The positive effect of pregnancy on ovarian endometriosis: reality or fiction?
It is generally believed that pregnancy positively affects endometriosis mainly due to suppression of ovulation and bleeding resulting from endometriotic lesions and various alterations associated with pregnancy. Pregnancy is usually recommended as a possible factor to reduce the progression of endometriosis for women with this condition. Nonetheless, endometriosis can develop differently and that there is no evidence that pregnancy can generally reduce the size and number of endometriotic lesions. Expansion of and structural changes in the lesions during pregnancy may be accompanied by decidualization. The results of studying the effect of pregnancy on endometriosis are controversial, whereas pregnancy in women with endometriosis is not always associated with improved symptoms. This paper highlights the progression of endometriosis during pregnancy and subsequent acute complications that require surgery in some cases. Therefore, women with endometriosis who want to get pregnant should not be convinced that pregnancy may be a possible strategy for managing symptoms and reducing disease progression.Dubrovina S.O., Berlim Yu.D., Gimbut V.S., Vovkochina M.A., Voronova O.V., Aleksandrina A.D.
Conclusion. The results of studying the effect of pregnancy on endometriosis are controversial, whereas pregnancy in women with endometriosis is not always associated with improved symptoms.
Keywords
endometriosis
endometrioid cyst
pregnancy
dydrogesterone
decidualization
References
- Sampson J.A. The life history of ovarian hematomas (hemorrhagic cysts) of endometrial (Müllerian) type. Am. J. Obstet. Gynecol. 1922; 4: 451-512.
- Sampson J.A. Benign and malignant endometrial implants in the peritoneal cavity, and their relation to certain ovarian tumors. Surg. Gynecol. Obstet. 1924; 38: 287-311.
- Meigs J.V. Endometrial hematomas of the ovary. Boston Med. Surg. J. 1922; 187: 1-13.
- Kistner R.W. Endometriosis and infertility. Clin. Obstet. Gynecol. 1959; 2: 877-89.
- Dunselman G.A.J., Vermeulen N., Becker C., Calhaz-Jorge C., D’Hooghe T., De Bie B. et al. ESHRE guideline: management of women with endometriosis. Hum. Reprod. 2014; 29(3): 400-12. https://dx.doi.org/10.1093/humrep/det457.
- Missmer S.A., Hankinson S.E., Spiegelman D., Barbieri R.L., Malspeis S., Willett W.C., Hunter D.J. Reproductive history and endometriosis among premenopausal women. Obstet. Gynecol. 2004; 104(5, Pt 1): 965-74. https://dx.doi.org/10.1097/01.AOG.0000142714.54857.f8.
- Passos F., Calhaz-Jorge C., Graxca L.M. Endometriosis is a possible risk factor for spontaneous hemoperitoneum in the third trimester of pregnancy. Fertil. Steril. 2008; 89(1): 251-2. https://dx.doi.org/10.1016/j.fertnstert.2007.02.009.
- Katorza E., Soriano D., Stockheim D., Mashiach R., Zolti M., Seidman D.S. et al. Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy. Am. J. Obstet. Gynecol. 2007; 197(5): 501. e1-4. https://dx.doi.org/10.1016/j.ajog.2007.04.030.
- Chiodo I., Somigliana E., Dousset B., Chapron C. Urohemoperitoneum during pregnancy with consequent fetal death in a patient with deep endometriosis. J. Minim. Invasive Gynecol. 2008; 15(2): 202-4. https://dx.doi.org/10.1016/j.jmig.2007.09.004.
- Denny E., Mann C.H. A clinical overview of endometriosis: a misunderstood disease. Br. J. Nurs. 2007; 16(18): 1112-6. https://dx.doi.org/10.12968/bjon.2007.16.18.27503.
- Ueda Y., Enomoto T., Miyatake T., Fujita M., Yamamoto R., Kanagawa T. et al. A retrospective analysis of ovarian endometriosis during pregnancy. Fertil. Steril. 2010; 94(1): 78-84. https://dx.doi.org/10.1016/j.fertnstert.2009.02.092.
- Pateman K., Moro F., Mavrelos D., Foo X., Hoo W.L., Jurkovic D. Natural history of ovarian endometrioma in pregnancy. BMC Womens Health. 2014; 14: 128. https://dx.doi.org/10.1186/1472-6874-14-128.
- Bailleux M., Bernard J.P., Benachi A., Deffieux X. Ovarian endometriosis during pregnancy: a series of 53 endometriomas. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 209: 100-4. https://dx.doi.org/10.1016/j.ejogrb.2015.09.037.
- Schmeler K.M., Mayo-Smith W.W., Peipert J.F., Weitzen S., Manuel M.D., Gordinier M.E. Adnexal masses in pregnancy: Surgery compared with observation. Obstet. Gynecol. 2005; 105(5, Pt 1): 1098-103. https://dx.doi.org/10.1097/01.AOG.0000157465.99639.e5.
- Barbara A.G., Pamela J.P., Wui-Jin K., Stephen H.P., James G.D., Benjamin E.G. Cancer in the pregnant patient. In: Principles and practice of gynecologic oncology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000: 501-28.
- Benaglia L., Somigliana E., Calzolari L., Busnelli A., Cardellicchio L., Ragni G., Fedele L. The vanishing endometrioma: the intriguing impact of pregnancy on small endometriotic ovarian cysts. Gynecol. Endocrinol. 2013; 29(9): 863-6. https://dx.doi.org/10.3109/09513590.2013.813476.
- Phupong V., Rungruxsirivorn T., Tantbirojn P., Triratanachat S., Vasuratna A. Infected endometrioma in pregnancy masquerading as acute appendicitis. Arch. Gynecol. Obstet. 2004; 269(3): 219-20. https://dx.doi.org/10.1007/s00404-003-0569-7.
- Sammour R.N., Leibovitz Z., Shapiro I., Degani S., Levitan Z., Aharoni A. et al. Decidualization of ovarian endometriosis during pregnancy mimicking malignancy. J. Ultrasound Med. 2005; 24(9): 1289-94. https://dx.doi.org/10.7863/jum.2005.24.9.1289.
- Bashir R.M., Montgomery E.A., Gupta P.K., Nauta R.M., Crockett S.A., Collea J.V., al-Kawas F.H. Massive gastrointestinal hemorrhage during pregnancy caused by ectopic decidua of the terminal ileum and colon. Am. J. Gastroenterol. 1995; 90(8): 1325-7.
- Maggiore U.L.R., Ferrero S., Mangili G., Bergamini A., Inversetti A., Giorgione V. et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum. Reprod. Update. 2016; 22(1): 70-103. https://dx.doi.org/0.1093/humupd/dmv045.
- Leeners B., Damaso F., Ochsenbein-Kölble N., Farquhar C. The effect of pregnancy on endometriosis – facts or fiction? Hum. Reprod. Update. 2018; 24(3): 290-9. https://dx.doi.org/10.1093/humupd/dmy004.
- Canlorbe G., Goubin-Versini I., Azria E., Abdul-Razak R., Muray J.M. Ectopic decidua: variability of presentation in pregnancy and differential diagnoses. Gynecol. Obstet. Fertil. 2012; 40(4): 235-40. https://dx.doi.org/10.1016/j.gyobfe.2012.02.008.
- Beavis A.L., Matsuo K., Grubbs B.H., Srivastava S.A., Truong C.M., Moffitt M.N. et al. Endometriosis in paraaortic lymph nodes during pregnancy: case report and review of literature. Fertil. Steril. 2011; 95(7): 2429. e9-13. https://dx.doi.org/10.1016/j.fertnstert.2011.01.157.
- Setúbal A., Sidiropoulou Z., Torgal M., Casal E., Lourenço C., Koninckx P. Bowel complications of deep endometriosis during pregnancy or in vitro fertilization. Fertil. Steril. 2014; 101(3): 442-6. https://dx.doi.org/10.1016/j.fertnstert.2018.05.009.
- Schweitzer K.J., van Bekkum E., de Groot C.J.M. Endometriosis with intestinal perforation in term pregnancy. Int. J. Gynaecol. Obstet. 2006; 93: 152-3.
- McArthur J.W., Ulfelder H. The effect of pregnancy upon endometriosis. Obstet. Gynecol. Surv. 1965; 20(5): 709-33. https://dx.doi.org/10.1097/00006254-196510000-00001.
- Schenken R.S., Williams R.F., Hodgen G.D. Effect of pregnancy on surgically induced endometriosis in cynomolgus monkeys. Am. J. Obstet. Gynecol. 1987; 157(6): 1392-6. https://dx.doi.org/10.1016/s0002-9378(87)80230-2.
- Clement P.B. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv. Anat. Pathol. 2007; 14(4): 241-60. https://dx.doi.org/10.1097/PAP.0b013e3180ca7d7b.
- Cohen J., Naoura I., Castela M., N’Guyen Von T., Oster M., Fontaine R. et al. Pregnancy affects morphology of induced endometriotic lesions in a mouse model through alteration of proliferation and angiogenesis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 183: 70-7. https://dx.doi.org/0.1016/j.ejogrb.2014.10.038.
- Barbieri M., Somigliana E., Oneda S., Ossola M.W., Acaia B., Fedele L. Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum. Reprod. 2009; 24(8): 1818-24. https://dx.doi.org/10.1093/humrep/dep089.
- Guerriero S., Ajossa S., Piras S., Parodo G., Melis G.B. Serial ultrasonographic evaluation of a decidualized endometrioma in pregnancy. Ultrasound Obstet. Gynecol. 2005; 26(3): 304-6. https://dx.doi.org/10.1002/uog.1986.
- Kobayashi F., Monma C., Nanbu K., Konishi I., Sagawa N., Mori T. Rapid growth of an ovarian clear cell carcinoma expressing LH/hCG receptor arising from endometriosis during early pregnancy. Gynecol. Oncol. 1996; 62(2): 309-13. https://dx.doi.org/10.1006/gyno.1996.0233.
- Sugiyama T., Nishida T., Kataoka A., Okura N., Iwanaga S., Yakushiji M. A pregnant woman with clear adenocarcinoma of the ovary arising from endometriosis and with benign and borderline adenofibroma of the clear and endometrioid types. Eur. J. Obstet. Gynecol. Reprod. Biol. 1997; 72(1): 47-50. https://dx.doi.org/10.1016/s0301-2115(96)02645-0.
- Makrydimas G., Sotiriadis A., Paraskevaidis E., Pavlidis N., Agnantis N., Lolis D. Clear cell ovarian carcinoma in a pregnant woman with a history of infertility, endometriosis and unsuccessful IVF treatment. Eur. J. Gynaecol. Oncol. 2003; 24(5): 438-41.
- Goh W., Bohrer J., Zalud I. Management of the adnexal mass in pregnancy. Curr. Opin. Obstet. Gynecol. 2014; 26(2): 49-53. https://dx.doi.org/10.1097/GCO.0000000000000048.
- Liang B., Wu L., Xu H., Cheung C.W., Fung W.Y., Wong S.W., Wang C.C. Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: a comparison study in mice. Reprod. Biol. Endocrinol. 2018; 16(1): 32. https://dx.doi.org/10.1186/s12958-018-0347-9.
- Оразов М.Р., Радзинский В.Е., Хамошина М.Б., Кавтеладзе Е.В., Шустова В.Б., Цораева Ю.Р., Новгинов Д.С. Бесплодие, ассоциированное с эндометриозом: от легенды к суровой реальности. Трудный пациент. 2019; 17(1-2): 6-12. [Orazov M.R., Radzinsky V.E., Khamoshina M.B., Kavteladze E.V., Shustova V.B., Tsoraeva Yu.R., Novginov D.S. Endometriosis-associated infertility: from myths to harsh reality. Difficult Patient/Trudnyi patsient. 2019; 17(1-2): 6-12. (in Russian)].
Received 26.05.2020
Accepted 28.05.2020
About the Authors
Svetlana O. Dubrovina, MD, professor, the main scientific researcher of Scientific Research Institute of Obstetric and Pediatric of Rostov State Medical University.Е-mail: s.dubrovina@gmail.com. 344022, Rostov-On-Don, per. Nakhichevansky, 29, Russia.
Yuliya D. Berlim, PhD, MD, the Head of Department of the out-patients¢ clinic of Rostov State Medical University. Tel.: +7(918)500-23-56. Е-mail: juliaberlim@yandex.ru.
344022, Rostov-On-Don, per. Nakhichevansky, 29, Russia.
Vitaliy S. Gimbut, PhD, MD, senior scientific researcher of Scientific Research Institute of Obstetrics and Pediatrics of Rostov State Medical University.
Tel.: +7(863)232-18-40. E-mail: vgimbut@gmail.com. 344022, Rostov-On-Don, per. Nakhichevansky, 29, Russia.
Marinа A. Vovkochina, gynecologist obstetrician of Scientific Research Institute of Obstetric and Pediatric of Rostov State Medical University.
Tel.: +7(918)559-00-30. E.-mail: Jordan-85@inbox.ru. 344022, Rostov-On-Don, per. Nakhichevansky, 29, Russia.
Olga V. Voronova, the leader of Department of clinical pathomorphology and cytology «Clinical hospital «Russian Railways-Medicine», Rostov-on-Don.
Tel.: +7(904)340-18-73. E.-mail: 9043401873@mail.ru. 344011, Rostov-on-Don, Varfolomeeva 92а, Russia.
Anna D. Alexandrina, gynecologist obstetrician of Rostov State Medical University. Tel.: +7(904)448-58-42. E.-mail: anna221215@inbox.ru.
344022, Rostov-On-Don, per. Nakhichevansky, 29, Russia.
For reference: Dubrovina S.O., Berlim Yu.D., Gimbut V.S., Vovkochina M.A., Voronova O.V., Aleksandrina A.D. The positive effect of pregnancy on ovarian endometriosis: reality or fiction?
Akusherstvo i Ginekologiya. 2020; 5: 174-80
https://dx.doi.org/10.18565/aig.2020.5.174-80
Similar Articles
