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Peer-reviewedCC BYAJOG Global Reports

Cesarean section as a risk factor for recurrent endometriosis

  • George Qiaoqi Chen, MD1
  • Lin Wang, MD2
  • Yunhui Tang, MD3
  • Ying Gu, MD4
  • Qi Chen, MD, PhD5
  • Min Zhao, MD, PhD6
6 affiliations
  1. 1Department of Medicine, The Alfred Hospital, Melbourne, Australia (Chen)
  2. 2Department of Gynaecology, Wuxi Maternity and Child Health Care Hospital, Jiangnan University, Wuxi, China (Wang, Zhao); Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand (Wang, Chen)
  3. 3Department of Family Planning, The Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China (Tang)
  4. 4Department of Obstetrics, Wuxi Maternity and Child Health Care Hospital, Jiangnan University, Wuxi, China (Gu)
  5. 5Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand (Wang, Chen)
  6. 6Department of Gynaecology, Wuxi Maternity and Child Health Care Hospital, Jiangnan University, Wuxi, China (Wang, Zhao); Corresponding author: Min Zhao, MD, PhD.
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Abstract

BACKGROUND: Endometriosis is a chronic inflammatory disease, with recurrence rates of 20% to 50% within 5 years after surgery. Cesarean section involves tissue injury and inflammation that may contribute to the reactivation of endometriotic lesions. Previous studies suggested an association between cesarean sections and the development of endometriosis. However, it remains unclear whether these factors affect recurrence. OBJECTIVE: In this study, we investigated the association between previous cesarean sections and the recurrence of endometriosis. STUDY DESIGN: We retrospectively analyzed 1817 women diagnosed with endometriosis at our hospital. RESULTS: Recurrent endometriosis occurred in 125 women (6.8%). The median time to recurrent endometriosis was 7 years. Among 1297 women with a history of live birth, 526 (41%) had undergone cesarean section(s). Previous cesarean section(s) significantly increased the recurrence of endometriosis by 84% ( P =.006), compared to vaginal delivery. In contrast, when compared to nulliparous women, a previous vaginal delivery was not associated with developing recurrence ( P =.3181). Furthermore, the interval to recurrence was significantly longer in patients with a live birth than in those without a live birth (7.8 vs 5.1 years, P =.004). CONCLUSION: Although endometriosis recurrence after surgery is relatively common, our study suggests that previous cesarean sections significantly increase the risk of recurrence.

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Cite

BibTeXRIS
BibTeX
@article{georgeqiaoqichen2026cesarean,
  title = {{Cesarean section as a risk factor for recurrent endometriosis}},
  author = {George Qiaoqi Chen, MD and Lin Wang, MD and Yunhui Tang, MD and Ying Gu, MD and Qi Chen, MD, PhD and Min Zhao, MD, PhD},
  journal = {AJOG Global Reports},
  year = {2026},
  month = nov,
  doi = {10.1016/j.xagr.2026.100707},
  url = {https://doi.org/10.1016/j.xagr.2026.100707},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Cesarean section as a risk factor for recurrent endometriosis
AU  - George Qiaoqi Chen, MD
AU  - Lin Wang, MD
AU  - Yunhui Tang, MD
AU  - Ying Gu, MD
AU  - Qi Chen, MD, PhD
AU  - Min Zhao, MD, PhD
PY  - 2026
DA  - 2026/11/06
JO  - AJOG Global Reports
DO  - 10.1016/j.xagr.2026.100707
UR  - https://doi.org/10.1016/j.xagr.2026.100707
AB  - BACKGROUND: Endometriosis is a chronic inflammatory disease, with recurrence rates of 20% to 50% within 5 years after surgery. Cesarean section involves tissue injury and inflammation that may contribute to the reactivation of endometriotic lesions. Previous studies suggested an association between cesarean sections and the development of endometriosis. However, it remains unclear whether these factors affect recurrence. OBJECTIVE: In this study, we investigated the association between previous cesarean sections and the recurrence of endometriosis. STUDY DESIGN: We retrospectively analyzed 1817 women diagnosed with endometriosis at our hospital. RESULTS: Recurrent endometriosis occurred in 125 women (6.8%). The median time to recurrent endometriosis was 7 years. Among 1297 women with a history of live birth, 526 (41%) had undergone cesarean section(s). Previous cesarean section(s) significantly increased the recurrence of endometriosis by 84% ( P =.006), compared to vaginal delivery. In contrast, when compared to nulliparous women, a previous vaginal delivery was not associated with developing recurrence ( P =.3181). Furthermore, the interval to recurrence was significantly longer in patients with a live birth than in those without a live birth (7.8 vs 5.1 years, P =.004). CONCLUSION: Although endometriosis recurrence after surgery is relatively common, our study suggests that previous cesarean sections significantly increase the risk of recurrence.
SN  - 2666-5778
ER  -