A new study has concluded that women with endometriosis have an increased risk of miscarriage and ectopic pregnancy. Women with endometriosis were also found to have an above average risk of pregnancy complications, such as preterm birth and haemorrhage.
The researchers analysed discharge data from hospitals across Scotland. A total of 14,655 women were included in the research. Of these, 5,375 had been previously diagnosed with endometriosis.
The results were adjusted to take into account age and previous pregnancies, and then this information was processed to determine whether endometriosis increased the risks during pregnancy.
The study found that women with endometriosis had a 76 percent increased of miscarriage and were almost three times as likely to suffer an ectopic pregnancy. The risk of ectopic pregnancy increased from 0.6 to 1.6 percent.
The study also found that women with endometriosis had an increased risk of preterm birth and ante and postpartum haemorrhage. Women with endometriosis were also found to be more likely to have a c-section.
Endometriosis Findings Are Nothing New
Reproductive and Women's Health specialist, Dr Andrew Orr is not surprised by the results, and says the findings are unfortunately nothing new.
“My motto has always been ‘period pain is not normal.' Endometriosis is one of the first conditions I investigate. But women do need to know that endometriosis doesn’t always present as pain. It's now estimated that over 50% of women will have endometriosis, and a significant portion of the women who have endometriosis (diagnosed and undiagnosed), are asymptomatic (no symptoms). So, many women don’t even realise they have the disease.”
What Is Endometriosis?
Endometriosis is a condition that causes tissue that acts like the lining of the womb to end up in other parts of the body. For some women, this tissue ends up on the ovaries, pelvis or vagina, though it can appear anywhere in the body. This build up of tissue has no way of leaving the body, and can cause inflammation and pain, as well as structural and functional changes to the uterine lining.
“Endometriosis is an inflammatory disease, believed to be caused by estrogenic factors. Any inflammation in the pelvic cavity will also lead to increased complications around implantation, preterm delivery and postpartum complications. Increased inflammation also increases the likelihood on increased natural killer cells, which is now known as a major cause of miscarriage.
Endometriosis is thought to affect around one in 10 women. Most of the studies into this condition have looked at its effect on fertility, and so the impact endometriosis has during pregnancy is relatively unknown. The study’s authors hope that the results will be used to improve medical care of pregnant women with endometriosis. It is hoped that increased monitoring and a better understanding of the condition may be able to improve outcomes.
Diagnosing and Treating Endometriosis
One of the most important things to understand about endometriosis is that scans, blood tests and other imaging, will not diagnose endometriosis.
Doctor Orr says that the only way to properly diagnose endometriosis is via a laparoscopy, which is the gold standard investigation for investigating diseases that could affect a woman’s reproductive function.
He says: “So many clinicians overlook endometriosis, and lack the necessary knowledge to see the signs and symptoms of this disease. This is why it's often 12 years from the initial onset of symptoms to a proper diagnosis. It can be hard to diagnose, because it often overlaps with other inflammatory conditions such as irritable bowel syndrome… but there are signs that do point to it. Endometriosis evaluation and investigation should always be a priority for any women experiencing infertility, miscarriage, period pain and other symptoms that many be hindering a pregnancy.”
Doctor Orr ensures all couples are evaluated and investigated properly, and every woman he sees with long term fertility issues is investigated via a laparoscopy, before any interventions such as IVF or Assisted Reproductive Therapy (ART).
The results of the study are due to be presented at the annual meeting of the European Society of Human Reproduction and Embryology this week.