Pregnancy & Endometriosis

Written by Dr. Casey Schlottman, PT, DPT, PCES

Pelvic Floor Physical Therapist | Dry Needling Certified | Perinatal Exercise Specialist

Published: July 2026

What No One Talks About

For many women with endometriosis, a positive pregnancy test feels like more than just exciting news. It
can feel like a miracle. After years of pain, uncertainty, fertility concerns, surgeries, and feeling dismissed, pregnancy often brings a mix of joy, relief, fear, and a whole new set of questions. How will I feel throughout pregnancy after living in chronic pain all these years? Will I carry my baby to term? Will this help my endometriosis symptoms?

While pregnancy can improve some symptoms, it doesn’t magically erase your history or the impact endometriosis has had on your body and mind. Plus, you may be feeling some common pregnancy symptoms even more than the average woman. Let’s talk about it.

The Emotional Side of Pregnancy & Endometriosis

Pregnancy after infertility or uncertainty can feel different.

● Difficulty trusting your body
● Fear of loss or complications
● Anxiety between appointments
● Feeling guilty for not enjoying every moment

*Women with endometriosis who conceived spontaneously had an 81% higher odds of miscarriage compared with women without endometriosis (Huang et al., 2020).

Many women with endometriosis are familiar with this statistic, unfortunately. I don’t add this to scare you; I add this to inform you and let you know your uncertainty is valid.

Give yourself permission to feel everything.

● Gratitude and anxiety can coexist
● Excitement and fear can coexist
● There is no “right” way to experience pregnancy

Although the uncertainty can be overwhelming, remind yourself that you are a strong woman who was MADE to do this

Will My Endometriosis Symptoms Go Away During Pregnancy?

The answer is: Maybe. But pregnancy is not a CURE for endometriosis.

Some women experience:
● Reduced pelvic pain
● Fewer painful flare-ups due to not having a period while pregnant
● Less inflammation-related discomfort

Others may still experience:
● Pelvic pain
● Round ligament discomfort
● Scar tissue restrictions
● Hip, back, rib, or abdominal pain
● Some patients with adenomyosis and/or endometriosis may feel more pain while the uterus is
stretching and making room for the baby to grow

 Symptom relief is one thing, while symptom resolution is another. Endometriosis is endometrial-like
tissue that grows outside of the uterus. This tissue that grows in some women will not spontaneously
resolve with pregnancy. The gold standard for the reduction of endometriosis tissue is excision surgery
performed by an expert endometriosis surgeon.

However, with relatively stable hormone levels that are no longer fluctuating with a regular menstrual cycle during pregnancy, endometriosis symptoms sometimes improve while pregnant.

Why Pregnancy Can Feel Different in an Endometriosis Body

Previous surgeries
● Abdominal scars
● Laparoscopic incisions

Adhesions and tissue restrictions

● Changes in the mobility of surrounding tissues
● Potential impact on comfort as your baby grows
● Nervous system sensitization
● Living with chronic pain changes how the body processes sensation
● Normal pregnancy sensations may feel more intense

Common Symptoms Women Ask Me About

Pelvic pressure
Hip pain
Rib pain
Low back pain
Pain with position changes
Bladder urgency and frequency
Constipation
Abdominal Pain

Any of these symptoms warrants a referral to a pelvic floor PT to ensure your body is functioning well as a whole in preparation to progress through pregnancy and eventually endure labor and delivery.

Clinical Pearl: The relationship between endometriosis and hypermobility syndromes (particularly hypermobile Ehlers-Danlos syndrome [hEDS] and Hypermobility Spectrum Disorder [HSD]) is an area of growing research interest. While we still don’t have definitive prevalence statistics, several studies suggest there is a meaningful overlap.

What we do know:
● Endometriosis affects approximately 10% of reproductive-aged women in the general
population
● Studies in women with hEDS suggest that 6-23% have a diagnosis of endometriosis, although
findings vary significantly between studies.

● A recent cross-sectional study identified joint hypermobility as being more common in women
with endometriosis, though exact prevalence estimates remain uncertain and vary based on the
diagnostic criteria used for hypermobility (Ghazal et al., 2016).

What could this mean?
Women with endometriosis and hypermobility may be at risk for joint pain, pelvic organ prolapse, pelvic pressure, and more if not addressed early in pregnancy. So, if you are a patient experiencing these symptoms or a provider who has a patient experiencing these symptoms, don’t wait. Refer them to pelvic floor PT early before symptoms worsen.

How Pelvic Floor Physical Therapy Can Help

• Optimize breathing mechanics
• Improve pelvic floor mobility
• Address scar tissue restrictions
• Improve core and pressure management
• Prepare for labor and delivery
• Reduce fear surrounding movement and exercise

Pelvic Floor PT Exercise During Pregnancy with Endometriosis

Focus on:
● Walking
● Strength training
● Mobility
● Breathing work
● Pelvic floor relaxation Most importantly, a one-on-one approach to ensure all concerns are addressed properly, and you feel the best you possibly can during your pregnancy and into postpartum.

Avoid the “all or nothing” mindset.

Some movement is almost always better than none.

Labor and Delivery Considerations

Topics to discuss with your provider:
● Previous excision surgery
● What structures may have been removed during excision surgery (uterosacral ligaments, broad
ligaments, round ligaments, etc)
● History of pelvic pain
● Birth preferences
● Pelvic floor preparation
● Recovery planning

TIP! Always ask your excision surgeon for a surgical report that you can share with your providers. This helps your OBGYN, midwife, doula, and pelvic floor PT know what structures were most affected by endometriosis and how to best proceed with your care.

What I Wish Every Woman with Endometriosis Knew

Your diagnosis does not define your pregnancy.

Your body is not broken.

You were made to do this, regardless of any other diagnoses. And just because your pregnancy journey may have looked different doesn’t mean you are any less capable of having a beautiful pregnancy, birth, and postpartum experience.

Final Thoughts

If you’re pregnant with endometriosis, give yourself grace. Your body has already been through a lot. Surround yourself with providers who listen, support you, and understand the unique challenges that can come with navigating pregnancy after chronic pelvic pain. You deserve care that sees the whole picture; not just your pregnancy, but the journey that brought you here.

References

Huang, J., Lin, J., Cai, C., Cai, H., Fan, Y., & Huang, K. (2020). Miscarriage in endometriosis and
adenomyosis in women by assisted reproductive technology or with spontaneous conception: A systematic
review and meta-analysis. BioMed Research International, 2020, Article 4381346.
https://doi.org/10.1155/2020/4381346Ghazal, S., et al. (2016). Prevalence of hypermobility and Ehlers-Danlos syndrome in women withendometriosis. Journal of Minimally Invasive Gynecology, 23(7 Suppl.), S20-S21.

How to Connect with Dr. Casey Schlottman

www.insideoutpelvicpt.com

Book Online: www.insideoutpelvicpt.janeapp.com

Instagram: @insideoutpelvicpt

Empowering you from the inside out.