What is caesarean scar endometriosis, and what are the main symptoms?

Written by: Mr Mahantesh Karoshi
Edited by: Conor Lynch

Top Doctors recently spoke to revered London-based consultant gynaecologist, Mr Mahantesh Karoshi, who, in this article, details what caesarean scar endometriosis is, outlines the main symptoms of the condition, and reveals how it is diagnosed.

What is caesarean scar endometriosis?

Caesarean scar endometriosis is a term given to endometriosis occurring in a caesarean section scar. It can be located on the skin, subcutaneous tissue, rectus muscle/sheath, or in the uterine myometrium (within the uterine scar).


Caesarean scar endometriosis is a rare disease, and is, thus, very difficult to diagnose. It is commonly seen following caesarean section. Patients are usually unaware of this condition.


What are the main symptoms, and are the causes obvious?

It may take a while to get to the bottom of it. This is because symptoms are non-specific, with patients typically experiencing abdominal wall pain at the skin incision site at the time of menstruation. Patients suffering from scar endometriosis also notice palpable tender mass in the incision site.


Patients may also complain of tenderness, and a raised, unsightly hypertrophic scar. Most patients have cyclical pain (up to 70%). The pain is usually intermittent, and is typically associated with the patient's menstrual cycle. The overlying skin may be hyperpigmented due to the deposition of haemosiderin. In some cases, patients may be asymptomatic.


How is caesarean scar endometriosis diagnosed?

The diagnosis is made after the affected tissue is extracted and thoroughly analysed under a microscope.


How is it treated?

If the mother is willing to have more children, and aims to have repeat caesarean deliveries, then the index scar endometriosis can be excised at the time of a repeat caesarean section. The interval pain and swelling can be controlled with pills such as cerazette as a short-term measure.


Mr Mahantesh Karoshi is a highly experienced consultant gynaecologist who specialises in women’s health and infertility. Book a consultation with him today via his Top Doctors profile

By Mr Mahantesh Karoshi
Obstetrics & gynaecology

Mr Mahantesh Karoshi is a London-based women’s health expert and consultant gynaecologist, with a special interest in ovarian cysts, heavy menstrual bleeding, infertility, fibroids, and adenomyosis. He is currently one of the most highly-rated gynaecologists in London with a very good reputation amongst his patients and peers.

Mr Karoshi's work is recognised internationally, having volunteered in Ethiopia’s Gimbie Hospital, and later receiving the Bernhard Baron Travelling Fellowship from the Royal College of Obstetricians and Gynaecologists which led to his work in the University of Buenos Aires. Here he worked on the techniques needed to surgically manage morbidly adherent placental disorders - a serious condition that can occur in women with multiple caesarean sections.

He believes in an open doctor-patient relationship, being sure to include the patient and educating them so that they understand their condition better and they can be directly involved in their care and management at every stage. Aside from his clinical work, he is actively involved in research, which together with his experience, has given him the opportunity to publish the first stand-alone textbook on postpartum haemorrhage which was launched by HRH Princess Anne.

At the core of Mr Karoshi's practice is a high standard of professionalism where patients are involved in their treatment and where the latest techniques and advancements are used to provide an extremely high level of care.

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