The effect of hormone-modulating therapy during pregravid preparation on the course of pregnancy and childbirth in patients with a history of endometriosis

Chimnaz I. Seyidova, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2023 · vol. 72(6) , pp. 105–114 · doi:10.17816/jowd622745 · W4391725751
article OA: closed CC0
Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study analyzed pregnancy and childbirth in endometriosis patients, finding that pregravid hormone therapy reduced preeclampsia risk but complications like miscarriage and preterm birth remained higher than in controls.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective study analyzed pregnancy and childbirth outcomes in 140 patients with surgically confirmed endometriosis of varying severity who received hormone-modulating therapy during pregravid preparation, comparing them with 50 pregnant women without endometriosis. Most patients with endometriosis reported pain reduction during therapy, but the study found that threatened miscarriage was more common across trimesters, miscarriage occurred in 38.5%, recurrent pregnancy loss in 18.6%, and preeclampsia in 23.8% of patients, with fetal growth restriction in 18.6% and preterm birth in 20% (higher than controls). The authors report that pregravid hormone-modulating therapy reduced the risk of preeclampsia and that using dienogest 2 mg further reduced preeclampsia frequency relative to no treatment, while endometriosis increased the likelihood of fetal growth restriction and altered delivery mode patterns. Limitation: the design is retrospective and group comparability beyond endometriosis status and treatment exposure is not described. This paper is centrally about endometriosis—evaluating how pregravid hormone-modulating therapy affects obstetric complications and pregnancy course in women with a history of endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

BACKGROUND: Endometriosis is a benign proliferation of tissue similar in morphological and functional characteristics with endometrium outside the uterine. In the structure of gynecological diseases, it ranks on the third place and its prevalence is growing steadily every year. AIM: The aim of this study was to analyze the features of pregnancy and childbirth in patients with endometriosis who received hormone-modulating therapy during pregravid preparation. MATERIALS AND METHODS: This retrospective analysis of the course of pregnancy and childbirth in patients with a surgically confirmed diagnosis of varying severity endometriosis (n = 140) in history was carried out at the Center for Diagnosis and Treatment of Endometriosis, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The control group consisted of pregnant women without endometriosis (n = 50). RESULTS: Before pregnancy, 82.1% (n = 115) of patients with endometriosis used hormone-modulating therapy, while 17.9% (n = 15) of patients did not comply with the given therapy. During therapy, 70% (n = 98) of patients mentioned decreasing in the severity of pain. In patients with a history of endometriosis, threatened miscarriage took the leading place and was identified in 24.3% of cases in the first and second trimesters and in 33.6% of cases in the third trimester of pregnancy, which was consistently higher than in the control group. Miscarriage was observed in 38.5% of patients and recurrent pregnancy loss in 18.6% of women. Preeclampsia was diagnosed in 23.8% (n = 33) of patients with endometriosis. The use of hormone-modulating therapy during pregravid preparation was shown to reduce the risk of developing preeclampsia among patients with endometriosis by 4.1 times, and the use of dienogest 2 mg as the therapy of endometriosis to reduce the frequency of preeclampsia by ten times in comparison with patients who did not receive any treatment. Fetal growth restriction was observed in 18.6% (n = 26) of patients with endometriosis. The presence of endometriosis increased the likelihood of developing fetal growth restriction by 3.6 times and reduced the likelihood of having a large fetus by 2.7 times. Preterm birth was observed in 20% (n = 28) of patients with endometriosis, which is four times higher than in the control group (p = 0.019). Most pregnant women with a history of endometriosis – 64.3 % (n = 90) of patients – were delivered by cesarean section, while 35.7% (n = 50) of women had vaginal birth, which was 3.34 times higher than the frequency of cesarean section in the control group. CONCLUSIONS: Patients with a history of endometriosis are at high risk for the development of obstetric complications associated with the pathogenesis of the disease. An integrated approach to the treatment of endometriosis with the use of hormone-modulating therapy during pregravid preparation and personalized management of patients in different trimesters of pregnancy can reduce the risk of complications of pregnancy and childbirth.
Full text 11,726 characters · extracted from oa-doi-fallback · 4 sections · click to expand

Abstract

BACKGROUND: Endometriosis is a benign proliferation of tissue similar in morphological and functional characteristics with endometrium outside the uterine. In the structure of gynecological diseases, it ranks on the third place and its prevalence is growing steadily every year. AIM: The aim of this study was to analyze the features of pregnancy and childbirth in patients with endometriosis who received hormone-modulating therapy during pregravid preparation.

Materials and methods

This retrospective analysis of the course of pregnancy and childbirth in patients with a surgically confirmed diagnosis of varying severity endometriosis (n = 140) in history was carried out at the Center for Diagnosis and Treatment of Endometriosis, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The control group consisted of pregnant women without endometriosis (n = 50).

Results

Before pregnancy, 82.1% (n = 115) of patients with endometriosis used hormone-modulating therapy, while 17.9% (n = 15) of patients did not comply with the given therapy. During therapy, 70% (n = 98) of patients mentioned decreasing in the severity of pain. In patients with a history of endometriosis, threatened miscarriage took the leading place and was identified in 24.3% of cases in the first and second trimesters and in 33.6% of cases in the third trimester of pregnancy, which was consistently higher than in the control group. Miscarriage was observed in 38.5% of patients and recurrent pregnancy loss in 18.6% of women. Preeclampsia was diagnosed in 23.8% (n = 33) of patients with endometriosis. The use of hormone-modulating therapy during pregravid preparation was shown to reduce the risk of developing preeclampsia among patients with endometriosis by 4.1 times, and the use of dienogest 2 mg as the therapy of endometriosis to reduce the frequency of preeclampsia by ten times in comparison with patients who did not receive any treatment. Fetal growth restriction was observed in 18.6% (n = 26) of patients with endometriosis. The presence of endometriosis increased the likelihood of developing fetal growth restriction by 3.6 times and reduced the likelihood of having a large fetus by 2.7 times. Preterm birth was observed in 20% (n = 28) of patients with endometriosis, which is four times higher than in the control group (p = 0.019). Most pregnant women with a history of endometriosis – 64.3 % (n = 90) of patients – were delivered by cesarean section, while 35.7% (n = 50) of women had vaginal birth, which was 3.34 times higher than the frequency of cesarean section in the control group.

Conclusions

Patients with a history of endometriosis are at high risk for the development of obstetric complications associated with the pathogenesis of the disease. An integrated approach to the treatment of endometriosis with the use of hormone-modulating therapy during pregravid preparation and personalized management of patients in different trimesters of pregnancy can reduce the risk of complications of pregnancy and childbirth. Full Text About the authors Chimnaz I. Seyidova The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-6800-8661 Russian Federation, Saint Petersburg Maria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 MD, Dr. Sci. (Med.), Professor of the Russian Academy of Sciences Russian Federation, Saint PetersburgReferences - Tomassetti C, Bafort C, Meuleman C, et al. Reproducibility of the Endometriosis Fertility Index: a prospective inter-/intra-rater agreement study. BJOG. 2020;127(1):107–114. doi: 10.1111/1471-0528.15880 - Endometrioz. Klinicheskie rekomendatsii. Rossiyskoe obshchestvo akusherov-ginekologov. 2020. (In Russ.) [cited 2023 Oct 24]. Available from: https://roag-portal.ru/recommendations_gynecology#pdfcontent_gin_3 - Yarmolinskaya MI, Denisova VM. Importance of genital endometriosis in pathogenesis of infertility. Journal of Obstetrics and Women’s Diseases. 2013;62(6):67–77. (In Russ.) doi: 10.17816/JOWD62667-77 - As-Sanie S, Black R, Giudice LC, et al. Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol. 2019;221(2):86–94. doi: 10.1016/j.ajog.2019.02.033 - Koninckx PR, Zupi E, Martin DC. Endometriosis and pregnancy outcome. Fertil Steril. 2018;110(3):406–407. doi: 10.1016/j.fertnstert.2018.06.029 - Janowitz L, Cooper-Mercado R, Soto M. Endometriosis in pregnancy: a case report. Cureus. 2022;14(9). doi: 10.7759/cureus.28749 - Zullo F, Spagnolo E, Saccone G, et al. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril. 2017;108(4):667–672. doi: 10.1016/j.fertnstert.2017.07.019 - Alberico D, Somigliana E, Bracco B, et al. Potential benefits of pregnancy on endometriosis symptoms. Eur J Obstet Gynecol Reprod Biol. 2018;230:182–187. doi: 10.1016/j.ejogrb.2018.08.576 - Günther V, Allahqoli L, Gitas G, et al. Impact of adenomyosis on infertile patients-therapy options and reproductive outcomes. Biomedicines. 2022;10(12):3245. doi: 10.3390/biomedicines10123245 - Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206. doi: 10.1016/j.rbmo.2020.09.023 - Alkatout İ, Meinhold-Heerlein I, Keckstein J, et al. Endometriosis: a concise practical guide to current diagnosis and treatment. J Turk Ger Gynecol Assoc. 2018;19(3):173–175. doi: 10.4274/jtgga.2018.0026 - Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endomet riosis. Hum Reprod Open. 2022;2022(2). doi: 10.1093/hropen/hoac009 - Yarmolinskaya MI, Rusina EI, Semenova VO, et al. Extragenital endometriosis: diagnostic difficulties, modern treatment policy. Obstetrics and Gynecology. 2022;(8):154–162. doi: 10.18565/aig.2022.8.154-162 - Liu Y, Zhang W. Association between body mass index and endometriosis risk: a meta-analysis. Oncotarget. 2017;8(29):46928–46936. doi: 10.18632/oncotarget.14916 - Lumeng CN, Bodzin JL, Saltiel AR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest. 2007;117(1):175–184. doi: 10.1172/JCI29881 - Pantelis A, Machairiotis N, Lapatsanis DP. The Formidable yet Unresolved Interplay between Endometriosis and Obesity. ScientificWorldJournal. 2021;2021. doi: 10.1155/2021/6653677 - Cohen Ben-Meir L, Soriano D, Zajicek M, et al. The association between gastrointestinal symptoms and transvaginal ultrasound findings in women referred for endometriosis evaluation: a prospective pilot study. Ultraschall Med. 2022;43(5):e81–e89. doi: 10.1055/a-1300-1887 - Yarmolinskaya MI, Beganova AK, Revenko AS. Endometriosis-associated pain and new therapeutic options: a review. Gynecology. 2023;24(6):444–450. doi: 10.26442/20795696.2022.6.201975 - Tamari M, Ver Heul AM, Kim BS. Immunosensation: neuroimmune cross talk in the skin. Annu Rev Immunol. 2021;39:369–393. doi: 10.1146/annurev-immunol-101719-113805 - Gao D, Gao X, Yang F, et al. Neuroimmune crosstalk in rheumatoid arthritis. Int J Mol Sci. 2022;23(15). doi: 10.3390/ijms23158158 - Gimenes C, Bianco B, Mafra FA, et al. The progins progesterone receptor gene polymorphism is not related to endometriosis-associated infertility or to idiopathic infertility. Clinics (Sao Paulo). 2010;65(11):1073–1076. doi: 10.1590/s1807-59322010001100002 - Barbara G, Facchin F, Buggio L, et al. What is known and unknown about the association between endometriosis and sexual functioning: a systematic review of the literature. Reprod Sci. 2017;24(12):1566–1576. doi: 10.1177/1933719117707054 - Pluchino N, Wenger JM, Petignat P, et al. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update. 2016;22(6):762–774. doi: 10.1093/humupd/dmw031 - Mehasseb MK, Panchal R, Taylor AH, et al. Estrogen and progesterone receptor isoform distribution through the menstrual cycle in uteri with and without adenomyosis. Fertil Steril. 2011;95(7):2228–2235.e1. doi: 10.1016/j.fertnstert.2011.02.051 - Karita M, Yamashita Y, Hayashi A, et al. Does advanced-stage endometriosis affect the gene expression of estrogen and progesterone receptors in granulosa cells? Fertil Steril. 2011;95(3):889–894. doi: 10.1016/j.fertnstert.2010.12.026 - Aghajanova L, Giudice LC. Molecular evidence for differences in endometrium in severe versus mild endometriosis. Reprod Sci. 2011;18(3):229–251. doi: 10.1177/1933719110386241 - Lysenko BM. Features of pathogenesis of combination of a genital endometriosis and hypothyrosis. Health of Woman. 2016;9(115):75–77. doi: 10.15574/HW.2016.115.75 - Lima AP, Moura MD, Rosa e Silva AA. Prolactin and cortisol levels in women with endometriosis. Braz J Med Biol Res. 2006;39(8):1121–1127. doi: 10.1590/s0100-879x2006000800015 - Tai FW, Chang CY, Chiang JH, et al. Association of pelvic inflammatory disease with risk of endometriosis: a nationwide cohort study involving 141,460 individuals. J Clin Med. 2018;7(11):379. doi: 10.3390/jcm7110379 - Kimura F, Takebayashi A, Ishida M, et al. Review: chronic endometritis and its effect on reproduction. J Obstet Gynaecol Res. 2019;45(5):951–960. doi: 10.1111/jog.13937 - Vannuccini S, Clifton VL, Fraser IS, et al. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update. 2016;22(1):104–115. doi: 10.1093/humupd/dmv044 - Porpora MG, Tomao F, Ticino A, et al. Endometriosis and pregnancy: a single institution experience. Int J Environ Res Public Health. 2020;17(2):401. doi: 10.3390/ijerph17020401 - Yarmolinskaya M.I. Genital’nyy endometrioz: vliyanie gor monal’nykh, immunologicheskikh i geneticheskikh faktorov na razvitie, osobennosti techeniya i vybor terapii [dissertation]. Saint Petersburg; 2009. (In Russ.) [cited 2023 Sept 12]. Available from: https://www.dissercat.com/content/genitalnyi-endometrioz-vliyanie-gormonalnykh-immunologicheskikh-i-geneticheskikh-faktorov-na - Farland LV, Prescott J, Sasamoto N, et al. Endometriosis and risk of adverse pregnancy outcomes. Obstet Gynecol. 2019;134(3):527–536. doi: 10.1097/AOG.0000000000003410 - DoPierala AL, Bhatta S, Raja EA, et al. Obstetric consequences of subfertility: a retrospective cohort study. BJOG. 2016;123(8):1320–1328. doi: 10.1111/1471-0528.13584 - Cha J, Sun X, Dey SK. Mechanisms of implantation: strategies for successful pregnancy. Nat Med. 2012;18(12):1754–1767. doi: 10.1038/nm.3012 - Miura M, Ushida T, Imai K, et al. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth. 2019;19(1):373. doi: 10.1186/s12884-019-2514-1 - Uccella S, Manzoni P, Cromi A, et al. Pregnancy after endometriosis: maternal and neonatal outcomes according to the location of the disease. Am J Perinatol. 2019;36(2):S91–S98. doi: 10.1055/s-0039-1692130

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (36)

Source provenance

openalex
last seen: 2026-06-04T00:00:01.174412+00:00
unpaywall
last seen: 2026-06-02T02:00:03.124865+00:00
License: CC0 · commercial use OK