Can I Get Endometriosis After a C-Section?

You've had a C-section, and now you're worried about endometriosis. Is there a link?

marble statue with c-sectile dotted scar and reproductive organ visible on blue gradient background

Illustration by Brandon Cornwell

You're taking it easy and recovering from your cesarean delivery and adjusting to life with a new baby. Now you have a different worry.

Can you get endometriosis after a cesarean section?

What is endometriosis?

Endometriosis occurs when endometrium-like tissue grows in other parts of the reproductive system. (The endometrium is the lining of the uterus.)

The condition affects around 10 percent of women of reproductive age around the world, or roughly 176 million globally, according to Endometriosis UK.

This chronic condition has no cure. Treatment consists of alleviating endometriosis symptoms.

The symptoms of endometriosis, according to the World Health Organization (WHO), include the following:

Severe pain during periods
Pain during sexual intercourse
Pain during bowel movements or urination
Persistent pelvic pain
Abdominal bloating
Nausea
Fatigue
Infertility
Depression
Anxiety

Speak with your doctor if you have noticed uncomfortable new symptoms since having your C-section.

"Within the female reproductive system, the ovaries produce eggs, which are normally released monthly and travel down the fallopian tubes to implant into the endometrium of the womb," said Gareth Nye, B.Sc., Ph.D., a senior lecturer at the Chester Medical School at the University of Chester in England. "Endometriosis develops when the cells and tissue that resemble the part of the womb which sheds during menstruation are found in locations outside of the womb."

This can occur in a number of places in the reproductive system. In about 60 percent of cases, according to Nye, it's found in the ovaries and can lead to fertility issues.

What causes endometriosis?

The cause of endometriosis is unknown. It is likely related to the "backflow" of the womb lining back up the fallopian tubes that can often occur during menstruation, according to Nye.

"This occurs in 90 percent of women," Nye said.

Retrograde menstruation isn't a problem unless it causes pain or is associated with endometriosis.

"The idea is that material can leave the uterine tubes via the small gap between the ovary and tubes and move around the body, settling down in different regions," Nye said. "This tissue is found by the immune system, which thinks it is harmful to the body and acts to remove it, leading to inflammation and pain."

That's not all. This tissue behaves like the endometrial lining, so as a woman's monthly hormonal cycles occur, the tissues can grow and even bleed, Nye added.

While endometriosis usually develops within a few years of a person's first menstrual cycle, in some rarer cases, the condition can be triggered later in life as a result of other factors, according to Mayo Clinic.

"Endometriosis can occur at any stage of life before menopause and there is often a significant delay in the diagnosis of endometriosis," said Sheila Ramgopal, M.D., M.A., an OB-GYN at the Allegheny Reproductive Health Center in Pittsburgh.

Can you get endometriosis after a cesarean section?

If you plan to have a C-section or have already had one, you may wonder if the procedure links to endometriosis.

Yes, it can—but abdominal wall endometriosis (AWE) is rare, according to Nye.

"There is a link due to the cutting aspect of the procedure, but the rate is less than 0.5 percent," Nye said.

"Cesarean delivery is rarely associated with endometriosis of the abdominal wall scar or the skin incision," Ramgopal said. "With increased rates of cesarean deliveries, OB-GYN providers are more aware that abdominal wall endometriosis can occur in their clients who have had cesareans or other surgeries; however the incidence is rare—less than 0.45 percent."

The exact rate of abdominal wall endo is 0.03 percent to 0.45 percent, according to a 2017 report. Other procedures, such as a hysterectomy, can lead to the same uncommon condition.

So how does this chronic condition potentially develop after a C-section?

It may occur when endometrial tissue moves outside of the uterus when the surgeon makes the incision, the study suggested. If this transplanted tissue begins to grow outside of the uterus, this can result in endometriosis. Usually, this endometriosis will lead to the usual symptoms.

Scar endometriosis at the incision site after a C-section is also rare, a 2006 study shared. A small mass or lump can grow at the site and cause painful periods.

Do you have endometriosis after having a C-section?

If you notice the common symptoms of endometriosis after undergoing a C-section—painful menstrual cramps, pain during sex and irregular bleeding—speak to your doctor.

"Signs of abdominal wall endometriosis include finding a lump on or near your skin incision that will enlarge and become tender, especially cyclically," Ramgopal said. "Some people also experience dark bloody or brown discharge from that lesion with their cycles."

Receiving an endometriosis diagnosis can be a long and painstaking process that can take an average of 10 years in the U.S., according to Yale Medicine.

While endometriosis is a chronic and incurable condition, for women who develop the condition after a C-section, it can sometimes be treated by surgery to remove the endometrium-like tissue that has grown outside of the womb, a 2019 study reported.

Summing up

Endometriosis is a chronic condition that can lead to painful periods and infertility. While it is rare, it can sometimes develop on C-section scar tissue.

If you hope to become pregnant again or are experiencing painful periods, this type of endometriosis can sometimes be surgically removed. Your symptoms may be reduced with the help of birth control pills or other contraceptive methods.

Speak with your doctor if you have noticed uncomfortable new symptoms since having your C-section. Your doctor will help determine the best course of treatment for you.