HORMONES

CAN ENDOMETRIOSIS CAUSE A MISCARRIAGE AND OTHER FREQUENTLY ASKED QUESTIONS

March 04, 2024

Quick Answer

Yes, but the increase is smaller than many sources claim. Research links endometriosis to roughly 13 to 37 percent higher odds of a single miscarriage compared to women without the condition, and more than double the odds of recurrent pregnancy loss (three or more losses in a row). If you conceive through IVF, that risk gap mostly disappears.

Key Takeaways

Endometriosis is linked to roughly 13 to 37 percent higher odds of a single miscarriage, and more than double the odds of recurrent pregnancy loss
The increased risk shows up mainly with natural conception. IVF and other fertility treatments largely close that gap
Mild endometriosis has been linked to a higher miscarriage rate than severe disease in at least one study, which surprises most people
The leading theory is that endometriosis disrupts progesterone signaling and creates inflammation that makes it harder for a pregnancy to implant and stay implanted
Major guidelines do not recommend extra pregnancy monitoring just because you have endometriosis
Know the red flags that mean it’s time to call your OB/GYN

If you have endometriosis and you’re thinking about pregnancy, or you’ve already had a miscarriage and you’re wondering if endometriosis played a role, I want to give you a straight answer backed by real research. Below, I’ll walk through what the evidence actually shows about miscarriage risk, why it may happen, what changes with fertility treatment, and what to watch for if you’re pregnant now.

What Is Endometriosis?

Endometriosis happens when tissue similar to the lining of the uterus grows outside of it, often on the ovaries, fallopian tubes, or pelvic lining. I’ve written a full guide covering symptoms, the four stages, and treatment options if you want the complete picture. This page focuses specifically on what the current research says about miscarriage risk, since for many women planning a pregnancy, that’s the more urgent question.

Does Endometriosis Increase Miscarriage Risk?

Yes, though the size of the increase is smaller and more nuanced than a lot of what circulates online.

The best current evidence comes from a nationwide Danish cohort study that followed nearly 30,000 women with endometriosis and almost 300,000 women without it. After adjusting for other factors, women with endometriosis had 13 to 37 percent higher odds of experiencing at least one pregnancy loss. For recurrent pregnancy loss, defined as three or more losses in a row, the odds were more than double.

A separate meta-analysis pooling data from 39 studies and nearly 700,000 women found a similar pattern when it broke the numbers down by how conception happened. Women who conceived naturally with endometriosis had about 81 percent higher odds of miscarriage compared to women without the condition. Women who conceived through IVF or another assisted reproductive technology showed no significant difference in miscarriage risk at all. I’ll cover why in the next section.

I want to be direct about one thing. You may have seen figures online claiming endometriosis raises miscarriage risk by 77 percent, or drops it to 67 percent without an infertility diagnosis. I looked for the original study behind those numbers and couldn’t find one. I’d rather give you numbers I can actually trace back to a real study than repeat a statistic that sounds precise but isn’t verifiable.

Why Might Endometriosis Raise the Risk?

The honest answer is that researchers don’t have one single confirmed mechanism, but a few explanations have the most support in the current literature.

Endometriosis is linked to progesterone resistance, meaning the uterine lining doesn’t respond normally to progesterone, the hormone that prepares your body to support early pregnancy. Inflammatory signals from endometriosis can suppress the receptors that progesterone needs to do its job. Without normal progesterone signaling, the lining may not develop the way it needs to for an embryo to implant and stay implanted.

Endometriosis is also associated with chronic inflammation in the pelvis. That inflammation can change the uterine environment in ways that make it harder for a pregnancy to establish itself, even before you’d know you were pregnant.

None of this means endometriosis makes pregnancy impossible or even unlikely. It means the same underlying hormonal imbalance and inflammatory changes that cause your symptoms in the first place, the pain, the heavy periods, are part of the same picture as the modest increase in miscarriage risk.

Does It Matter If Your Endometriosis Is Mild or Severe?

You might expect that more severe endometriosis means a higher miscarriage risk, but the research on this is genuinely surprising.

One study comparing 268 women found that those with mild endometriosis (stage I or II) had a higher miscarriage rate, 42 percent, than those with severe endometriosis (stage III or IV), who had a 31 percent rate. Both were higher than the 22 percent rate in women without endometriosis at all.

Researchers aren’t entirely sure why. One theory is that mild endometriosis is more often driven by active inflammation, while severe endometriosis involves more scar tissue and less active inflammatory signaling. If that’s correct, it fits with the progesterone resistance and inflammation mechanisms above.

Here’s what this means for you. Your stage of endometriosis on its own doesn’t predict your miscarriage risk in a straightforward way. Talk to your OB/GYN about your specific history rather than assuming milder disease means lower risk.

What About IVF and Fertility Treatments?

If you’re going through IVF or considering it, and you’re also noticing other signs of infertility, this is likely the most important section for you.

The data is genuinely reassuring here. A meta-analysis of 40 studies covering nearly 9,000 women with endometriosis found no significant difference in live birth rate or clinical pregnancy rate compared to women without endometriosis going through the same treatments. The one difference researchers did find was a somewhat lower implantation rate, meaning embryos may take slightly longer or need more attempts to implant successfully. Once a pregnancy is established, though, the miscarriage risk looks similar to anyone else going through fertility treatment.

This tracks with the earlier point about conception method. The elevated miscarriage risk associated with endometriosis shows up most clearly in spontaneous, unassisted conception. When conception happens through IVF, that gap largely closes.

Complication	Increased Odds	What This Means
Preterm birth	About 63% higher odds	Higher chance of delivering before 37 weeks
Placenta previa	About 3 times higher odds	Placenta covers the cervix, usually caught on ultrasound and managed with monitoring or a planned delivery
Cesarean delivery	About 57% higher odds	More likely to need or choose a C-section

When to Talk to Your OB/GYN

Here’s what I want you to know before anything else. Most major guidelines, including the European Society of Human Reproduction and Embryology’s, state that having endometriosis does not automatically mean you need extra monitoring during pregnancy or that you should worry about carrying a pregnancy to term. The complications above are real, but they remain uncommon. It’s still worth mentioning your endometriosis history at your first prenatal care visit so it’s part of your chart from the start.

Call your OB/GYN promptly if you notice any of these.

Heavy vaginal bleeding that soaks through a pad in an hour or less
Severe one-sided pelvic pain, especially early in pregnancy. This can, though rarely, signal an ectopic pregnancy. The evidence on whether endometriosis itself raises ectopic pregnancy risk is mixed, so this symptom is worth calling about regardless of your endometriosis history
Cramping or pain that feels different or more severe than your usual endometriosis pain
An endometrioma, an endometriosis-related ovarian cyst, found on an ultrasound during pregnancy that looks unusual. This should prompt a referral to a specialist familiar with endometriosis in pregnancy

One more thing I want to be clear about. Pregnancy is not a treatment for endometriosis. Symptoms sometimes ease temporarily during pregnancy because of hormonal changes, but there’s no reliable evidence that pregnancy cures or permanently improves the condition.

Frequently Asked Questions

Does endometriosis increase the risk of ectopic pregnancy?

The evidence is mixed. The European Society of Human Reproduction and Embryology notes there may be a slightly increased risk, but the largest meta-analysis on the topic, covering nearly 700,000 women, found no statistically significant association. Because ectopic pregnancy is a medical emergency regardless of the cause, any woman experiencing sharp one-sided pelvic pain with bleeding early in pregnancy should be evaluated right away, endometriosis history or not.

Does having a baby cure or improve endometriosis?

No. This is a common myth. Pregnancy can temporarily ease some symptoms because of hormonal changes, but current guidelines specifically caution against recommending pregnancy as a treatment for endometriosis. Symptoms typically return once your cycle resumes after delivery.

Does having surgery for endometriosis before pregnancy lower miscarriage risk?

There isn’t enough evidence yet to say for certain. Some research has looked at excision surgery and pregnancy outcomes, but the findings are inconsistent, and no large study has clearly shown that surgery reduces miscarriage risk specifically. If you’re considering surgery before trying to conceive, that decision should weigh your symptoms and fertility goals with your OB/GYN, not a promise of a lower miscarriage risk.

Does endometriosis cause acne?

Not directly, but the hormonal shifts that come with endometriosis, particularly fluctuations in estrogen, can contribute to breakouts by increasing oil production in the skin. If you’re dealing with persistent acne alongside other endometriosis symptoms, it’s worth mentioning to your OB/GYN or a dermatologist, since treating the underlying hormonal picture often helps more than treating the skin alone.

Can I still get pregnant naturally with endometriosis?

Yes. Most women with endometriosis, even moderate to severe cases, are able to conceive, though it may take longer for some. Endometriosis is associated with a real but modest increase in infertility and miscarriage risk, not an inability to get pregnant. If you’ve been trying for six months to a year without success, or sooner if you’re over 35 or have known moderate to severe endometriosis, talk to your OB/GYN about your options. In the meantime, here are some tips for reducing stress while trying to conceive.

If you’re navigating endometriosis while trying to conceive, or recovering from a loss, I want you to hold onto this. The research shows a real but modest increase in risk, not a guarantee of loss, and treatment options exist that can improve your odds further. Give yourself a little bit of time, a little bit of grace, and lean on your OB/GYN as a partner in the process, not just someone you see once something goes wrong.

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