Endometriosis and Pregnancy

Endometriosis affects roughly 1 in 10 women of reproductive age, yet it remains one of the most misunderstood conditions when it comes to fertility and pregnancy. If you have endometriosis and you’re hoping to conceive, or you’re already pregnant, you probably have a lot of questions. Can you get pregnant naturally? Will your symptoms get worse? Is your baby at higher risk?

The good news is that most people with endometriosis go on to have healthy pregnancies and healthy babies. But the condition can make the road to pregnancy a little bumpier, and it’s worth understanding why. Here’s what current research says about endometriosis and pregnancy, from conception through the postpartum period.

What Is Endometriosis?

Endometriosis happens when tissue similar to the lining of the uterus grows outside of it. This tissue can show up on the ovaries, fallopian tubes, the outer surface of the uterus, the bladder, the bowel, or the tissue lining the pelvis.

Like the normal uterine lining, this tissue responds to your monthly hormone cycle. It thickens, breaks down, and bleeds along with your period. The problem is that it has no way to leave your body, since it isn’t inside the uterus. Over time, this can lead to inflammation, scar tissue, and cysts on the ovaries called endometriomas.

Symptoms vary widely from person to person. Some people have almost no symptoms at all, while others deal with severe pelvic pain, painful periods, pain during sex, and heavy bleeding. If you’re noticing new or worsening symptoms, it helps to know the first signs of endometriosis so you can bring them up with your doctor early, along with the red flags for endometriosis that often get dismissed as “normal” period pain.

Does Endometriosis Affect Fertility?

Yes, endometriosis can make it harder to get pregnant, though it doesn’t rule pregnancy out. Estimates suggest that about 30 to 40 percent of people with endometriosis experience some degree of infertility, compared with roughly 10 to 15 percent of the general population. That also means the majority of people with endometriosis, especially mild to moderate cases, conceive without any medical help at all.

Researchers still don’t fully understand every mechanism behind endometriosis-related infertility, but a few explanations come up again and again in the research:

• Egg development problems. Endometriosis may disrupt how follicles develop in the ovaries, which can affect egg quality and how well an egg matures before ovulation.
• Hormonal imbalances after ovulation. Some studies point to luteal phase defects, where the second half of the menstrual cycle doesn’t produce enough progesterone to support early pregnancy.
• Lower fertilization rates. Endometriosis has been linked to lower rates of successful fertilization, even with assisted reproduction like IVF.
• Abnormal embryo development. Some research suggests the condition may interfere with how an embryo develops in its earliest days.
• Physical distortion. In more advanced cases, scar tissue and adhesions can physically block the fallopian tubes or change the position of the ovaries, making it harder for an egg to travel and get fertilized.

Age plays a role too. Fertility naturally declines for everyone starting in the late 30s, and this decline can compound the effects of endometriosis. If you want a deeper look at how the condition interacts with fertility over time, this guide on whether endometriosis affects fertility walks through it in more detail.

According to the Pregnancy, Birth and Baby resource from the Australian Government, around 1 in 3 women with endometriosis experience difficulty getting pregnant, though many still conceive naturally. Similarly, Endometriosis UK notes that an estimated 60 to 70 percent of people with endometriosis are able to get pregnant spontaneously, without any fertility treatment.

If you’ve been trying to conceive for a year or more (or six months if you’re over 35) without success, it’s worth talking to your doctor about a referral to a fertility specialist. Treatment options range from surgery to remove endometriosis tissue and improve your chances of natural conception, to assisted reproductive technology like IUI or IVF for more complex cases.

Can Surgery Improve Your Chances of Getting Pregnant?

For people with mild to moderate endometriosis, laparoscopic surgery to remove endometrial tissue has been shown to improve natural pregnancy rates. This is a keyhole procedure performed under general anesthetic, where a surgeon uses a small camera and instruments to locate and remove or destroy the misplaced tissue.

For deep endometriosis, where the disease has grown into the bowel, bladder, or ureter, there’s much less research on whether surgery improves pregnancy outcomes, so this decision usually involves a more detailed conversation with a specialist.

It’s also worth knowing that endometriosis can return after surgery. Research shows that symptoms come back for close to half of patients within five years, which is one reason doctors often recommend trying to conceive within one to two years after the procedure, depending on severity, as Tommy’s fertility guidance explains.

Endometriosis and Pregnancy Complications

Once you are pregnant, most people with endometriosis go on to have completely healthy pregnancies. That said, research has identified a somewhat higher risk of certain complications, including:

• Miscarriage or early pregnancy loss
• Ectopic pregnancy, where the embryo implants outside the uterus
• Babies who are small for their gestational age
• Cesarean delivery
• Heavy bleeding, or hemorrhage
• Preterm birth, before 37 weeks
• Placenta problems, including a low-lying placenta known as placenta previa
• Hypertensive conditions of pregnancy, such as pre-eclampsia

A detailed review published in the Journal of Personalized Medicine, available through the National Library of Medicine, points out that although these risks are statistically elevated compared to pregnancies without endometriosis, the overall likelihood of a healthy pregnancy and delivery remains high for most people with the condition.

In rare cases, doctors have also documented more serious complications during pregnancy in people with endometriosis, including rupture of an ovarian endometrioma, appendicitis, bowel perforation, and bleeding into the abdominal cavity. These events are uncommon, and many obstetricians aren’t highly familiar with them simply because they haven’t been studied in large numbers. This is part of why researchers are calling for more focused study of endometriosis throughout pregnancy and the postpartum period, not just at the point of conception.

Currently, there’s no official guideline recommending extra monitoring for every pregnant person with a history of endometriosis. Most people follow standard prenatal care. However, if you have a history of severe endometriosis, deep infiltrating disease, or ovarian endometriomas, it’s worth discussing with your obstetrician whether additional monitoring makes sense for your specific situation.

Does Pregnancy Help or Hurt Endometriosis Symptoms?

Many people notice their endometriosis symptoms ease up during pregnancy. This is largely thanks to hormonal shifts, particularly sustained high progesterone, which can suppress the growth and activity of endometrial tissue. Some people report feeling close to symptom-free for the first time in years while pregnant.

That said, this isn’t universal. Some people continue to experience pelvic pain throughout pregnancy, and a few even report their pain getting worse in the early months before it settles down. Pregnancy does not cure endometriosis, and there is currently no cure for the condition at all. Symptoms typically return once your period comes back after birth, whether that’s a few weeks postpartum if you’re not breastfeeding, or several months later if you are.

If you’re wondering how long endometriosis symptoms might stick around or whether they ever fully go away with age, this breakdown of when endometriosis tends to ease up covers what research says about menopause and symptom changes over the long term.

Treating Endometriosis Pain During Pregnancy

Many of the standard hormonal treatments for endometriosis, including birth control pills, hormonal IUDs, and contraceptive implants, aren’t options during pregnancy since they work by preventing or altering ovulation. You’ll need to come off these before trying to conceive, whether naturally or through fertility treatment.

Pain relief options are also more limited while pregnant, since many common medications aren’t considered safe for the baby. Always check with your doctor, midwife, or pharmacist before taking anything for pain, even over-the-counter options. Some people find relief through:

• Physiotherapy, particularly pelvic floor physiotherapy
• Talk therapies like counseling or mindfulness-based approaches
• Acupuncture
• Dietary adjustments

On that last point, some people explore anti-inflammatory eating patterns or intermittent fasting to help manage inflammation-related symptoms. It’s important to set realistic expectations here: there’s no strong evidence that any diet or fasting protocol eliminates endometriosis, since the condition isn’t caused by diet alone. Still, many people report meaningful symptom relief from eating patterns that reduce inflammation, and it’s a subject worth researching if you want a non-hormonal way to support your body. This piece on whether fasting can help with endometriosis digs into what the evidence actually shows.

If you want a structured, done-for-you approach to eating for endometriosis, my 4 Week Endometriosis Diet Plan lays out a simple, day-by-day plan built around anti-inflammatory foods, without requiring you to become a nutrition expert first. You can check it out here: 4 Week Endometriosis Diet Plan.

Giving Birth With Endometriosis

Having endometriosis makes a cesarean section somewhat more likely, but it absolutely does not mean you’ll need one. Most people with endometriosis can still plan for, and have, a vaginal birth unless there’s a separate medical reason for a cesarean.

Your care team will look at your full medical history, keep a close eye on your pregnancy, and talk with you about your options as your due date approaches. This is typically a shared decision between you and your provider, factoring in the location and severity of your endometriosis, rather than a one-size-fits-all rule.

Life After Birth: Postpartum Recovery With Endometriosis

The postpartum period brings major hormonal shifts, and if you have endometriosis, it helps to know what’s coming.

Right after birth, estrogen and progesterone levels drop sharply. Your period may return within a few weeks if you’re not breastfeeding, or it may be delayed for several months if you are. Breastfeeding itself changes your hormone levels in ways that can suppress endometriosis activity for some people, which may mean a longer stretch of symptom relief. That relief tends to fade once periods resume, though the timeline is different for everyone.

Once your body starts returning to its regular cycle, it’s a good time to revisit your long-term management plan with your doctor. That might include:

• Hormonal contraception
• Progestin-based therapies
• A pain management plan tailored to your day-to-day life with a newborn
• Pelvic floor physiotherapy
• A conversation about surgery, if your symptoms are significant

If you’re hoping to have another baby down the road, it’s worth discussing timing with your doctor or gynecologist while your current pregnancy and recovery are still fresh in your chart.

Mental Health, Endometriosis, and New Parenthood

Living with endometriosis is physically and emotionally demanding, especially if you’ve struggled to conceive or had a difficult pregnancy. Combine that with the normal emotional ups and downs after birth, and it’s common to feel anxious, low, or overwhelmed on top of managing pain.

You don’t have to carry this alone. Support can come from your partner, family, friends, your GP, a child health nurse, a therapist, or a dedicated endometriosis support group. If pain is making it hard to care for your baby, or if low mood or anxiety is sticking around, reach out to your doctor. Looking after your mental health is just as much a part of recovery as managing physical symptoms.

The Bottom Line

Endometriosis adds real complexity to the path to pregnancy, from conception through delivery and beyond. It can make getting pregnant take longer, and it’s linked to a modestly higher risk of certain complications. But it does not stop most people from having healthy pregnancies and healthy babies.

Because so much about how endometriosis affects pregnancy is still being studied, the most important thing you can do is build a care team you trust and stay proactive about your symptoms. If something feels off, whether that’s new pain, unusual bleeding, or symptoms that don’t match what your doctor described, speak up. And if you’re looking for a practical, food-based way to support your body while you manage endometriosis, my 4 Week Endometriosis Diet Plan is designed to be an easy starting point alongside your medical care, not a replacement for it.