Is It Hard to Get Pregnant with Endometriosis?

Reviewed on 4/4/2022

Pregnant women sitting on floor together in prenatal class
Most women who have mild endometriosis are not infertile, but people who have more severe endometriosis may have more difficulty conceiving.

Endometriosis is a common condition in which tissue similar to the lining of the uterus grows outside the womb, causing pelvic pain and fertility problems.

Though endometriosis can affect fertility, most women who have mild endometriosis are not infertile.

  • It may be a little harder to get pregnant with endometriosis, but about 70% of women with mild to moderate endometriosis are able to conceive naturally.
  • People who have more severe endometriosis may have more difficulty conceiving, but even with severe endometriosis, conception without fertility treatment is possible.

Treatments for infertility related to endometriosis include:

What Are Symptoms of Endometriosis?

While infertility can be a symptom of endometriosis, the condition does not always cause symptoms. When symptoms do occur, symptoms of endometriosis may include: 

  • Pelvic pain
    • Can be severe and disabling in some cases
    • Tends to occur just before or during menstrual periods
    • May occur between menstrual periods and worsen during a period
    • Periods may worsen over time
    • May occur with bowel movements or while urinating, especially during a period
    • May occur during or after sex
    • May also occur in the lower back or in the abdomen
  • Heavy menstrual bleeding
  • Irregular bleeding/spotting between periods
  • Constipation
  • Ovarian cysts called endometriomas (cysts containing endometriosis tissue)
    • Sometimes referred to as “chocolate cysts” because they are usually filled with old blood resembling chocolate syrup 
    • They are benign (not cancerous) but can cause pelvic pain

How Is Endometriosis Diagnosed?

There is no one simple test to diagnose endometriosis, and it can be difficult to diagnose. A complicating factor is that many women are brought up to believe their pain symptoms are normal, and birth control hormones or pregnancy can temporarily relieve symptoms even without a diagnosis.  

The only way to definitively diagnose endometriosis is with an invasive laparoscopic procedure and a biopsy of the tissue. This procedure may also be used to remove endometriosis at the same time. 

Endometriomas (ovarian cysts containing endometriosis tissue) may be seen with ultrasound

A common problem among patients with endometriosis is having a healthcare provider take the pain seriously so it is important for women to find a doctor experienced in treating endometriosis.


Pelvic Pain: What's Causing Your Pelvic Pain? See Slideshow

What Is the Treatment for Endometriosis?

Endometriosis symptoms usually go away when a woman goes through menopause.

Medications used to treat endometriosis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Hormonal birth control
  • Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists 
  • Aromatase inhibitors 

Surgery for endometriosis is used both to diagnose endometriosis and also to remove it. It may be performed before medications are tried since it’s used diagnostically. It may also be considered if medications do not work to relieve pain. 

  • Endometriosis surgery is often done laparoscopically, and the goal is to remove endometriosis and scar tissue.
  • It is not a permanent cure and endometriosis tissue frequently grows back and pain returns without post-surgical treatment such as hormonal birth control
  • Surgery for endometrioma (ovarian cysts containing endometriosis tissue) is usually only done if the cyst is larger than 4 to 5 cm, symptomatic, or growing
  • Removal of the uterus (hysterectomy), ovaries (oophorectomy), or ovaries and fallopian tubes (salpingo-oophorectomy) is the only potential cure for endometriosis and may be recommended for patients who:
    • Have tried other treatments and still have severe symptoms
    • Do not wish to become pregnant in the future
    • Want a permanent treatment 

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Reviewed on 4/4/2022
Image Source: iStock Images