Scar endometriosis

Medically Reviewed by Dr Sravya, MBBS, MS 


Have you had a C-section for childbirth and have a painful scar now? It may be due to a medical condition called ‘Scar endometriosis.’

scar endometriosis

Endometriosis is a condition where the endometrial tissues that are supposed to grow inside the uterus grow at some other places like outside the uterus. The endometrial-like tissue that grows on any type of scar, for example, the one that you got from your C-section, is called ‘Scar endometriosis.’

Not all women who have C-sections have a painful scar. It is a very rare disease that causes painful scars. The most commonly affected areas are the surgical scars on abdominal skin and subcutaneous tissue.

What causes Scar endometriosis?

Scar endometriosis is also known as incisional endometriosis. It causes abdominal wall pain during menstruation, where there is an incision site, which means that it occurs in women who have previously undergone pelvic or abdominal surgery. The most commonly accepted cause of endometriosis is that the endometrial tissue is transferred from its site to the place where the incision is made during surgery (pelvic or abdominal). Furthermore, some of the causes responsible for scar endometriosis include ectopic pregnancies, laparoscopy, amniocentesis (taking amniotic fluid during gestation for diagnosis of certain medical conditions), appendectomy, episiotomy ( a cut given to the vagina during childbirth), salpingostomy ( a procedure to treat issues in fallopian tubes, removal of ectopic pregnancies), vaginal hysterectomy (removal of uterus) and hernia repair. 

According to the available study data, mid-trimester abortions are responsible for scar endometriosis with less occurrence.

Symptoms of Scar endometriosis

The only symptom of scar endometriosis is a painful scar. The patient may present with unbearable pain and tenderness at the incisional site.

Scar endometriosis pathology outlines

Scar endometriosis is characterized by small, dark red, bluish, or black cysts that grow on the surface of peritoneal or pelvic organs. According to the study reports, it is a mass that grows beneath the cesarean scar. Only a small number of patients present with pain and the size of the endometrial-like tissue that is implanted. However, patients generally complain of tenderness upon physical examination of the scar, along with a raised scar that is visually unattractive to look at.

Diagnosis of Scar endometriosis

Diagnosis of endometriosis is difficult since it is misdiagnosed for tumors. Clinical diagnosis of scar endometriosis involves assessment of the patient’s history and a physical examination. Patients generally present with a mass near the surgical scars. They complain of severe pains during their menstrual cycles, and it can only be diagnosed early with careful examination and considering it to be a case of endometriosis. Unfortunately, the diagnosis of scar endometriosis goes undetected until histopathology is performed.

The most accurate diagnostic method of detecting endometriosis is Magnetic Resonance Imaging (MRI). It is the most effective method of diagnosing deep pelvic endometriosis since it precisely diagnoses infiltration of the abdominal wall. Furthermore, histology is a key factor in the proper diagnosis of scar endometriosis. It confirms the presence of endometrial glands and stromal tissues by using hematoxylin and eosin-stained slides. However, the cytologist must be experienced enough to have a clear diagnosis and check for abnormalities if any.

Scar endometriosis treatment

Scar endometriosis is most commonly treated using medications and performing surgeries. However, surgical procedures give relief from this condition. Here, the solid mass to be excised is marked with a well-defined margin made in a way that should cover an area of at least 1 cm from the solid tissue. This ensures the removal of possibly affected areas around the solid mass. 

If the scar endometriosis has penetrated the muscles of the abdominal wall, the healthy tissue surrounding the affected area is also removed. This procedure is called en bloc resection. The excision site should be sterilized with a neomycin solution or 0.9% sodium chloride.

 When the scar endometriosis is surgically removed, there are chances that the patient develops postoperative hernia weeks after surgery. It is common in people undergoing abdominal surgeries. To avoid this, a synthetic mesh is used as it strengthens the abdominal wall and stops the development of postoperative hernia. 

Taking medicines has shown a low success rate in the treatment of scar endometriosis. Medications like hormonal treatment, including oral contraceptives, gonadotropin-releasing hormone agonists, danazol, and progesterone, are some of the drugs that can be taken for the treatment. However, taking these reduces the symptoms only for a short period, and symptoms reoccur once the medicines are stopped.

The hormonal treatment proves to be effective when taken after the surgery as it reduces the chance of recurrence of scar endometriosis. The rate of recurrence is very low and occurs only if the excision is inadequately done.


Endometriosis is a condition where the endometrial-like tissues grow outside the uterus in places like ovaries, abdominal walls, and extra pelvic areas, including lungs, Kidneys, bladder, and bowels. This condition is one of the leading causes of infertility in young women. Additionally, there is a condition called scar endometriosis, where endometrial-like tissues grow on the scar, generally from abdominal or pelvic surgery. The main symptom of scar endometriosis is a painful scar during the menstrual cycle. It is believed that endometrial-like tissue is transferred from the inside of the uterus to the incision site. It may also be caused by ectopic pregnancies, episiotomy, or hysterectomy.

Pathologically, a scar endometriosis mass is bluish, black, or dark red in color and small in size. It grows beneath the cesarean scar.

Diagnosis of scar endometriosis is very difficult and is accidentally done. The most reliable diagnostic method is MRI since it diagnoses the infiltration of tissues in the abdominal wall. A careful physical examination, a proper assessment of patient history, and histopathology help in the correct diagnosis of scar endometriosis. Treatment of scar endometriosis includes medications like hormonal treatment i.e., oral contraceptives. But taking these medications subsides only for a short period, and it reoccurs when medications are stopped. Hence, this is a less effective method. Surgeries have proven to be the best treatment option for scar endometriosis. The surgeon removes some healthy tissue along with the affected tissue so that there are no chances of recurrence. This procedure is called en bloc resection. Hormonal treatment is recommended after the surgery to reduce the chance of scar endometriosis regrowth. But there are very less chances of recurrence, and it occurs only if the affected tissue is not properly excised. Also, there are chances of patients developing postoperative hernia after abdominal surgery, and to avoid this, a synthetic mesh is used. Now, you must be wondering how a synthetic mesh prevents postoperative hernia. The mesh strengthens the abdominal wall and stops the development of postoperative hernia. Women need to see a doctor if they have had a C-section and are suffering from unbearable pain during menstrual cycles. There is a possibility of you having scar endometriosis. If it is left untreated, it may cause damage to the surrounding organs, obstruction in bowel movements, and may affect your mental health.

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