Having a cesarean section is a risk factor for endometriosis. Endometriosis following a cesarean delivery remains relatively rare, but it is a potential complication that women should discuss with their doctors.
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A 2013 study found that women who had undergone cesarean delivery were more likely to receive an in-hospital endometriosis diagnosis. They also found a small risk of endometriosis developing on the cesarean scar.

In this article, learn more about endometriosis after a cesarean delivery, including how doctors diagnose and treat the condition.

How does cesarean delivery affect endometriosis?

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Having a cesarean delivery may increase the risk of endometriosis.

Endometriosis happens when endometrial tissue, which usually lines the uterus, develops outside of the uterus. This can cause heavy or painful periods, as well as pain between periods, as the body tries to get rid of the tissue.

Adhesions are accumulations of endometrial tissue that can develop either into large masses or bands that form between organs, connecting them.

During pregnancy, some women with endometriosis find that their endometriosis symptoms temporarily get better. This may result from increased levels of progesterone in the body during pregnancy.

After having a cesarean delivery, the risk of developing endometriosis may be slightly higher. A Swedish study involving 709,090 women who had given birth found 3,110 new endometriosis cases after the women’s first deliveries.

The researchers determined that cesarean delivery significantly increased the risk of endometriosis. They identified one additional case of endometriosis for every 325 women who had undergone a cesarean delivery.

Cesarean delivery may injure endometrial tissue, causing it to move outside of the uterus. A 2016 study found that physical injuries, especially repeated ones, could lead to endometriosis.

While this study did not directly address the effects of cesarean deliveries on endometriosis, it offers one potential explanation for their relationship.

Symptoms

The standard symptoms of endometriosis can occur following cesarean delivery.

They include:

  • 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

Incisional endometriosis

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Surgery can treat incisional endometriosis.

C-section scars can also cause endometriosis, but this is relatively uncommon. When endometriosis results from a cesarean scar, the medical name is incisional endometriosis.

Endometrial tissue can build up along the scar, leading to painful adhesions that can affect a person’s fertility or make periods more painful.

Authors of a 2017 case report suggest that doctors are encountering more cesarean scar-related endometriosis because the number of cesarean deliveries is rising.

Surgery can effectively treat many cases of incisional endometriosis.

Diagnosis

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 4.4 years. Younger women tended to wait longer than older women for a diagnosis.

According to the Endometriosis Foundation of America, the average time of diagnosis is 10 years after the onset of symptoms.

To ensure a prompt and accurate diagnosis, people who suspect they have endometriosis may need to see an endometriosis specialist, 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 include:

  • 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.
  • Pelvic 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, usually a laparoscopy, is the only way for a doctor to definitively diagnose endometriosis. This allows a surgeon to identify and sometimes remove the adhesions.

Treatment

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Acupuncture may help treat endometriosis pain.

Endometriosis is a chronic illness with no cure. However, a range of treatments can manage symptoms.

Some may also prevent endometriosis from getting worse.

To cope with the pain, a doctor may recommend over-the-counter or prescription pain medication.

Some women also choose alternative and complementary pain management techniques, such as acupuncture or massage therapy.

Progesterone is typically the first line of treatment for endometriosis. It is a hormone that can help prevent endometrial tissue from growing.

Hormonal birth control pills contain progesterone, so a doctor may recommend these to people who are not currently trying to get pregnant.

While hormonal medications can help with mild endometriosis, people with severe endometriosis may require surgery.

Also, if progesterone does not provide relief or a woman wants to conceive, a doctor may perform surgery to remove overgrown endometrial tissue.

People who do not want to become pregnant may choose a hysterectomy, which is surgery to remove the uterus and sometimes the ovaries.

Outlook

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 often experience symptoms after stopping the treatment.

Even among people who have undergone surgery, endometriosis may come back. Treatment with progesterone may reduce the risk of recurrence or slow new growth.

A hysterectomy greatly reduces the risk of recurrence, but it is not a definitive cure.

There is a high rate of endometriosis recurring among people who have undergone hysterectomies that did not involve removing the ovaries.

Authors of a study from 2014 found that 62 percent of participants experienced endometriosis symptoms after undergoing hysterectomies but keeping their ovaries.

For this reason, it is important to thoroughly discuss the risks, benefits, and long-term outlook for all endometriosis treatments with a doctor.

Women contemplating cesarean delivery should talk to their doctors about the risks and benefits of surgery. Cesarean deliveries can be life-saving and reduce the risk of some childbirth complications. However, it is vital to be aware of the short- and long-term health risks.

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