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You are here: Home - Pregnancy - Labor & Childbirth

New Study Links Cesarean Sections to Endometriosis

by Katlyn Joy | July 17, 2013 9:18 AM
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A new study appearing June 28, 2013 on ObGyn.net cites an increase in the occurrence of endometriosis following cesarean section births. While it's been noted in various medical publications for years that later-onset endometriosis is typically tied to uterine surgery such as c-sections, and referred to often as "iatrogenic" which means "doctor or medically caused", this is the first large scale study to confirm those suspicions.

The study looked at data from the Swedish Patient Registrar and the Swedish Medical Birth Registry to find patients who were identified as having endometriosis after their first birth. Of the 709,090 women, 3110 women were diagnosed with endometriosis after giving birth.

The risk of endometriosis was .4 percent with vaginal births and .6 percent with cesarean births. The increase in cases of the condition was not just for scar types of endometriosis but for all types. Scar endometriosis is when an endometrial stem cell becomes implanted in the incision area during a surgery involving the endometrium. This is fairly uncommon.

Most cases of endometriosis are diagnosed earlier in life, typically around a girl's first period or within the first several years of the onset of menses. According to the Mayo Clinic, the most likely cause of these types of endometriosis is retrograde menstruation. This is when the menstrual blood, which contains endometrial cells, goes back through the fallopian tubes and into the pelvic cavity. Endometrial cells are cells that line the uterus. In a normal period, the menstrual blood including endometrial cells shed in the process, flow out of the vagina each month.

Cases of endometriosis increased with time but not with repeated c-sections. A woman who had multiple births by cesarean section did not have a higher risk of the condition, but over the years following a c-section, her risk did rise. Over a ten-year period, one woman out of every 325 developed the condition each year.

However, women should note that the overall risk of endometriosis due to c-section is still quite low. Other risks associated with c-sections include uterine rupture and placental problems in future pregnancies.

Other risk factors for endometriosis include never giving birth, having a close relative such as a sister, aunt or mother, with the condition, uterine abnormalities, pelvic infections, and any conditions that interfere with the flow of menstrual blood from the body.

Symptoms of endometriosis include very painful periods, pain during or after sex, excessive bleeding during or between periods, pain during urination or defecation particularly during menstruation, and symptoms like diarrhea, fatigue, constipation, nausea and bloating during periods. Often women find out they have endometriosis when they are unable to get pregnant, as endometriosis can cause infertility.

Treatment typically begins with a conservative approach, such as controlling pain and often taking hormone therapy. If these more conservative therapies don't work, surgery may be needed. Surgery can often be done by laparoscopy although some cases demand abdominal surgery. Most times the uterus and fallopian tubes will be preserved. In only the most severe cases will hysterectomy be indicated, where the uterus, both ovaries and cervix will be removed. This would result in total infertility and thus is a last resort.

If you suspect you may have endometriosis, your doctor can diagnose you by pelvic exam, palpitating for any abnormalities. However, often this is not sufficient to find the condition so an ultrasound is performed. This won't result in a definite diagnosis but will show cysts formed by the condition. Laparoscopic surgery will be done under general anesthesia and involves a tiny incision at the belly button. Samples of tissue will be extracted and the general size, location and condition of the endometrial areas will be determined.

Katlyn Joy is a mother to 7 children, and a freelance writer. She earned her Master of Arts in Creative Writing and Poetry, and a Bachelor of Arts in English and was previously an adviser to new mothers on breastfeeding through a maternity home program. She currently resides in Colorado with her family.

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