Having a C-section, which is also known as a cesarean delivery, is a risk factor for endometriosis. Endometriosis following a C-section remains relatively rare, but it is a potential complication that women should discuss with their doctors.
Endometrial tissue typically lines the uterus. Classic endometriosis occurs when endometrial-like tissue develops outside of the uterus.
This can cause the development of adhesions, or scar tissues. These can grow into large masses, or into bands that form between organs.
When endometriosis causes either inflammation or scar tissue, a person can experience heavy or painful periods, as well as pain between periods.
During pregnancy, a person already living with endometriosis may find that their endometriosis symptoms temporarily get better. This may result from increased levels of progesterone in the body during pregnancy.
However, this may not be true for every person. In some cases, the pain relief may be more related to the absence of a menstrual cycle during pregnancy. Some people may not experience any pain relief during pregnancy.
There is also evidence that endometriosis could develop after a c-section in people who did not have the condition prior to giving birth.
This article discusses endometriosis after a C-section, including how doctors diagnose and treat the condition.
Endometriosis can develop after a C-section when it develops inside the surgery scar, which is known as incisional endometriosis.
Incisional endometriosis is rare. The incidence of the condition is only 0.03-0.45%. However, the authors of a 2017 case report suggest that doctors are encountering more C-section scar-related endometriosis because the number of C-sections is rising.
The number could also be higher because not all people may realize they have endometriosis after having a c-section and may not report it.
When a surgeon performs a c-section, endometrial tissue is cut and can move outside the uterus. Endometrial tissue
The endometrial tissue then builds up along the scar, leading to painful adhesions that can affect a person’s fertility or make periods more painful. In addition, a person
Surgery can effectively treat many cases of incisional endometriosis, as it involves removing the inflammatory endometrial tissue.
Incisional endometriosis can cause cyclic pain, swelling, and brown-like leakage at the site of the scar during menstruation. In addition, a person can experience the standard symptoms of endometriosis.
- severe pain during menstruation
- pain or cramps between periods
- pain during sex
- painful bowel movements
- bleeding between periods
- heavy or clot-filled periods
- trouble getting pregnant
- unexplained stomach pain, diarrhea, or constipation
- bladder pain that resembles a bladder or urinary tract infection
A person experiencing any of these symptoms should see their doctor to rule out endometriosis or another condition that may be causing similar symptoms.
Many people with endometriosis wait years for a diagnosis.
A 2017 study found that the average time between the beginning of symptoms and diagnosis in the United States was
However, according to the Endometriosis Foundation of America, there can be as much as a
Generally, to ensure a prompt and accurate diagnosis, people who suspect they have endometriosis may need to see their gynecologist, specifically ask about endometriosis testing, or seek a second opinion.
Usually, doctors take a complete medical history and perform a pelvic exam before testing. A person may then need to undergo several tests to get an accurate diagnosis.
A doctor may be able to feel adhesions or endometrial growths during an exam, though this is uncommon. If a person experiences unusual pain during a pelvic exam, this may also be a sign of endometriosis.
If a pelvic exam causes a doctor to suspect endometriosis, other tests can confirm the diagnosis. These
- Pelvic ultrasound: During this procedure, a doctor uses sound waves to view the uterus and surrounding organs. They may insert a small transducer into the vagina to get a better look or use the transducer only on the outside of the abdomen.
- Biopsy: A doctor may use a needle to remove a small section of endometrial tissue. Testing this sample can help rule out other issues, such as cancerous growths.
- Exploratory surgery: Surgery like laparoscopy is the only way a doctor can definitely diagnose endometriosis in the abdominal wall. However, it is possible to diagnose incisional endometriosis with ultrasound, MRI, and typically by
makinga new incision at the old incision site and removing the tissue. A pathologist then examines the tissue to confirm the condition.
Endometriosis is a chronic illness with no cure. In cases of endometriosis after a c-section, surgery to remove the endometriosis is the
For endometriosis in general, surgery is not always the first treatment choice. There are other treatments that can manage symptoms that could benefit some people depending on their specific symptoms. Some treatments may also prevent endometriosis from getting worse. A doctor may recommend:
- over-the-counter or prescription pain medication.
- alternative pain management techniques such as acupuncture or massage therapy
- Hormonal birth control pills contain progesterone, which is a hormone that can help prevent endometrial tissue from growing. Learn more about birth control for endometriosis.
- Hormonal contraceptives that do not contain progesterone such as gonadotropin-releasing hormone (GnRH) agonists or antagonists.
In severe cases, people who do not want to become pregnant may choose a hysterectomy, which is surgery to remove the uterus. This may also include a bilateral salpingo-oophorectomy (BSO), in which the surgeon also removes the ovaries.
Learn about the new guidelines for endometriosis diagnosis and treatment.
Endometriosis is a chronic condition, but surgical and medical treatment can help manage the symptoms.
People who have used medication, such as progesterone, to control endometriosis
Even among people who have undergone surgery, endometriosis may come back. Treatment with progesterone or with GnRH agonists and antagonists may reduce the risk of recurrence or slow new growth.
A hysterectomy on its own can greatly reduce the risk of recurrence. Research from 2020 found that the proportion of women living with endometriosis who experienced pain went down by
However, earlier research found that
The removal of ovaries, however, also
Is scar endometriosis dangerous?
Incisional endometriosis can cause pain and discomfort. But the condition is so rare, that there is not enough data to indicate whether it is dangerous. In extremely rare cases, the condition
Why does my c-section scar hurt years later?
A person should not experience pain in the area of their scar years after a C-section. If they are experiencing pain, they may wish to rule out endometriosis or other conditions
Learn more about hernias after a C-section.
Can a hard lump in the stomach after a C-section indicate endometriosis?
What is post-partum endometritis?
Post-partum endometritis is a different condition than endometriosis, although both occur after pregnancy and delivery. When a person is pregnant, bacteria can reach the lining of the uterus and cause an infection. This can occur during vaginal delivery, but also during pregnancy through pelvic examinations, for example. The condition typically develops after delivery, which can be vaginal or via c-section. It affects up to