Cesarean Section and Risk of Adenomyosis: A Retrospective Study


BACKGROUND: History of uterine surgery, most notably a history of dilation and curettage (D&C), has been shown to be a risk factor for the development of adenomyosis. The association between prior cesarean sections (CS) and adenomyosis remains unclear. OBJECTIVE: The primary aim of this study is to determine if there is an association between adenomyosis and history of uterine surgery, including CS, D&C, and myomectomy. We also examine if repeat uterine surgery increases the risk of adenomyosis development. STUDY DESIGN: In this retrospective case control study we collected data from the electronic medical records of all women who underwent hysterectomy for benign indications at Parkland Hospital between January 2014 and December 2018. We then compared patients with and without adenomyosis on surgical pathology regarding history of uterine surgery, including CS, myomectomy and D&C. RESULTS: 2,911 patients were included in final analysis. History of any uterine surgery was associated with an increased risk of adenomyosis. Patients with a history of D&C were significantly more likely to have adenomyosis on surgical pathology (OR 1.57, 95% CI 1.30-1.90). There was also risk associated with repeat D&C (OR 1.31, 95% CI 1.01-1.72). The association between history of prior CS was not statistically significant (OR 1.12, 95% CI 1.00-1.37). A history of prior myomectomy was also not significantly associated with adenomyosis (OR 0.95, 95% CI 0.59-1.54). CONCLUSION: Of the risk factors explored, history of any uterine surgery, D&C and repeat D&C were associated with an increased risk of adenomyosis, which is consistent with prior studies. There was not an association between history of CS or increasing numbers of repeat cesareans with adenomyosis development. This contradicts the theory that disruption of uterine endometrium and the trauma of cesarean section predisposes individuals to developing adenomyosis. This is the largest retrospective case control study to date investigating this association, and with the results found, it can be concluded that CS individually do not increase the risk of adenomyosis.

General Notes

The 60th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, February 1, 2022, 3-6 p.m., Microsoft Teams)

Table of Contents


Ford, L., Allen, R., Wilson, A., Xiao, H., Sendukas, E., & Chao, L. (2022, February 1). Cesarean section and risk of adenomyosis: a retrospective study [Poster session]. 60th Annual Medical Student Research Forum, Dallas, Texas. https://hdl.handle.net/2152.5/9689

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