as Advil (ibuprofen) and Aleve (naproxen). There is a risk of addiction to opioid pain medications, and long-term use of these medications may not be appropriate for everyone.
• Hormone therapies: Hormone therapies, including hormonal birth control, change hormone levels involved in menstruation, and some birth control may stop periods altogether. While many forms of birth control are safe for long-term use, some may cause unwanted side effects. Some research also suggests that endometriosis symptoms recur in 50% of individuals after two years of treatment. They are also not appropriate if you are trying to get pregnant.
• Laparoscopic surgery: This technique uses small abdominal incisions, a camera, and surgical instruments to evaluate and remove extra endometrial tissue from inside the abdominal cavity. Unfortunately, the tissue often regrows in 40% to 50% of those treated within five years.
• Hysterectomy: Complete removal of the uterus and other reproductive organs may improve symptoms, but it is not an option for those who wish to get pregnant.

Summary

Endometriosis is a chronic condition, and researchers are still unclear about how and why the disease progresses. However, pregnancy and breastfeeding appear to reduce symptoms in many individuals, and some people may experience long-term resolution in their pain and heavy bleeding after pregnancy.

However, the disease follows a unique path in every individual, and it's impossible to know what will occur in any given person.