CAN AN ABORTION TRIGGER ENDOMETRIOSIS?

Abortion is a delicate situation for even the most sophisticated of women. A universe of conscious and unconscious thoughts and feelings are connected with it. There often is an accompanying sense of fear (associated with the medical procedure itself) and a measure of sadness or guilt (United to one’s personal view of abortion). Although everyone differs in response, any woman who has had an abortion wonders how her health might be affected by the procedure: Will she be infection-free? Will abortion influence her ability to have children? Could it bring on some other as-yet-unnamed disease sometime in the future?

In evaluating my own work on the subject as well as the research of others, my scientific conclusion is this; endometriosis—as a consequence of abortion—is not an absolute biological inevitability. In fact, cases of abortion causing the disease are rare. When they do occur, it could directly involve an abortion technique, now out of favor, called hysterotomy.

Perhaps the best way to understand hysterotomy is to think of it as a mini-cesarean section. In this type of abortion, a small incision is made in the abdomen; then an internal incision is made in the womb and its contents arc removed. Surgeons make a transverse (horizontal) or classical (vertical) incision in the lower portion or lower flap of the uterus—the same choice of incisions used for full-term deliveries by cesarean section. It is this type of surgical procedure, made during the late first trimester or early second trimester of pregnancy, that could be most responsible for the onset of endometriosis.

Why is this so? In the early months of pregnancy, there are still living endometrioric cells lining the uterus that have the potential to implant themselves on abdominal organs, and on the scar, given the chance. We know that pregnancy halts menstruation, which is the usual time of transport of these cells from the uterus. Therefore, another avenue into the abdominal cavity is required before any invasive endometriotic cells can run wild. Hysterotomy supplies the route. (Full-term cesarean deliveries differ entirely. At term, the placenta is fully formed and no endometriotic tissue remains in the uterus. Therefore, there is no way for random tissue to implant itself, or spread to an abdominal incision and implant itself there.)

immediately following hysterotomy, surgeons wilt routinely cleanse the internal abdominal area of cells and blood clots with saline solution. However, in some cases, the cleansing is not effective enough; random cells that have been sprayed outward when the incision was made find a host organ. If the patient has a tendency toward endometriosis, the disease could take hold. (It is also possible that she already had endometriosis before the abortion, and the operation released other live cells.)

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