Something that we are not used to hearing or reading about is the risks of C-sections.
C-sections are considered when the risk of Vaginal Birth is “too high”, therefore, the risk of C-sections is reduced in comparison with vaginal birth. However, the rate of c-sections has increased dramatically over the last few decades, and indeed this cannot be all because the risk of a vaginal birth is too high… if this was the case, then humans would no longer exist. Coupled with the PTSD and birth trauma rates at an all-time high, maybe it is time we start talking about some of those other risks associated with C-sections (planned or not).
I am currently struggling with my menstrual cycle; to be honest, I can’t remember what they were like before I got pregnant with my first because I was solidly on birth control since I was 16 (4 years into starting my period) and only really coming off them 10 months before getting pregnant. With all the signs starting to point towards endometriosis, I looked further into what it is and what causes it.
Understanding Endometriosis
Endometriosis is a chronic condition where tissue similar to the lining inside the uterus, known as the endometrium, begins to grow outside the uterus. This can lead to various symptoms, including chronic pain, heavy periods, and infertility. While the exact cause of endometriosis remains unclear, several risk factors have been identified. One such risk factor is undergoing a caesarean section (C-section).
Before diving into the connection between C-sections and endometriosis, it's essential to understand what endometriosis entails. The misplaced endometrial-like tissue behaves like normal endometrial tissue—thickening, breaking down, and bleeding with each menstrual cycle. However, because this tissue cannot exit the body, it becomes trapped, leading to inflammation, cysts, scar tissue, and adhesions. This often results in severe pain, especially during menstruation, and can also affect fertility.
The Link Between C-Sections and Endometriosis
A C-section is a standard surgical procedure used to birth a baby through incisions made in the mother’s or birther's abdomen and uterus. This is a major surgery and comes with risks such as infections, blood loss, etc, but there is a risk of developing endometriosis from this surgery. A study done in 2013 noted that there was a 0.4% or 1 in 250 chance of a new diagnosis of Endometriosis, with an 80% increase if you have a c -c-section birth. That means it increases to 0.6% or 1 in 167 chances. (1) With the overall risk of caesarean scar, endometrioma rates range from 0.03–1.73 %. (2) Considering we get put under the “high risk” pregnancy category for 0.5%, my view is that we should be talking about this.
While there is a link, those who had a c-section had an increased chance of endometriosis, one study did find that there was no increase with multiple c-sections. However, it did show that the risk of endometriosis did increase with time, with an additional case of endometriosis for every 325 who had a c-section.
How Does a C-Section Increase the Risk?
Implantation of Endometrial Cells: Endometrial cells can be accidentally transferred to the surgical wound during a C-section. These cells can implant and grow in the scar tissue, leading to a specific type of endometriosis called "scar endometriosis."
Inflammation and Immune Response: The surgical process can trigger an inflammatory response and alter the local immune environment, promoting the survival and growth of any misplaced endometrial cells.
Mechanical Factors: The mechanical disruption of the uterus during surgery can facilitate the dissemination of endometrial cells to ectopic sites.
Symptoms of Post-C-Section Endometriosis
The symptoms of endometriosis following a C-section are like those of general endometriosis but can also include:
Pain at the Surgical Site: Persistent, cyclic pain at or around the C-section scar.
Nodules or Masses: Palpable lumps in the abdominal wall near the scar.
Pain During Physical Activity: Increased pain during activities that put strain on the abdominal area.
Diagnosis and Treatment
Diagnosing endometriosis after a C-section typically involves a combination of patient history, physical examinations, imaging tests (like ultrasound or MRI), and sometimes a biopsy of the scar tissue.
Treatment options include:
Medication: Pain relief through NSAIDs or hormonal therapies to reduce or eliminate menstruation.
Surgery: Surgical removal of the endometrial implants and scar tissue may be necessary for more severe cases.
Lifestyle Changes: Dietary adjustments, regular exercise, and stress management can help manage symptoms.
The numbers above are the women and birthers who have had a diagnosis. We know that here in the UK, on average, it takes eight years and ten months to get a diagnosis from the onset of symptoms. (3)
Prevention and Risk Mitigation
While not all cases of post-C-section endometriosis can be prevented, specific measures may reduce the risk:
Surgical Techniques: Surgeons can use meticulous techniques to minimize the dissemination of endometrial cells during a C-section.
Early Diagnosis and Intervention: Prompt attention to symptoms post-surgery can lead to earlier diagnosis and treatment, potentially limiting the extent of endometrial growth.
Endometriosis and C-sections.
There is a bidirectional link to c-sections in that people with endometriosis are twice as likely to have a c-section than those who do not have endometriosis. (4)
Conclusion
While C-sections are sometimes necessary and can be lifesaving, they come with risks, including the potential development of endometriosis. Awareness of this risk allows for early recognition and intervention, which can significantly improve quality of life for those affected. If you've had a C-section and are experiencing unusual pain or symptoms, it's crucial to consult with your healthcare provider to explore the possibility of endometriosis and discuss appropriate treatment options. Chronic Pain is not something you should HAVE to put up with.
It is so important to understand the risks involved, and as c-sections are increasing, we are starting to see the longer-term impacts and more research on c-sections come to light.
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