Purpose <p>Isthmocele is recognized as a potential complication following cesarean delivery. Women affected by isthmocele experience an increased risk of various complications throughout their lives. The objective of this study was to investigate the clinical manifestations associated with isthmocele.</p> Materials and methods <p>A systematic search was conducted across Medline, Scopus, and Web of Science for studies potentially eligible for inclusion as of November 6, 2024. All observational studies that evaluated the clinical symptoms associated with isthmocele were considered for this systematic review. The outcomes of interest included abnormal bleeding (hypermenorrhea, polymenorrhagia, amenorrhea, and spotting), dyspareunia, dysmenorrhea, pelvic pain, vaginal discharge, and urinary incontinence. Data extraction and statistical analyses were performed using EndNote X9 and Review Manager software, respectively. The NIH Quality Assessment Tool for Observational Studies was utilized to assess the quality of the included studies.</p> Results <p>Out of 5,530 studies reviewed, eight studies met the criteria for inclusion in this review. A total of 703 women with isthmocele were compared to 754 women without isthmocele regarding clinical symptoms. The findings indicated that isthmocele was positively correlated with the incidence of vaginal spotting (odds ratio (OR) = 2.39, 95% CI 1.79, 3.19; I² = 71%, P &lt; 0.00001, N = 6), and amenorrhea (OR = 3.00, 95% CI 1.89, 4.76; I² = 0%, P &lt; 0.00001, N = 2). No other significant relationships between isthmocele and additional clinical manifestations were identified.</p> Conclusion <p>The results of this study demonstrate a positive correlation between isthmocele and the incidence of amenorrhea and vaginal spotting. A comprehensive understanding of the clinical manifestations associated with isthmocele could contribute to improved care for women affected by this condition.</p> Prospero id <p>CRD42024619952.</p>