Could Your Caesarean Scar Be Causing Endometriosis Pain?

If you're experiencing ongoing pain or unusual menstrual symptoms at the site of your caesarean section scar, it's easy to feel frustrated and confused. You might wonder if this pain is "just part of healing" or if it's something your doctor will take seriously—especially if the issues seem to come and go with your menstrual cycle. But did you know that endometriosis can develop right in your caesarean scar, sometimes even spreading through the uterine wall?

Recent reports highlight that although rare, endometriosis can grow within or around your caesarean (C-section) scar, causing a very distinctive set of symptoms. The good news: surgical removal can bring real relief.

What Is Scar Endometriosis—and Why Does It Happen?

Scar endometriosis—specifically, involving a C-section scar—develops when endometrial-like cells incidentally get moved to the surgical site during your caesarean. Over time, these cells can set up home in the scar, grow, and respond to your monthly hormones, leading to pain and swelling that feels different from regular healing.

How Do You Know If Your Scar Pain Is Endometriosis?

You may notice a few key signs that set scar endometriosis apart from normal scar discomfort:

• Cyclical pain or swelling around your C-section scar: The pain often gets worse right before or during your period and improves after.
• New or worsening lump at the scar: Sometimes you can feel or see a nodule under the skin, which may also become tender with your cycle.
• Heavy or prolonged periods: Symptoms aren't always limited to the scar—some people develop heavier menstrual flow or worsening cramps.
• Minimal relief with standard painkillers or birth control pills: The pain may not improve much with the usual treatments for period pain.

If this sounds familiar, you're not alone—and it's worth speaking up. Many people brushing off these symptoms find lasting relief once the real cause is found.

Diagnosis: What Should You Expect?

Your doctor will often start with a detailed discussion of your symptoms, especially focusing on the timing of your pain around your cycle and any changes to your scar. An exam may or may not help because C-section scars can be thick and nothing special is found if endo is located within the scar, other than it may be more painful to the touch.

Imaging, such as ultrasound or MRI, can often spot abnormalities in or around the scar—such as a mass or area that looks like endometrial tissue. MRI is especially helpful because it looks not only at the anatomy but the characteristics of the tissue, which means it may be able to tell the difference between scar which has endo in it vs not. However, definitive diagnosis requires surgery and examination of the tissue (histopathology) after removal. An intermediary step may be a needle biopsy but if that is negative for endometriosis, it may just have missed the area where endo is growing. So, the accuracy is not absolute.

It's important to know: Scar endometriosis is uncommon, but awareness is growing, and prompt diagnosis is possible if you know what to look for. It is also possibly under-reported. C-sections are usually fairly bloody and rapid because the main goal is to safely get the baby out and then rapidly clean up and make sure bleeding stopped and then rapidly sutured closed. There is plenty of opportunity for endometriosis cells that were growing in tissues near the uterus to get intermixed in the suture line, which is where the scar forms.

What Actually Helps: Is Surgery Always Needed?

The evidence consistently points to one thing: Surgical removal of the affected tissue brings the best chance of being pain-free. In real cases, women who have the endometriosis fully excised—including some of the healthy tissue around it—report complete resolution of pain and heavy periods.

Hormonal treatments like birth control pills may bring some improvement but rarely provide lasting relief for scar endometriosis. Surgical excision is considered curative in most cases, with symptoms disappearing soon after recovery.

Key points you should know:

• Careful surgical technique is crucial: Removing all the endometriosis tissue (with clear borders) is needed to minimize the risk it will come back.
• Most patients have rapid relief: Pain and abnormal bleeding usually resolve within weeks of surgery.
• Recurrence is rare if all tissue is removed, but regular follow-up is wise.

Side Effects and Recovery: What’s The Downside?

Most people make a smooth recovery following surgical excision. While any surgery carries basic risks (bleeding, infection, scar), these are generally low for this type of procedure.

You may have some soreness at the site for a few days or weeks. Doctors aim to keep the procedure as targeted as possible, preserving function and minimizing scarring. Rarely, further intervention is needed if symptoms return.

It is crucial that the surgeon understands the disease and gets the right imaging before surgery. The endo can be growing into or on the bladder as well because it is right below this area. Addressing that as well as possible endo that may be deeper in the pelvis would give you the best outcome. This can be done partly with scar removal and revision and partly with minimally invasive MIGS surgery deeper in the pelvis. The expertise level has to be higher than a general gynecologist in most cases and likely best addressed by a gynecologic oncologist (higher level of training, especially when multiple organs can be involved) or a team of gynecology, urology and general surgery that are MIGS capable.

Can It Be Prevented?

There’s growing discussion about preventive steps surgeons can take during a C-section to minimize the risk of endometriosis implanting in the scar. Techniques like thoroughly cleaning or irrigating the area before closing are being considered—though, truthfully, the evidence is still developing and prevention is not guaranteed. The risk remains low overall.

Who Should Consider Scar Endometriosis?

Scar endometriosis is rare, but you may want to raise the possibility if you have:

• Painful, swelling, or tender mass at your caesarean scar that flares with your period.
• Worsening menstrual symptoms with no clear explanation.
• A history of multiple caesarean sections.

Don't hesitate to bring these concerns to your doctor—especially if standard treatments aren’t helping.

What Questions Should I Ask My Doctor?

If you suspect scar endometriosis, here are key questions to guide your conversation:

• Could my C-section scar pain be due to endometriosis?
• What imaging tests are helpful in my case?
• Is surgery necessary, or do I have other choices?
• What does surgical recovery look like, and what are the risks?
• How will you ensure all the endometriotic tissue is removed or can you? (It may not be possible to remove all the micro-disease, which is why the highest level of surgeon is best equipped for the job of trying to remove it "all.")
• What follow-up do I need to prevent recurrence?

Watch For These Signs

• Any new lump, swelling, or pain at a surgical scar site that worsens with your menstrual cycle.
• Symptoms that don’t improve with conventional treatments.
• Heavy or irregular periods that start after your C-section.

A Reality Check: What’s Still Unclear?

While surgical excision is generally effective, the exact cause of scar endometriosis isn’t fully understood—and it’s still rare compared to other causes of post-surgical pain. Preventing scar endometriosis isn’t yet a guaranteed science, but awareness among both patients and surgeons is growing.

Remember: Your pain and symptoms deserve to be investigated. You aren’t overreacting by bringing up concerns about your Caesarean scar, especially if they coincide with your cycle. Not all pain at a surgical scar is endometriosis, but you shouldn’t have to live with ongoing discomfort without answers.

If you recognize your symptoms in this post, speak up. With the right diagnosis and treatment, real relief is possible.