Scar Endometriosis

Scar Endometriosis is an extrapelvic type of endometriosis that occurs at the site of a previous surgical scar, most commonly a cesarean section scar.

Despite being less than 2.5 cm in size, even the smallest lesions can cause extreme pain, typically aggravating during or just prior to the menstrual cycle.

The most common symptom of Scar Endometriosis is cyclic pain, usually located at the surgical site. Other symptoms may include:

• Pelvic or abdominal tenderness
• Dysmenorrhea (painful periods)
• Chronic pelvic pain
• Fertility issues
• Menstrual irregularities
• Pain during or after intercourse

The commonest complaint of patients with Cesarean Scar Endometriosis is severe pain at the scar site. This pain often worsens during or just before the menstrual cycle, leading women to resort to taking painkillers for relief.

Scar endometriosis does invade the Rectus Muscle and the muscle sheath is extremely common in patients with Cesarean Scar Endometriosis.

When the rectus muscle is invaded, patients can experience continuous pain even outside the menstrual cycle, necessitating a surgical approach that often involves the excision of a large part of the muscle.

Diagnosing Scar Endometriosis can be a challenge due to its non-specific symptoms. Typically, a detailed medical history combined with a thorough physical examination is the first step.

A healthcare professional may palpate the area of concern, looking for any hard lumps or nodules. Imaging techniques such as ultrasound, MRI, or CT scans are often utilised for more precise identification of lesions.

In some cases, a definitive diagnosis is made through a biopsy, where a small tissue sample is examined under a microscope. Hence, a comprehensive multidisciplinary approach is imperative for accurate diagnosis.

Treatment for Ureteral Endometriosis will generally depend on the severity of the condition. The primary aim is to relieve any pain and discomfort, as well as preserve fertility if possible.

The treatment of choice for Cesarean Scar Endometriosis is surgical management with wide excision of the disease with clear margins.

With adequate expertise, Scar Endometriosis can be completely removed via surgery.

This procedure may require a large excision of the muscle, repair using a permanent mesh to replace the abdominal muscle, and a special drain with a vacuum.

Despite common practice, medical management of Cesarean Scar Endometriosis, including the use of Dienogest or depot medroxyprogesterone acetate (DMPA), only provides temporary symptomatic relief and does not reduce the size of the lesion.

The use of injections of GnRH Agonist (Leupride/ Zoladex) also only offers temporary benefits, as it does not affect the fibrosis and the size of the lesion will return to its original state once the effect of the injection wears off.

Dr Jay Mehta have a large series of these cases and a popular patient educational Masterclass on YouTube, strongly advocates for this approach.

Dr. Jay Mehta and his team operates more than 500 cases of Endometriosis across India annually. Dr. Jay is very experienced fertility & one of the best endometriosis doctor in Mumbai.

Not all patients require post-surgery physiotherapy, but in cases where the replacement of the abdominal muscle is extensive, it may be recommended.

After a complete surgery, patients usually don’t need any medications to prevent recurrence. Typically, patients are discharged within 24-48 hours of the procedure.

In conclusion, though Scar Endometriosis can be extremely painful and invasive, it is treatable with expert surgical intervention.

Understanding the condition and seeking appropriate treatment can help patients manage their symptoms and live a healthy life after diagnosis and surgery.

For any endometriosis treatment, consider seeking a consultation with Dr. Jay Mehta. He is a highly experienced endometriosis doctor in Mumbai & can provide the necessary expertise to address your specific concerns.