Cesarean section as a risk factor for recurrent endometriosis

George Qiaoqi Chen, Lin Wang, Yunhui Tang, Ying Gu, Qi Chen, Min Zhao
In: AJOG Global Reports · 2026 · pp. 100707 · doi:10.1016/j.xagr.2026.100707 · W7221832057
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This retrospective analysis of 1,817 women found that previous cesarean sections significantly increased the risk of recurrent endometriosis by 84% compared to vaginal delivery.

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Abstract

Endometriosis is a chronic inflammatory disease, with recurrence rates of 20% to 50% within five 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. In this study, we investigated the association between previous cesarean sections and the recurrence of endometriosis. We retrospectively analysed 1,817 women diagnosed with endometriosis at our hospital. Recurrent endometriosis occurred in 125 women (6.8%). The median time to recurrent endometriosis was 7 years. Among 1,297 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=0.006), compared to vaginal delivery. In contrast, when compared to nulliparous women, a previous vaginal delivery was not associated with developing recurrence (p=0.3181). 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=0.004). 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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