Adenomyosis and Pregnancy

Adenomyosis is a common but often overlooked condition that can significantly impact a woman’s reproductive health and pregnancy outcomes. Characterized by the abnormal growth of endometrial tissue into the muscular wall of the uterus, adenomyosis can lead to symptoms such as heavy menstrual bleeding, severe cramps, and chronic pelvic pain. However, the implications go far beyond discomfort—especially for women who are pregnant or trying to conceive. It is important to understand the risks, symptoms, and management of adenomyosis and pregnancy.

Recent research, large cohort studies, and meta-analyses have shed light on how adenomyosis affects pregnancy. The condition has been strongly associated with an increased risk of serious complications, collectively known as the “great obstetrical syndromes.” These include preterm labor, preterm delivery, small for gestational age (SGA) infants, preeclampsia, and various forms of placental disease.

1. Adenomyosis and Preterm Labor/Preterm Delivery

Preterm labor occurs when contractions and cervical changes begin before 37 weeks of gestation, potentially resulting in preterm birth. Babies born prematurely face a higher risk of health problems including respiratory issues, feeding difficulties, and developmental delays.

Studies have shown that women with adenomyosis are up to twice as likely to deliver prematurely. This is likely due to chronic inflammation, disrupted uterine contractility, and abnormal hormone signaling—factors that interfere with normal pregnancy progression.

2. Adenomyosis and Small for Gestational Age (SGA) Infants

A small for gestational age (SGA) baby weighs less than the 10th percentile for their gestational age, often due to impaired placental function. This can lead to complications such as low birth weight, hypoglycemia, difficulty regulating body temperature, and developmental delays.

In pregnancies affected by adenomyosis, abnormal uterine tissue may hinder optimal blood flow to the placenta, reducing the oxygen and nutrient supply needed for fetal growth. Numerous meta-analyses support the increased incidence of SGA infants among women with adenomyosis.

3. Adenomyosis and Preeclampsia

Preeclampsia is a serious complication marked by high blood pressure and potential organ damage, often involving the liver and kidneys. If left untreated, it can escalate to eclampsia, a life-threatening condition that may require emergency intervention.

Research indicates a strong link between adenomyosis and hypertensive disorders in pregnancy. Inflammation and defective placental implantation are believed to play a central role in this association, raising the likelihood of preeclampsia in expectant mothers with adenomyosis.

4. Placental Disease and Adenomyosis

Adenomyosis may also elevate the risk of placental complications such as:

• Placental abruption (early detachment of the placenta)
• Placenta previa (when the placenta covers the cervix)

Both conditions can result in severe bleeding, fetal distress, or emergency cesarean delivery. These complications make high-risk pregnancy management essential for women with adenomyosis.

Why Early Monitoring for Adenomyosis in Pregnancy Matters

Adenomyosis is more than just a source of painful periods—it can be a critical factor in pregnancy risk. Women with this condition should be closely monitored throughout pregnancy to help identify and address complications early.

At Fertility Centers of New England, our team of reproductive endocrinologists emphasizes the importance of proactive and personalized care for patients with adenomyosis. We strongly recommend early consultation with a maternal-fetal medicine (MFM) specialist, especially for those undergoing fertility treatments or who have conceived through assisted reproductive technologies (ART).

“It is vital for engaged fertility experts—the only true experts in adenomyosis total care—to be the staunchest advocates for high-risk obstetrical care protocols in all pregnant patients with adenomyosis,” says Dr. Antonio Gargiulo, Director of the Advanced Reproductive Surgery Program at Fertility Centers of New England. “Professional societies are catching up too slowly on this issue, and many general practitioners remain unaware of the connection between adenomyosis and obstetrical syndromes.”

Adenomyosis and Fertility—A Silent Risk With Loud Consequences

Adenomyosis is often called the “silent enemy of fertility”—and its effects can reverberate through conception, pregnancy, and delivery. With growing awareness, advanced monitoring, and expert reproductive care, women with adenomyosis can still achieve healthy pregnancies.

At Fertility Centers of New England, we’re committed to evidence-based care, early diagnosis, and individualized pregnancy planning for every patient. If you have been diagnosed with adenomyosis or are experiencing symptoms, we encourage you to schedule a consultation with one of our specialists.