Endometriosis, Miscarriage Risk, and Hope for Healing

endometriosis, endometriosis miscarriage, endometriosis miscarriage risk, endometriosis stillbirth

Last September, Chrissy Teigen shared the heart-breaking news of the loss of her son, Jack. In an Instagram post, she attempted to verbalize the indescribable pain that many women have experienced from the loss of their babies during pregnancy.  

Teigen’s pain was further expressed in a tweet last week when she opened up about her scheduled surgery for endometriosis the week that Jack was supposed to be born. While it is unknown whether Chrissy’s loss was related to her endometriosis, she has allowed for open dialogue within the media about the relationship between endometriosis and miscarriage, stillbirth, and other pregnancy complications.  

What is endometriosis, and what are its symptoms? 

Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows in areas outside of the uterus. This abnormal tissue growth can lead to cysts, scar tissue/adhesions, and inflammation within the body. While this disease has been known to occasionally show no symptoms at all, a common symptom of endometriosis is pain throughout the menstrual cycle. This pain is commonly reported  during menses (periods), ovulation, sex, or bowel movements. However, despite the fact that 1 in 10 women are known to have this devastating disease, treatment options are limited. Many girls and women presenting with symptoms of endometriosis are given hormonal birth control to override their cycles and mask their symptoms.  

Unfortunately, although some endometriosis symptoms may lessen on birth control, there is no guarantee that the disease isn’t still growing and manifesting itself in the body. In an article for the Endometriosis Foundation of America on the different forms of birth control often prescribed to women with endometriosis, Dr. Robert N. Taylor, M.D., Ph.D., professor of Reproductive Endocrinology and Infertility at the University of Utah Health says, “We don’t have evidence to prove we’re actually protecting their fertility, but theoretically, we like to think [birth control pills] could stop endometriosis from growing.” Dr. Taylor points to decreased menstrual bleeding as evidence that birth control is prohibiting endometrial lesions from growing and bleeding. 

Troublingly, a 2011 study from the journal Human Reproduction found that “a history of OC [oral contraceptive] use for severe primary dysmenorrhea is associated with surgical diagnosis of endometriosis, especially DIE [deep infiltrating endometriosis], later in life.” While the authors point out that “this does not necessarily mean that use of OC increases the risk of developing endometriosis,” they do suggest further studies to examine the relationship between the use of birth control, and the development of endometriosis [1].   

Whether birth control promotes or inhibits the growth of endometrial lesions, the synthetic hormones found in birth control frequently cause side effects that may be debilitating in their own right. Because of this tendency to prescribe birth control instead of finding and treating the root cause of menstrual pain, it takes an average of 8-10 years from the onset of symptoms for women with endometriosis to receive a diagnosis.  

The possible connection between endometriosis and miscarriage 

It is becoming more well-known that endometriosis is one of the leading causes of infertility. In fact, it is estimated that up to 50% of women with infertility will have endometriosis discovered at the time of surgery (although this does not necessarily mean that endometriosis is the cause of infertility in those cases) [2].  However, what is less discussed is the additional difficulty women with endometriosis face with sustaining a pregnancy once they’ve conceived. The American College of Obstetricians and Gynecologists (ACOG) defines miscarriage as the loss of pregnancy during the first trimester, or first 13 weeks of pregnancy. Several studies have shown that women with endometriosis are at a significantly higher risk of having a miscarriage compared to those without endometriosis [3-7]. One study claims that women with endometriosis are 80% more likely to have a miscarriage compared to those without endometriosis [5].  

Fertility awareness can help diagnose endometriosis faster 

While these statistics are quite unsettling, there is still hope for women who are suffering with endometriosis and want to get pregnant someday. As previously mentioned, many of the symptoms of endometriosis occur during particular phases of the menstrual cycle. Because of this, a woman who charts her cycle with a Fertility Awareness Method (FAM) is at a significant advantage when it comes to recognizing the correlation between certain symptoms and the phases of her cycle. This recognition could contribute to closing the gap of time between onset of endometriosis symptoms and diagnosis and treatment of the disease.  

Taking hormonal birth control, on the other hand, creates the illusion of regular cycles and reduced pain, eliminating the urgency of getting a true diagnosis—and all the while, the disease continues to ravage a woman’s reproductive system.  

How to get (and stay) pregnant with endometriosis 

Another advantage of FAM is that there is a growing number of doctors who are using women’s fertility charts to inform their patients’ treatment options. For example, the natural hormone progesterone plays a significant role in the menstrual cycle, and in supporting a pregnancy and preventing a miscarriage. Doctors who practice restorative reproductive medicine (RRM) can use your charts to test for the levels of various hormones during different phases of your menstrual cycle. Often, women suffering from menstrual difficulties are found to be deficient in progesterone, especially during the second half of their cycles. Using all of this information, doctors trained in RRM can craft a treatment plan  that supports the needs of your body. This is just one way that Fertility Awareness Methods, together with RRM, can reduce the risk of miscarriage (although there is no evidence yet that supplemental progesterone helps prevent miscarriage specifically in the context of endometriosis). 

While there is no cure for endometriosis, the current standard of treatment is laparoscopic excision surgery. Performed by a highly trained gynecologist who will remove the disease in all of its forms, this procedure leads to a significantly reduced risk of disease recurrence and an increased likelihood of reduced symptoms [8]. This also creates an environment in the body which will better support a future pregnancy. Doctors trained to identify endometriosis and remove the disease via excision (versus superficial treatment like ablation) are uniquely trained to prevent scar tissue from forming after the procedure—scar tissue that could be equally detrimental to a woman’s fertility. 

By charting their menstrual cycles, girls and women can have a fuller picture of their health and fertility. Encouraging girls to begin charting with their first period will equip them with the tools they need to advocate for their health should any reproductive issues or abnormalities arise throughout their lives. Early detection of symptoms could contribute to earlier diagnosis and treatment of endometriosis before it creates havoc on the body.  

Early diagnosis and treatment are key to decreasing the number of women suffering from endometriosis who may then experience the added devastation of miscarriage or stillbirth. Fertility awareness methods are an important part of a holistic view of woman’s health—one that sees fertility as a “fifth vital sign,” and supports a woman across the full spectrum of her fertility.

Learn more about Fertility Awareness Methods here. 

References

  1. Chapron, C., Souza, C., Borghese, B., Lafay-Pillet, M. C., Santulli, P., Bijaoui, G., Goffinet, F., & de Ziegler, D. (2011). Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis. Human reproduction (Oxford, England)26(8), 2028–2035. https://doi.org/10.1093/humrep/der156 
  2. Holoch, K. and Lessey, B. (2010). Endometriosis and Infertility. Clinical Obstetrics and Gynecology, 53(2), 429-438. doi: 10.1097/GRF.0b013e3181db7d71 
  3. Farland, L. V., Prescott, J., Sasamoto, N., Tobias, D. K., Gaskins, A. J., Stuart, J. J., Carusi, D. A., Chavarro, J. E., Horne, A. W., Rich-Edwards, J. W., & Missmer, S. A. (2019). Endometriosis and Risk of Adverse Pregnancy Outcomes. Obstetrics and gynecology, 134(3), 527–536. https://doi.org/10.1097/AOG.0000000000003410 
  4. Huang, Y., Zhao, X., Chen, Y., Wang, J., Zheng, W., & Cao, L. (2020). Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis. BioMed research international, 4381346. https://doi.org/10.1155/2020/4381346 
  5. Minebois, H., De Souza, A., Mezan de Malartic, C., Agopiantz, M., Guillet May, F., Morel, O., & Callec, R. (2017). Endométriose et fausse couche spontanée. Méta-analyse et revue systématique de la littérature [Endometriosis and miscarriage: Systematic review]. Gynecologie, obstetrique, fertilite & senologie, 45(7-8), 393–399. https://doi.org/10.1016/j.gofs.2017.06.003 
  6. Santulli, P., Marcellin, L., Menard, S., Thubert, T., Khoshnood, B., Gayet, V., Goffinet, F., Ancel, P.Y., Chapron, C. (2016). Increased rate of spontaneous miscarriages in endometriosis-affected women. Human Reproduction, 31(5), 1014–1023.  https://doi.org/10.1093/humrep/dew035 
  7. Zullo, F., Spagnolo, E., Saccone, G., Acunzo, M., Xodo, S., Ceccaroni, M., & Berghella, V. (2017). Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertility and sterility108(4), 667–672.e5. https://doi.org/10.1016/j.fertnstert.2017.07.019 
  8. Abbott J. (2003). The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Human Reproduction. 18(9), 1922-1927. https://doi.org/10.1093/humrep/deg275 

Additional Reading:

Learn more about Endometriosis

Managing Endometriosis Pain with Fertility Awareness

How I got help with endometriosis without the Pill

Learn More About NaProTechnology

How My Problems with Irregular Periods were Solved by FAMs (Not Birth Control)

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