Endometrial tissue is usually present inside a woman’s uterus. It’s meant to support pregnancy. It also sheds itself on a monthly basis while you have your period. This tissue is beneficial to your fertility when you’re trying to get pregnant. But it can be very painful if it starts to grow outside your uterus.
Women who have endometrial tissue in other places in their bodies have a condition called endometriosis. Examples of where this tissue can grow include the:
While very rare, it’s possible that endometrial tissue can grow in the incision site of a woman’s stomach after a cesarean delivery. This happens infrequently, so doctors may misdiagnose the condition after pregnancy.
The most common symptom of endometriosis after a cesarean delivery is the formation of a mass or lump in the surgical scar. The lump can vary in size. It’s often painful. This is because the area of endometrial tissue can bleed. The bleeding is very irritating to the abdominal organs. It can cause inflammation and irritation.
Some women may notice that the mass is discolored, and it can even bleed. This can be very confusing after giving birth. A woman may think the incision isn’t healing well, or that she’s forming excess scar tissue. Some women don’t experience any symptoms other than a noticeable mass at the incision site.
Endometrial tissue is meant to bleed with a woman’s menstrual cycle. A woman may notice that the incision site bleeds more around the time she has her period. But not all women notice bleeding that’s related to their cycles.
Another confusing part can be that many moms who choose to breast-feed their babies may not have a period for some time. Hormones released during breast-feeding can suppress menstruation in some women.
Is it endometriosis?
Other conditions doctors often consider in addition to endometriosis after a cesarean delivery include:
- incisional hernia
- soft tissue tumor
- suture granuloma
It’s important that a doctor consider endometriosis as a possible cause of the pain, bleeding, and mass at the cesarean delivery incision site.
Doctors divide endometriosis into two types: primary endometriosis and secondary, or iatrogenic, endometriosis. Primary endometriosis doesn’t have a known cause. Secondary endometriosis has a known cause. Endometriosis after a cesarean delivery is a form of secondary endometriosis.
Sometimes, after a surgery that affects the uterus, endometrial cells may transfer from the uterus to the surgical incision. When they start to grow and multiply, they can cause endometriosis symptoms. This is true for surgeries like a cesarean delivery and a hysterectomy, which is the surgical removal of the uterus.
Between 0.03 and 1.7 percent of women report endometriosis symptoms after a cesarean delivery. Because the condition is so rare, doctors don’t usually diagnose it right away. A doctor may have to do several tests before they suspect endometriosis. Sometimes a woman may have surgery to remove the lumpy area where endometriosis is before a doctor ever identifies the bump as having endometrial tissue.
Having both primary endometriosis and getting secondary endometriosis after surgery is even rarer. While having both conditions could occur, it’s unlikely.
The most reliable method to diagnose endometriosis is to take a sample of the tissue. A doctor who specializes in pathology (the study of tissues) will look at the sample under a microscope to see if the cells resemble those in the endometrial tissue.
Doctors usually start by ruling out other possible causes of the mass or tumor in your stomach through imaging studies. These aren’t invasive. Examples of these tests include:
- CT scan: The tissue may have distinctive streaks in it that look like endometrium.
- MRI: Doctors often find the results from MRIs are more sensitive to endometrial tissue.
- Ultrasound: Ultrasound can help a doctor tell if the mass is solid or not. Doctors can also use ultrasound to rule out a hernia.
Doctors can use imaging studies to get closer to an endometriosis diagnosis. But the only way to really know is to test the tissue for endometrial cells.
Treatments for endometriosis usually depend on your symptoms. If your discomfort is mild and/or the area of endometriosis is small, you may not want invasive treatments. You could take an over-the-counter pain reliever, such as ibuprofen, when the affected area bothers you.
Doctors usually treat primary endometriosis with medications. Examples include birth control pills. These control hormones that cause bleeding.
Will you need surgery?
Medications don’t usually work for surgical scar endometriosis.
Instead, a doctor may recommend surgery. A surgeon will remove the area where the endometrial cells have grown, plus a small portion around the incision site to make sure all the cells are gone.
Because endometriosis after cesarean delivery is so rare, doctors don’t have as much data about how much skin to remove. But it’s important during surgery to keep the risks that endometriosis could come back down.
A doctor should discuss the surgical approach with you. Take your time when deciding so you can make the best and safest decision. You may even wish to get a second opinion.
After surgery, the chances that endometriosis will come back are small. Women who choose surgery have a recurrence rate of 4.3 percent.
While this can be some years in the future, the discomfort usually goes away after menopause. As you age, your body doesn’t make as much estrogen, which can trigger pain and bleeding. This is why women don’t usually have endometriosis after menopause.
If you notice a painful area of scar tissue after a cesarean delivery, talk to your doctor. While there are several potential causes for this, pay attention to if your symptoms get worse when you’re on your period. This could mean that endometriosis is the cause.
If your symptoms are very painful, discuss your treatment options with your doctor.
Endometriosis can affect fertility in some women. But this is mostly the case with primary endometriosis. Having a cesarean delivery increases the likelihood you’ll have one again if you have another child, so you and your doctor will need to create a plan to reduce the risk for spreading the tissue if you need another cesarean delivery.