C-Section Scar Endometriosis

C-section scar endometriosis is a condition where endometrial tissue grows at the site of a previous cesarean incision. This tissue behaves like normal endometrium, responding to hormonal changes during the menstrual cycle. People with this condition may notice a firm lump near the scar that can become tender or painful, especially during periods. Sometimes, the area may swell or even bleed in sync with the menstrual cycle.

The cause is thought to be implantation of endometrial cells into the incision during surgery. Diagnosis usually involves physical examination and imaging such as ultrasound or MRI. Treatment often requires surgical removal of the affected tissue to relieve symptoms and prevent recurrence.

C-section scar endometriosis prevalence

Due to its varying clinical presentation and overall rareness, there are currently no concrete data on the prevalence of this type of endometriosis. The literature reports an incidence of 0.03% to 0.8%. 

The increasing number of C-section procedures means that there is also an increase in the prevalence of C-section scar endometriosis.

C-section scar endometriosis causes

The exact way in which a C-section can cause endometriosis is not clear. Factors, such as hormones or wound environment may contribute to the development of this type of endometriosis. 

C-section scar endometriosis symptoms

As with other types of endometriosis, the most common symptom of C-section scar endometriosis is pelvic pain, which is often cyclical in nature. However, non-cyclical pain may also occur. 

Another common symptom is the development of a mass or lump in or adjacent to the C-section scar. The contamination of the wound with endometrial tissue or pre-existing intraperitoneal endometriosis likely causes the development of this mass. 

Symptoms may often take months or years to become apparent following a C-section.

Diagnosis

Patients often face misdiagnosis or delayed diagnosis in case of C-section scar endometriosis as with other types of endometriosis. 

The most reliable method for diagnosing this type of endometriosis is excisional biopsy. Here, the surgeon takes out a sample during surgery and sends it to a specialist who analyses it to identify any endometrial cells.

Imaging techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI) scan can also be used. However, these are non-specific and are useful mostly used to exclude alternative diagnoses of abdominal wall masses, such as tumors or hernias. 

Treatment

The treatment and management of C-section scar endometriosis depend on several factors. 

Doctors may choose medical treatments, surgery, or a combination of both. Medical treatment may involve painkillers and hormonal treatments such as combined oral contraceptives. 

Surgery with wide local excision with at least 1 cm margins is the gold standard treatment. This can help prevent the recurrence and malignant transformation of the disease.

Can C-section scars cause endometriosis?

Yes, C-section scars can lead to a specific type of endometriosis called scar endometriosis. This happens when endometrial cells from the uterus are accidentally transferred to the surgical incision during the procedure. These cells then implant and grow in the scar tissue. Over time, they respond to hormonal changes like normal endometrium, which can cause pain, swelling, or even bleeding from the scar, especially during menstrual periods.

While it is relatively rare, the risk increases with multiple cesarean deliveries or improper handling of uterine tissue during surgery. Early diagnosis and surgical removal are usually the most effective ways to manage this condition.

What is the theory of endometriosis on C-section scars?

The theory of endometriosis on C-section scars suggests that endometrial cells are accidentally transferred to the abdominal wall during the surgery. During a C-section, the uterus is opened, and some of the uterine lining can come into contact with the incision. These cells can implant in the scar tissue and continue to respond to hormonal cycles, just like normal endometrial tissue. Over time, this leads to the formation of endometriotic lesions in the scar. This process explains why pain or swelling at the scar often worsens during menstruation.

Can endometriosis affect a C-section?

Endometriosis itself does not usually affect the ability to have a C-section, but it can influence recovery and surgical outcomes. If endometriosis involves the uterus, abdominal wall, or pelvic organs, it may increase the risk of adhesions, making the surgery more complex.

Scar tissue from previous endometriosis lesions can make dissection and closure harder. Some women may also experience more post-operative pain due to existing endometriotic implants. Rarely, endometriosis at a prior C-section scar can complicate healing or cause localized swelling and bleeding during menstruation. Overall, while endometriosis doesn’t prevent a C-section, it can influence surgical management and recovery.

Patient story 

Read Natina’s story for whom a routine C-section caused her to have stage 4 endometriosis after more than a decade and Dr. Seckin’s approach that finally healed her.