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Wednesday, January 1, 2014

Post-Endometrial Ablation Syndrome

If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome. What is post-endometrial ablation syndrome? It is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation. We are able to diagnose this at Women's Health Practice but occasionally other conditions are causing similar symptoms. Other complications of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy. If you have had a tubal ligation then it is possible that the condition could be post-ablation tubal sterilization syndrome. The ablation procedure is designed to destroy all lining tissue, but in fact there is no way to confirm the completeness of the ablation. It is thought that either residual or regrowth of the tissue is producing the symptoms of post-endometrial ablation syndrome. Well, gynos not always sure what would be causing the pain, but many women who do not have complete success in eliminating the lining tissue from the uterus may have some inadvertent consequences of the persistent menstrual bleeding on a cyclic basis. Remember the process of having an endometrial ablation does not change your hormones and the cycles persist as they were before. One source of the syndrome might be some pain due to the distention of the end of the fallopian tube that is closest to the wall of the uterus when it fills, or a part of the uterus fills with blood that cannot completely shed out as previously, thus producing these symptoms. Particularly if that tubal end is really a stump from a previous tubal ligation. In those cases small amounts of menstrual blood each month can accumulate in the tubal stump. Scarring and trapped blood or secretions in a pocket might cause it. Ultrasound might offer a solution and be able to diagnose these pockets. Other women might have a scaring of the internal structure of the uterus, for instance the cervix, preventing the outflow of what menstrual blood is produced monthly.The blood entrapped may become infected, and this could produce symptoms as well. If you do have pain, first is to try to get an accurate diagnosis. Make sure there is no infection, or ovarian condition both of which can produce pelvic pain. Rare causes of the symptoms might be due to conditions such as tracks between the uterus and the bladder known as fistulas that have been seen after a woman has had prior c-sections and an endometrial ablation. Some gynecologists can tell based on examining the uterus with a device called a uterine sound that the scaring has occurred. Other signs of the scar tissue can be see on ultrasound. Ultrasound done once, when you are not bleeding might miss hematometra, so you may want to do this again. MRI examinations may help diagnoses either hematometra (blood within the uterus) or adenomyosis (glands within the wall of the uterus). Once the diagnosis is made, then you and your gyno can establish a planned solution. For some women the solution is repeat ablation, for some the removal of the fallopian tubes, for others a hysterectomy, for some treatment with antibiotics. Please see other posts on endometrial ablation,  or review some of the GynoGab comments, questions, and answers that follow for more information.

626 comments:

  1. I had an Ablation in December of 06', (for Dis. Ut. Bleeding) 18 months later I became pregnant. During the C-Section (complications due to ablation) I had my tubes tied. Since then, every period is so painful that no heavy drug I take will find me any relief for more than 2 hours at a time. Dr. says it is most likely Post Tubal Lit. Syndrome and the only relief I will find is a hysterectomy... I find that Dr. seem to be guessing as they go along collecting huge returns for expensive surgeries. Why is it that after all these years, doctors cant seem to have a real clue as to what is happening to the female body? We can't be that complex, can we?

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  2. We counsel women that they shouldn't plan to have a pregnancy after an ablation, and yet many who do conceive have a healthy pregnancy which is important. It's fortunate that few women after an ablation have menstrual abnormalities that lead to a hysterectomy, but it does happen. Severe cases of dysmenorrhea are cured by hysterectomy, so your personal physician may be giving you the best alternative for your case. Patients who are unhappy with their care may think that the advice is motivated by financial benefit, but most medical articles and texts lead us to treat according to the most "cost effective" treatments with many aspects of the case taken into the cost formula. Women may think that the "money" for doing surgery is greater than the "money" for medical management, but actually that typically isn't true when payments per hour and future visits are figured in. Sometimes it is not just complexity, but choice that makes the decisions more difficult.

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  3. I have several questions, but will start with just one. Would it seem odd that 4 years after an ablation I have NO bleeding? I have aquired other issues but I will start there.

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  4. Actually not having a menstrual period ever again is the desired treatment effect! Somewhere between 65 and 85% of women will have this successful outcome, and older women are more likely to have this be their outcome. Hopefully your counseling or information provided helped you understand that was was your physician was aiming for.

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  5. My readings had indicated that most women do start having regular cycles, just with must less bleeding. I guess I would like to see more information on Post Ablation Syndrome. I have searched online and found very little helpful information. I should first mention that thought not directly related, I have also had a hernia repair and a very aggressive repair to that first hernia repair. About a year and a half ago now I was doing all that same things I normally do, but had added a workout routine back into my life. I had noticed at one point that my belly seemed to grow into what looked like a little pregnant belly over a few weeks. I just ignored it at first thinking it to just be my imagination, but then my ex-husband asked my one day why my belly looked like it did (and that was covered with cloths). Over about 9 months things continued on this way in a sort of cycle and with great discomfort. I went to a few different docs and came up with nothing! They assume it must be IBS because they don’t know what else it could be. About 9 months ago I started to notice that my weight has starting to increase for the first time in my life outside of pregnancy (I have now added 10lbs). My menstrual cycles have always been hard to track, but now I have noticed changes with those also. My breast now swell a great deal and the tissue has a burning sensation. I now get cramps I had never had before, to include back pain that feels like child labor. Three weeks ago I was in one of these cycles and added a very bad headache to the other symptoms. I had this headache for 3 weeks straight and found no relief from Tylenol or my butalbital. I finally had a couple days of reprieve and figure I am at the start of another cycle. That belly swelling comes and goes with the same cycle. I have now had an MRI, colonoscopy, ultra sound, laparoscopy, and a bit of blood work, with still no real answer.

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  6. I am 53 years old and had an endometrial polypectomy done Mar 12th/10 for constant spotting throughout 2009. Last full period (or, recognizable as a period vs constant spotting) was Dec. 2008. At the same time as the polypectomy, my doc also did an ablation via hysteroscope/resectoscope. My in office biopsy came back clear for hyperplasia/cancer ie: "normal". However, the pathology came back post-op with "focal simple hyperplasia no atypia". My doc is referring me to an oncologist now to see if the ablation was enough to take care of that or whether I still need 3 months of Provera on top of what's been done. Of course, it's taking forever to get an appointment with an oncologist because I'm not considered a "rush case", according to my doctor.

    My questions are:

    At 7 weeks post-op, I've been alternating between clear, watery discharge in tiny gushes and yellowish tinge to red/pink and clear fluid back to clear and yellow and now, back to pink/red/brown and clear fluid. Is this a normal time frame still at 7 weeks post-op for this to still be happening?

    And, lastly, given that they found the focal simple hyperplasia with no atypia on post-op pathology, should I be concerned? (I've read that anyone with hyperplasia shouldn't have ablation done)????

    I thank you for being here to answer questions. I'm trying to get in touch with my doctor to see if I should

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  7. Your research has served you well, the official FDA approvals for endometrial ablations have been only studied in women with no significant endometrial pathology. That is not to say that treatment successes cannot occur in women with other endometrial pathology when these things happen. Healing from ablation is individual, and it's important to work with your own physician if healing is delayed beyond the expected. That may relate to the procedure as well as the long term issues of what your pathology shows. Endometrial tissue can be evaluated by a variety of tests, and hyperplasia may be resolved by hormonal treatments in some cases, so you have alternatives you may be offered. Typically it would take hyperplasia a long time to evolve to cancer, so you likely have time for additional consultation which is the next best step.

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  8. I just wanted to thank you so much for your answer. I've put in a call to my doctor to ask about the length of time but, have yet to have a return call. Your answer has been helpful and I will work with my doctor closely.

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  9. As always, working towards a diagnosis before the treatment is preferable. Testing like 3D ultrasonography and SIS (saline hysterosalpingogram) and endometrial sampling for culturing and the diagnosis of endometritis and diagnostic hysteroscopy are useful gynecologic tests when the gynecologic diagnosis becomes obscure.

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  10. i want to further about post endometrial ablation syndrome.i really want to share about tubal reversal at www.mybabydoc.com

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  11. Anytime tubal surgery is done it would be possible that subclinical blockage could be symptomatic. It would be a diagnosis to consider. Thanks for sharing.

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  12. HELLO,
    I HAD A UTERINE ABLATION IN SEPT OF 2007 AND HAVE HAD NOTHING BUT PROBLEMS SINCE THEN . IT TOOK ALMOST AN ENTIRE YEAR AND NUMEROUS TESTS TO FIND ONE WONDERFUL DOCTOR WHO SAID IT LOOKED AS IF SOME OF MY LINING WAS MISSED AND WAS STILL SHEDDING BUT MY CERVIX WAS FUSED SHUT AND THE BLOOD HAD NOWHERE TO GO BUT STAY INSIDE. I TOO WAS GAINING WEIGHT DESPITE NOTHING CHANGING IN MY DIET OR EXERCISE REGIMEN. MY STOMACH WAS CONSTANTLY BLOATED AND DISTENDED AND I HAD PAIN CONTINUALLY. I HAD A D AND C SEPT OF 2008 AND MY DOCTOR SAID IT ALL GUSHED OUT. I FELT BETTER AT THE BEGINNING BUT NOW I HAVE HAD CONTINUAL PROBLEMS. I HAVE CERVICAL STENOSIS OF THE CERVIX WHICH HAPPENS WITH ENDOMETRIAL ABLATION AND CONE BIOPSIES. I HAVE HAD MY CERVIX CUT OPEN IN THE DOCTORS OFFICE(VERY PAINFUL) WAY TOO MANY TIMES. I HAVE READ A STENT PLACED FOR A COUPLE OF WEEKS WILL HELP BUT MY DOCTOR SAID THERE IS OTO MUCH RISK FOR INFECTION. I AM MOST LIKELY GOING TO HAVE A HYSTERECTOMY NOW SINCE THERE IS NO CURE. YOU HAVE TO DO YOUR OWN RESEARCH SINCE SO MANY DOCTORS HAVE NO CLUE ABOUT A LOT OF THIS STUFF. I JUST HOPE THIS WILL HELP SOMEONE ELSE WHO HAS NOT GOTTEN ANY ANSWERS. GOOGLE POST ABLATON SYNDROME OR CERVICAL STENOSIS OF THE CERVIX.

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  13. Cervical Stenosis is a known problem from many gynecologic procedures and whether it was from the procedure itself or a subsequent infection is never known for certain. It's a big subject and this motivates me to write a more complete review of the subject which I will do soon. Thanks for sharing some of your experiences.

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  14. I had a Novasure ablation done in the beginning of 2009. It's been over a year now. Prior to that I had a tubal ligation in 2004 after I lost my son to stillbirth. The ablation did resolve the heavy periods. However, they are still erratic. I am 43, and although my doctor said my hormones when I last tested them, were in a normal range, I still wonder if I am perimenopausal. As I used to be very regular, every 24 days. Now I either go for long long periods without one, or they are every couple of weeks. Which I was experiencing before the ablation, so that part hasn't changed. What has changed since the ablation...but more recently in the last 5-6 months, is that when I get my cycles, I am getting very severe cramping. So much so, that I have to take ibuprofen and put a heating pad on the most painful side. Which seems to be my right side. Occasionally its the other side, but mostly my right side hurts the worst. I never had such severe cramping even with the really heavy periods. Sex has also become really severely painful. I seem to be really super dry and so when he penetrates me, its almost like he's going in with a bunch of knives, and hurts really bad. Usually after I have a burning feeling. I've tried most of the water based lubricants and they don't help. The best I have found is baby oil(helps it be not as painful), but that seems to be giving me infections each time we have sex. Is there anything a doctor can do to help? I really would like for sex to become mutually enjoyable for my husband and I. I also would like the severe severe cramps to go away. After sex last night even, I developed a severe cramp in my right side, that even caused my back to hurt around my kidney area. :( Please give some advice, so I can look into what I can do to help resolve this. It's really sad, because we had hoped that the ablation would enable us to have sex more often...and now it seems to have made things worse, even though we don't have to deal with the heavy bleeding any longer.

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  15. AS with every solution in medicine it begins with an accurate diagnosis. The differential diagnosis for pelvic pain is fairly long, but would include infections, and endometriosis, and adenomyosis, and pelvic inflammatory disease as well as bowel and bladder conditions. Intercourse is not likely to be satisfying for those with burning symptoms until they solve the vaginal component, and infections and atrophy are at the top of the list of problems for those symptoms. You need medical evaluation, and it seems your symptoms can be diagnosed and treated.

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  16. Thanks, I will make an appt. My biggest fear has been making the issue even worse with further medical intervention. I appreciate that you feel its treatable.

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  17. I had a Novasure ablation done about 7 weeks ago. Things went well, however I am already back to bleeding (heavy and clots). What is the reason for this? Could I have another problem causing this? I originally wanted to have a hysterectomy, but my doc didnt feel it was in my best interest because of my age (im 28). I am done having children (i have 4) and I even had a tubal after my last pregnancy. Help!

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  18. There are multiple reasons for still having a heavy bleed this early post ablation, all of which have to be evaluated by (your/a) physician. Most likely you haven't quite healed, and hopefully this will not persist. Other possibilities have to do with whatever was the cause of the heavy menstrual bleeding before you had your procedure: were there fibroids or adenomyosis, or polyps or endometrial hyperplasia or ovarian causes such as hormonal issues, or bleeding causes such as too much asprin use or von Willebrand's disease? And infections can cause heavier bleeding as well. Once a diagnosis is established then a treatment can be suggested. For those with nothing specific going on the new medicine Lysteda might be a solution.

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  19. I had uterine ablation in 2007. Found out after a year had scarring from ablation and periods were backing up in me. Had 3 other surgeries due to this thinking it might be something else going on. this last year I have been going in monthly to get dilated in the doctors office which is very painful. If I don't do it then my period will not come. I can't see doing this monthly because it is very painful. What is the treatment for this? Is the only remedy a hysterectomy??

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  20. For women who still have bleeding one thing to discuss with your gyno is how to get that bleeding to stop. Obviously if you don't bleed, you'll be less likely to have the issue. The other option would be to try to get the lining to re-grow in the lower segment where it is constricting off. It is unlikely that the process of dilating is going to be more than a one-cycle fix as you've discovered. So you need to talk to your gyno or get another opinion. And ultimately a hysterectomy may be the only option, but hopefully not!

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  21. sparker in st. louisJuly 10, 2010 at 8:26 PM

    After suffering from extremely heavy periods following the birth of my three children (in five years), I eventually had Novasure and my tubes tied 5 yrs. ago. I was one of the lucky women whose periods ceased altogether, and for four years, was thrilled with the result of my surgeries. Then, about a year ago, I found myself having intense pelvic pain on both sides of my lower abdomen(feels to me like the source is my ovaries or fallopian tubes, but the doctors keep insisting it's my uterus.) The pain is cyclical (every 21 to 28 days) and occurs intermittently over a period of one to three days. I think of this as my "unperiod" as even though I am not menstruating, my boy feels as though I am. Along with slight bloating, I feel moody, fatigued, crave salt/sweet foods, and have back and inner thigh pain. Although I work, I am uninsured, and have resorted to increasingly heavy doses of painkillers to make it through these spells. Sometimes a heating pad helps, but usually I just have to knock myself out to escape the pain, which at times comes in waves like labor contractions. I had a pelvic ultrasound with transvag. and it showed nothing out of order with the ovaries or pelvic cavity. Since doubling over at work a few weeks ago with such intense pain, I ended up having a talk with the gyno who did my ablation/tubal ligation. He's diagnosed adenomyosis and says I need a hysterectomy. He says if I had insurance, he might try a D&C or something less permanent, but he doesn't want to bankrupt me with the possible cost of multiple surgeries, so he suggests just taking out the uterus and cervix and leaving the ovaries. At 47, I'm already experiencing some perimenopausal symptoms. I'm really concerned a hysterectomy will throw me into full-blown menopause and the resulting consequences to my heart, bones, thyroid, and mental state. I've been treated before for depression/anxiety and have been meds-free and living a healthy lifestyle for nearly 10 years. I don't want to jeopardize the rest of my health if it can be avoided. So, I sought a second opinion from another ob/gyn I have seen in the past, and whose opinion I trust. He agreed with my current doctor that I should have the hysterectomy. He agrees with the diagnosis, and also says I could have Pelvic Congestion Syndrome, as I had varicose pain in my groin during my pregnancies. Until researching myself online TODAY, I never knew there even was such a thing as Post-ablation syndrome. Neither physician mentioned this as a possibility. Also, I wonder why no one ever told me that ablation is not recommended in women who've had c-sections (I had two, plus a forceps VBAC w/ 4th degree episiotomy)I'm confused, scared, and dreading the return of the debilitating pain. The cost of a hysterectomy will burden me with debt I am not equipped to take on presently. If I do have adenomyosis, is this a condition that will stop on its own when I go through menopause? At 47, I'm probably getting close...drugging myself for a few days each month is unpleasant and frustrating, but I'm afraid having the hysterectomy will bring its own set of consequences, financially, emotionally, and physically. What do I do??

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  22. So, second opinions are good, but sometimes you need a second opinion AND a NOTE TAKER you trust (a buddy) to just listen and take notes. And then it helps to sort out your choices. I do not want to presume to treat over blogs but here are some key facts:
    1. Hysterectomies without ovarian removal should not throw you into full blown menopause
    2. Adenomyosis, MIGHT, be able to be diagnosed on ultrasound or at the time of a diagnostic hysteroscopy
    3. A hysterosalpingogram might be able to diagnose whether there are blockages or scaring that could be contributing
    4. Patients with C-sections ARE still ablation candidates, but their success rates may be different, also they may have special problems with hysterectomies
    5. PMS/PMDD symptoms including eating, mood changes etc are more likely due to hormonal issues, ie something OVARIAN, not uterine, and uterine removal will not change that (menopause, however cannot be far away for most 47 year olds and that will change things as well! It sounds like you have good physicians and have considered alternatives and that most physicians feel that in the end you are the one to make the best choice for yourself. Thank you for sharing you thoughts!

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  23. In 2004 I had a tubal during my c-section with my last child. While I used to have normal periods prior, i ended up with very irregular periods after the tubal including heavy bleeding on my 2nd day of my period. I was told about an the novasure ablation and how wonderful it was. I ask about side effects and he told me that there were none! The ablation seemed a success until 8 months later. Extreme pain on my left side that Motrin wouldnt touch. I couldnt get comfortable. Then later the pain would go away but I would have bloating, tenderness in my lower stomach, diarrhea, and felt achy all over. Then I would go throught this 3-4 more times until my cycle was through. This always happens when I should have my period although I dont bleed anymore. What is so frusterating is that my doctor would not believe me until I printed off many womans testimonials and gave them to him. Then he acted embarrased. I feel lied to! Im having a hysterectomy this Thursday.

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  24. Post hysterectomy many answers become even clearer once the pathology is determined. I hope people write in what the pathology either confirmed or refuted about their case (although probably still not the whole story. And I want all those to consider that it is the minority of women who wind up with post endometrial ablation syndrome and I am a firm believer that this is an excellent alternative and does help to avoid hysterectomies in many women. Thanks for your story.

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  25. I was the one who posted last. Why arnt doctors telling us women what could happen especially women like me who had 4 c-sections and a tubal prior? I asked my doctor if he now intends to tell other patients who are looking to go through the Novasure, the possible problems that could happen. He said no because Im the rare exception. Now thats not fare for someone down the road who will go though what some of us are going through. Maybe for some it works but for others, like me, there should be something said about possible difficulties.

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  26. Consent process can be difficult and each case has to be treated individually, and it's When having a procedure women should hopefully find out the pros and cons of having the procedure, the pros and cons of not having the procedure and essentially the same for the alternatives.And the topics of infection, pain and bleeding: long term and short term, typically are covered in these discussions. There are many resources as well and I will start to surf patient outlets and try to get to a new post regarding them.

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  27. Thank you for your reply, although I am still uncertain about what to do. Like Anonymous, who posted after me, I wish my doctors knew (or bothered to mention)post-ablation syndrome. Though I'm having difficulty now, I'm not sorry I had Novasure, as it brought me four solid years without heavy periods with the horrible pain I had each month with them. Now the pain is back, but at least I'm not having to deal with the bleeding as well. I have not entirely ruled out hysterectomy, but I'd like to investigate less invasive treatment options. I hear there's a test to determine how close, or if, a woman is in menopause...if I'm close to menopause, maybe I could take birth control pills (the kind where you skip your period altogether) for a year or so, and then go off them and see if the pain returns? Or maybe there's an option I don't even know about yet? Also, if I DO have adenomyosis, why am I feeling the pain in the area of my ovaries? It feels very similar to when I was younger and had a blocked fallopian tube! It just really bothers me that the answer to everything seems to be "cut it out." At 22, I had a doctor tell me I needed a hysterectomy (due to abdominal pain), but after seeking a 2nd opinion (from the same doctor I just trusted with this 2nd!), I learned I had IBS!

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  28. Sparker, I had c-section with tubal ligation in 2004. I had the endometrial ablation in 2006. I had no periods and no pain for past couple years. I always had painful heavy periods and took birth control or Depo Provera shot. Recently over the past couple months, every 10-15 days I get light periods but severe cramping for 2-3 days. The light bleeding lasts for 5-8 days. I have no idea why this is happening to me, I am only 39!

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  29. In young woman who has had an ablation (you were about 35 when you had yours), four years later it's not unusual to have lining regeneration, and if lining has regenerated,menstrual bleeding will resume. Ablations won't control the reasons for irregular periods, in other words they won't change the hormonal reasons women can have long or irregular cycle. So testing has to be directed at 1)how much lining has returned and 2)what is the cause for the bleeding episodes to be so long. Then you can consider treatments, and one consideration might be just to repeat the procedure! I have had another post on that issue as well! Age 39 could just be typical start to the perimenopausal years as a possible guess as to what is going on hormonally. Thanks.

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  30. I had my tubal after the birth of my second child in 1998. My periods became so heavy I could not leave the house on the third day. This lasted until I had my ablation in 2007 . Yes i dealt with them for that long before learning that there was something I could do about it. After the abalation, my periods stopped . Never having a problem till now. I still dont have a period but When i have sex with my husband I bleed after. This has never happened and i feel like I am pregnant. Morning sickness, cravings,breast tenderness etc. What could be wrong with me ? Havent been to the dr , I was afraid they will think I am crazy . I do have some pelvic pain but its not bad. any Suggestions ?

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  31. Anyone who feels pregnant needs to first be accurately checked for pregnancy! Ablations are not designed for contraception. And if not, you are having systemic symptoms that may be related to other hormonal syndromes such as PMS or PMDD. You do need to check with your physician as post-coital bleeding (after sex) can also be a sign of infection. Thanks

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  32. I am 45yrs old. I had the ablation due to heavy bleeding & "extreme" pain every month that had been going on for years & getting worse. I asked my obyn several times about side effects or any possible issues from the surgery before having it. He kept saying, I would have some "minor' pain & discomfort for a couple of days & then i would be fine.
    I had the surgery 11/20/09 & Directly after had severe left leg pain. The surgery was done on a friday. Monday i called my obyn & of course was given to the office nurse that just repeated the same thing the dr had said before the surgery. The next morning i called again, Again was given to the office nurse that was extremely rude & said they have done thousands of these procedures & have never had a problem w/anyone but me. And they would not reschedule my check up for an earlier date. When, I did have my check up the obyn said that..The problem w/my leg is probley cuz i'm so short & it would be fine in a couple of days. i'm 5'3.
    I ended up at the emergency room 01/05/2010 as my leg hurt so bad it felt like it was going to fall off. After a # of appts w/dr's_I was diagnosed as having_neuroplaxia. Severe nerve damage in my leg from the surgery. It is now August 2010 & my leg is still in pain, I am unable to walk w/out the assistace of a crutch as it kills me to put complete pressure on my leg. I truly wish i had never had the surgery. I still have my period & no the bleeding is not as heavy but i still have the "extreme" pain w/it every month. On top of my leg still being an issue. And the neuro specialist says_There is nothing that can be done in reference to my leg that it will take time & has to heal on it's own. There has been no change in my leg & my regular dr says it may never get better. I can not continue to live this way. Is there "ANYTHING" that can be done???
    I am despeartly waiting your reply.

    Thank you,
    Signed: In pain & frustrated in Vermont

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  33. I know that these stories to the patients always start with "I had an endometrial ablation", but as a consultant one would ask, what medically led up to this? What was your diagnosis prior to the ablation, was it really just heavy menstrual bleeding? Monthly severe pain indicates something else may have been going on to begin with. "The term you use, "Neuroplaxia is not a medical term I am familiar. There is a medical term neuropraxia which means nerve damage. But something is off with this diagnosis in a case like yours, although it is possible. Cases of this are reported after complex pelvic surgeries, but for heat damage to go so far as to cause this, I'm having a hard time physiologically understanding how that could have occurred. I cannot presume to make a consultation on a blog. But as a general guideline anyone with walking difficulties and possible nerve injury post surgery needs a consultation with a neurologist who can make sure the individual has a correct diagnosis the nerve (in this case your leg). Once a firm diagnosis is made, then the prognosis can be discussed, and yes, nerve damage after surgeries do usually resolve over time. But neuropathic pain can be treated, so suffering can be diminished through pain treatments. After you deal through a neurologist a second opinion gynecologic consultation can help to understand what could cause cyclic symptoms. Vermont is near many very renown medical centers. Good Luck.

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  34. Hm. I wonder if this might be going on with me. I've had two surgeries due to Endometriosis, the second with appendectomy, (to learn that my appendix had adhesion that made it stick to my pelvis). I have really painful periods still and I clot horrifically. I've tried just about everything... I try to just take pain medication and work with it. It's really difficult at times.

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  35. Post endometrial ablation syndrome is a problem that women have after they have had a specific uterine treatment called endometrial ablation. These are surgeries like NovaSure or ThermaChoice or HTA which are all excellent procedures. This procedure would be a good treatment for your heavy clotting periods! Ask your gynecologist if she preforms these.

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  36. I had ablation in August of 2007,due to irregular bleeding and painful periods.At first I thought it was a dream come true, a year later I startert to have severe lower abdominal pain, at first it was very intermittent. By May of 2010 I was experiencing it way too often along with painful ovaries and pain shooting down my right leg. I was sent for an intrauterine ultrasound which diagnosed complex cysts on ovaries fibroids in uterus, in addition I had a slightly elevated ca125, so my gyn decided to schedule me for laparoscopy, which I had done 2 weeks ago. She removed and cauterized cyst and removed some endometriosis, I was recovering well, when the pain returned a week ago and has not let up since. I dont know what to do with myself. I had another intrauterine ultrasound 3 days ago which they said was normal except the fibroid is larger. I have an appointment to see my gyn in 2 days. Any suggestions please??

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  37. Seeing your gynecologist is absolutely the right thing to do. It is also a good idea for patients to make sure they gather all important records if the current physician didn't do the surgery. Operative notes, pathology reports, laboratory tests and ultrasounds are the most important tests to keep track of. For women with cysts Ova1 test may be helpful, it's very new, a blood test. Thanks for writing, and I hope you become a regular follower.

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  38. I am 44. Had heavy bleeding with clots for three months straight in the fall of 10. OB put me on oral contraceptives with no break for 2 1/2 months - no bleeding during this time. Started experiencing shortness of breath, have asthma, so I didn't think anything of it until I had an awful excruciating pain in my back every time I breathed. I ended up in ICU with multiple blood clots in both lungs - very scary!!! Now am on coumadin until January, and of course the contraceptive was d/c'd. I was worse than before, with coumadin being a blood thinner, the bleeding was worse than ever and I required blood transfusions. Had one ablation that failed due to an "over dilated cervix", then had another ablation that was successful on Aug. 9. Just having clear discharge, but the pressure I feel in my abdomen is at times very painful. At the end of urination, I feel the most unbelievable pressure in my pelvis. Feels like my uterus is a heavy iron ball in my stomach all the time. Will this go away? Just to note, I have had three c-sections. OB office said it's normal. Also have no appetite whatsoever. Any advice would be greatly appreciated!

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  39. Urinary pain and pelvic pressure may be linked, but they may not be. Women with urinary symptoms need to be evaluated for UTIs, urethritis, diverticula, stones, or other causes of what you describe. Most of the work up is straight forward. If that doesn't reveal the source of the pain, then attention can be focused on the uterus or an ovarian cause of your pain. Thanks for contributing.

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  40. I had an ablation 2 years ago, due to heavy and painful menustrations. Now I am experiencing cramping and bloating, along with sore breasts. ( I almost feel like I'm pregnant) I have been told by my gyno, that I have a cyst on my ovary. Could the cyst be causing me to feel this way?

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  41. Ovarian cysts can cause pain, and sometimes the pain is worse when they are actually leaking and resolving. Bloating and sore breasts may be more hormonally mediated, and ovarian cysts can disrupt the hormone cycles. So it's more likely that your symptoms are due to the cyst than to the ablation. Ovarian cysts can be well seen and tracked on ultrasound, so keep your follow up appointments!

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  42. HI! I had an endometrial ablation in October 2009 due to PCOS and painful periods and very heavy bleeding. I am 34 years old, have had 4 children (1 vaginally 3 c-section). When I first had the ablation I felt great, no periods or irregular bleeding,just the "normal" discharge the doctor warned me about then after around the 3rd month I noticed that atleast every 2 weeks or so I started bleeding black looking blood for 1-2 days.Now I still have the "old" looking blood along with heavy clear, sticky discharge.My pain has also returned and sometimes I feel like something is going to fall out of me. My question is this...Is this normally what people experience after ablation? If not, then what could the problem be?

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  43. An endometrial ablation is designed as a destructive procedure to the lining, the lining tissue has ability to regenerate and thus begin the process of shedding again. Once some of the lining regenerates, then the hormonal cycles of the ovary may be leading to the disordered nature of the shedding one experiences. The color of blood cannot always determine the nature of the bleeding, but, in general, blood exposed to oxygen will tend to darken and obtain that color some patients describe as black. On the other hand other conditions can do that as well. Nothing about the the ablation is designed to fundamentally address the hormonal issues of a woman's PCOS. So in a case like yours both the anatomy of the uterus and the cause of the disruptive cycles have to be addressed.

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  44. I am scheduled to have a hysterectomy in October for unresolved and undiagnosed ovarian and pelvic pain. Had laparoscopy with cysts and endometriosis removed..all were normal. My ca 125 is 27, should I be concerned with this number? Some say under 20 is normal some say under 35?

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  45. CA125 is a test that has many reasons for false positives and false negatives. Realistically one value cannot be interpreted without knowing the whole case. There is a new test that is more accurate than the CA 125 but your physician may not yet have access to this test. If you are uncertain of your decision it is reasonable to get a second opinion.

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  46. Dear GynoGab Girl-I was diagnosed with adenomyosis at age 35. My doc put me on 200mg bioidentical progesterone for a few years to help the condition but it didn't really help. It made my brain foggy and hardened my breast tissue. I still went through 2 D&C's and an ablation to hopefully correct the condition. I stopped using the prog. crm. before I had the ablation(@age 42). Now I am 44 and my new doc diagnosed me with post-ablation syndrome. I barely bleed but have a lot of pain. I have a foggy brain, an extremely dry vaginal canal, headaches & fatique. It seems there is vaginal atrophy as sex is painful. The vaginal canal feels different and KY Jelly gives me stinging pain as well. I worry that the pain from adenomyosis, ablation & culposcopy is spreading to the vagina. I have pain now off & on almost all the time. I had started on bioidentical estrogen w/ some progesterone last year which seemed to help the vaginal dryness, but my new doc took me off the hormone & says taking estrogen makes the adenomyosis worse. I am not sure I agree. The adenomyosis has continued regardless of hormone usage. I had tried to walk through this situation conservatively, but now I am having a hysterectomy in 3 weeks anyway. My questions- 1)if my vagina has atrophied, what are the chances that will improve with hysterectomy (uterus & cervix)? 2)What are the chances that sex with my husband will no longer be painful? 3)Do you agree that taking estrogen will help the vagina's wetness/lining improve as well as decrease brain fog, headaches and the like?

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  47. Your history is complex, and there's no treating or diagnosing over the internet. Vaginal dryness and atrophy respond to appropriate therapy with estrogen. The "bioidentical" term may or may not be exactly what you need, but you should be able to be treated. Adenomyosis is treated by hysterectomy, of course it goes away with menopause, or with treatments that simulate menopause, but hysterectomy is a standard treatment. 'Brain fog' is not in our medical dictionaries, so 'not able to comment'...kidding aside, women can suffer from mild cognitive impairment that should be worked up seriously.

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  48. I had an ablation about 4 years ago. Up until this summer, everything has been fine. No pain, no bleeding, everything good. Recently, I've begun to experience severe pain. It's worse when I would be having my period, but it's painful all the time. My doctor said it was post ablation syndrome and that he could do a D&C or a hysterectomy for it. He ordered an ultrasound to check for fibroids or cysts, and everything was fine. If this is post ablation syndrome, would there be any observable evidence on u/s? I hate to consider something like a hysterectomy if I don't have to.

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  49. I always remind patients that an important part of a work up for pain should probably include a work up for infection which would not necessarily show up on an ultrasound. Some individuals develop small pockets of fluid that can be seen on ultrasound, but it is true, some cases may only manifest on a microscopic level and not really show much on testing as you point out. Thanks for your story.

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  50. Post Op for ablation surgery month 2. The first month was an easy cycle with little spotting! SO excited! PMS and other symptoms were little to none. I hardly noticed!

    I do not want any other children, so I chose this procedure to help alleviate the heavy flow which limits my activities.

    Second cycle is a nightmare! Heavier bleeding for days that was as much or worse than my pre-op cycle. Four days ridiculously heavy, one day nothing, and now it's back again.

    Is this a normal reaction?

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  51. Typically most women will still bleed in the first month afer the procedure, and then the first menstrual period may or may not already have a successful outcome. The proceufe is usually accompanied by a D and C type operation. In otherwords, your physician likely cleaned out much of the lining tissue before the base of the lining was treated. Thus, the very first period is goood, as any first period may be good after a simple D and C, but that doesn't really mean the fundamental changes have occured that will achieve long term success. Long term success depends on many factors: the underlying cause of your bleeding, the size of the uterus, the device selected, to just name a few. During treatments we are now trying to move towards a clearer determination for our patient of long term goals of the therapy. So you want to go over those long term goals with your physician. How did your surgery go for instance? Does she or he expect this out of your second cycle? When a woman has an ablation, the ultimate success is not usually determined until 3-6 months afterwards. What is the most important is your quality of life. If you don't have what you perceive of as benefit to your quality of life, then, no matter what the statistics say, you have not gotten a successful treatment. Thanks for your input and hope you continue to follow our discussions!

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  52. I had the Essure Sterilization in March 2010. Wanted to have an ablation at the same time for heavy and painful periods - heavy coming every 3 or 4 months but all cycles painful all the way through. My Dr. indicated the Her Option Ablation was best and recommended I wait until after essure confirmation. Now that I am past that I have experienced very uncomfortable pelvic pressure all month long for the past 2 months. Not sure if I should do the ablation now?

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  53. Several issues are being discussed...it is tempting to do both the ablation and sterilization together, BUT lots of reasons not to...the best one medically is the fear that when it comes time to do the check to see if the tubes are clear or blocked your physician may have a hard time getting the information if there's been a recent ablation. It's possible you could be a candidate for Lysteda for a cycle or two, or a cycle of pills. I'm not clear on the nature and time course of your pains, so it's possible something else is going on. I'd rely on further testing before giving my patients more advice. Thanks.

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  54. I am 42 years old. I had an ablasion done in 2002. For the past 5 years I have been living with severe pain with my cycle which still comes faithfully. It is a light flow, but the pain is intense like labor. My legs hurt severly and at times I vomit from the pain. I don't understand how a procedure I had to help could have backfired and made things so bad. I am scared and dont know what to do.

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  55. From your story it seems that you did have a couple of years that were better, then a worsening. The fact that this developed over time is more suspicious of endometriosis or a fibroid than strictly a complication of ablation. An ultrasound done at the time of your period would be able to say if fluid is backing up into your uterus to produce this pain. Only a laparoscopy is fairly accurate to diagnose endometriosis, so most physicians will work up other causes. I would quote a guru of mine who said "knowledge conquers fear," it is is one of my favorite sayings, but alas the author remains unknown. Her (his) words could bring you guidance, you need a medical work up to first get a firm diagnosis.

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  56. Hi there. I've read pretty much most of the comments and some women seem to be really going through so much that I hate to take up any room but would appreciate any advice. I had the ablation done a year ago after having non-stop periods for over 8 years. The only control was to take oral contraceptives (2 a day), but those would only give me about 10 days a month without bleeding, and a period the rest of the time, and put my blood pressure high. Without it, I was having terrible flooding situations on top of the never-ending periods. I have a bicornuate uterus so the Mirena wasn't an option and I really hoped this ablation would work, but I find myself a year later with albeit a lighter period, but still some occasional flood situations and a period lasting at least 10 days, with so much swelling of my abdomen and cramps. I hate to bother a doctor as I feel these might just be the side effects to live with, but on the other hand, would hate to just ignore signs of things that could be dealt with. I also have an unbelievable ache in my hip that radiates down my thigh and it takes 4 extra strength tylenol to allow me to sleep with the pain. I've had a lot of stress lately so I'm wondering if all this is more stress-related than the ablation having side effects. I didn't have a tubal ligation, but did have a c-section when my child was born. If you could offer any insight, I would really appreciate it. Just want to know if I should bother a doctor about this, even the GP, rather than the busy gynecologist. Thanks for taking the time to read this.

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  57. Women with a bicornuate uterus may not get complete destruction of the lining of the uterus when they get standard ablations with Thermachoice or NovaSure, and might actually do better with the HTA ablation. I'm not sure what procedure you had. And women who didn't get successful control of bleeding with birth control pills prior to ablation, may have more luck post ablation. Time to go back in to your physician, maybe with your bleeding calendar in tow...mine used to be at this link
    http://womenshealthpractice.com/pdfs/menstrual_chart.pdf
    not sure why it's not coming up today...but will ask the webmaster...ST

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  58. I'm 45, and I had a healthy uterus until I had a Novasure ablation in January 2010 for DUB, which was caused by the hormonal changes of late stage perimenopause. My periods stopped afterward. I'd also had a tubal ligation many years earlier.

    In early June I started having daily bouts of severe pelvic pain (10 on a 1-10 scale) that lasted 2-5 hours. Sometimes I'd get more than one pain episode a day.

    My GP misdiagnosed me with diverticulitis. He also did an ultrasound, but it came back negative. I was in and out of the ER with severe pain, but ultrasounds and a CT scan showed nothing. Finally, I was given a colonoscopy in July. It showed that I had no bowel diseases.

    Two days later, I was in the ER again. This time, an Ultrasound showed that I had a hematrometra. I also had a sky high white count. A local OB/GYN came in to see me and diagnosed me with "Post Ablation Endometrial Syndrome," endometritis, and possible cervical stenosis. She thought I needed to be admitted, given IV antibiotics, and an emergency hysterectomy. She tried to dilate my cervix but couldn't.

    I decided to see my out of town OB/GYN instead to see if he had another solution as he's more on the cutting edge of technology and is the one who gave me the ablation.

    At first, he denied that the ablation caused my problems, and tried to blame it on a bladder infection, but when he saw that my husband and I weren't buying it, he admitted that I had Post Ablation Syndrome. But he said he could fix it. He also dilated my cervix and drained fluid.

    He gave me a DNC, a laparoscope, and a repeat ablation on August 30. He also found a 3 CM fibroid inside my uterus, which he removed (it was a surprise--it hadn't shown up on the ultrasounds). He told my husband and I that I'd only have pain for a couple of days.

    Afterward, I had mere spotting, but the severe pain returned within two days. And four days later, I had a huge gush of black blood. Horrified, I went to the ER again. An ultrasound showed that my uterus was full of tissue and fluid. A local OB/GYN on call wouldn't even see me, and sent me home with instructions to see my OB/GYN whom I saw within 3 days.

    The pain had stopped the day after the gush, but my cervix had closed up again. He had to open my cervix yet again and drain fluid.

    But this time, he told me that I need to have a hysterectomy. He said the pain may be gone, but it will come back when the uterus fills with fluid again, and so he suggested that I have it as soon as possible. It will be an abdominal hysterectomy as I want to keep my cervix.

    And that's where I am right now.

    I've been through hell with this all summer, and I'm so upset about it all--the way the ablation destroyed my uterus and cervix, the misdiagnosis and feet-dragging of many doctors all summer while I suffered, and now the upcoming hysterectomy. I don't want to have a hysterectomy, but there's no other choice. After what it has done to me, I think ablations should be banned. I question their value and wonder if doctors are pushing them to make an easy buck on the multitudes of middle-aged women with heavy late stage peri bleeding. It seems that most women end up with a hysterectomy after having one anyway. And I don't believe the stats. I think a lot more than 10-25% of women have trouble afterward, some maybe years later. I also think that many women are probably misdiagnosed with something else, which is why the stats favor a positive outcome with ablations. Another question is, how many doctors are purposely misdiagnosing post ablation syndrome with something else out of fear of lawsuits? It seems that no one wants to take the blame when the pain and problems start afterward.

    And I hope that any woman who's thinking about getting one will think twice, because the kind of hell I've gone through is not worth lighter periods. I can't express enough how much I regret having one. I would have only been a few years away from menopause anyway.

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  59. It is good to share one's story, and it's always important to remember that before the ablation is done it's important to contemplate alternatives. As you can probably tell from my answers I still do believe that ablations are an excellent choice for many women. As a physician, I cannot endorse the idea that there is a wide-scale "purposeful misdiagnosis", in fact I would say, that is blatantly not true.Remember, working with a physician has to be a partnership, and it's important that you seek a provider you can have an open-hearted relationship with. Because most physicians have had so many success stories with their ablation treatments, and many many long term cures, it's very likely excellent doctors have not encountered the complication of post endometrial ablation syndrome at all. Its very important to many of my patients to not have a hysterectomy until alternatives can be tried. That being said, for many women, having that hysterectomy right away is important. From the medical interpretation of a case like yours, and what I am not sure of from the standpoint of the stories I read, and what is so critical for women reading to remember: What does the testing show before your ablation and what alternatives are you given as an individual patient? If you have an alternative that is acceptable, then it should be tried. Oral contraceptives, Lysteda, cyclic progesterones, NSAIDs are just a few of the choices. And a hysteroscopy or a saline infusion ultrasound test may be helpful before you move on to the ablation. I welcome doing second opinions for patients. For the women that avoid hysterectomy, they are lucky to have encountered endometrial ablation as a choice. I wish you luck, do a lot of reading about the retention of the cervix, that can lead to retained pockets of blood as well. Thanks.

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  60. I had an endometrial ablation Novasure with a D&C first..approx 2 years ago to treat heavy bleeding. I did have a U/S prior to the ablation to check for fibroids. I had a tubal done approx 10 years ago. I am 49.
    Within the last 4 months I have been experiencing severe pain in my abdomen (cramps)which radiates to my right side (ovary area) with a severe lower back pain and front thigh pain (during my cycle.) I have also experieced what could be described as groin pain that comes and goes on my left side. Almost feels as if an artery is affected.
    I have never been in labor but I'm pretty sure this is what it would feel like. The pain comes in contractions and last for approx 3-4 days. Other days of the month are not completely free of pain, but nowhere near as severe.
    Early this year, I presented with what was thought to be untreatable yeast infection although all the cultures were negative. Don't know if ablation syndrome has any relation to this type of issue. I was tested for infections, STD's etc. Everything was negative. After using A&D ointment vaginally and lubricant during intercourse....watching contact irritants ie fabric softener, bleach, soaps etc., this resolved after about two months. Occasionally I do feel stinging in the vulva and opening of my vagina without any known cause.
    I went to the ER with extreme pain last month early August(cycle) and bloodwork showed an elevated WBC. The ER staff suspected a ruptured ovarian cyst or appendicitis. I had a CT scan which was negative. Sent home on pain medicine. Days later the pain subsided only to return two weeks ago Sept(cycle). I went to my Gyne and he suspects Post Ablation Syndrome. I had a U/S this morning, including vag U/S and it did show a pocket of fluid in my uterus and several small cysts on my right and left ovary. Does the pocket of fluid remain indefinately? Does it increase monthly as to why the pain has increased over the past 4 months? From what I have read about PAS it seems the lining that builds has nowhere to shed and remains stuck. Could you explain in detail what happens with PAS. Is hysterectomy the only cure? I do not want to be put into drug induced menopause. My gyne feels that hysterectomy would be the best treatment. I still have to wait and talk to him about my test results. Also, can PAS cause an elevated WBC? My gyne feels that the stuck fluid can cause an infection. He wanted me to try an atibiotic (Tetracycline family) of drugs. I am against meds unless they are absolutely necessary. Thank you in advance for any info you can offer.

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  61. I have been experiencing severe abdominal cramping, labor type pains 2 years post ablation. I did have a U/S this morning which showed a pocket of fluid in my uterus and small cysts on both of my ovaries. A month ago (last cycle) I went to the ER with what I thought was appendicitis My WBC was elevated. The CT scan produced negative results.
    I did have a tubal 10 years ago. I am 49 years old.
    Could this be PAS and is hysterectomy the best cure? I don't want medicine induced menopause. What would cause the WBC to be elevated? I
    Today I am 10 days past the start of my last cycle and the fluid was present. Does this remain indefinately and become worse over time with PAS? Thank you in advance for all info you can provide!

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  62. To the secon to the last comment: A and D ointment is not a lubricant that shoud be used internall first of all, but likely is not contributing to your symptoms. Uterine fluid on a single ultrasound is very common, even seen in very post-menopausal women, so one ultrasound with fluid cannot make the diagnosis of post endometrial ablation syndrome and would need more consultation from your physician. And to the last reader, elevated WBC count can be produced by many infections, both systemic and local. You need to have cultures and further tests to figure out if the infection is really in your uterus. Good luck with your care, and thanks for writing.

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  63. How is Post Ablation Syndrome diagnosed?

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  64. For a discussion on aspects of how to diagnose PAS please see
    http://gynogab.blogspot.com/p/gyno-911-topics.html

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  65. I had a tubal in 2005 and NovaSure in March 2010. Since the procedure my periods are lighter and last about 2 days, but my cramps are severe and worse than prior to the procedure. Motrin does not help and I bought a heating pad (which I haven't used since I was about 16). My doctor does not seem concerned about my pain, but I've set up an appointment to coincide with my annual exam in early Dec. I'd like to arrive at that appointment informed about Post Ablation Syndrome with educated questions to ask her and possible tests to be considered. Any information or suggestions would be appreciated.

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  66. Tracking your symptoms, both bleeding and pain and their timing is going to be helpful. Finding out if you can get a 3D ultrasound or a color flow ultrasound to help determine whether there is entrapped fluid pockets is going to be the most helpful way to diagnose this condition. I am trying to update the Page on Endometrial ablation
    http://gynogab.blogspot.com/p/gyno-911-topics.html
    and will be trying to get some references there for you as well.

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  67. Thank you 'Gyno Gab' for answering my questions so quickly. I'm gathering information and will track my symptoms as recommended and reference your link/references. Your timely response and knowledge is terrific!

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  68. Thank you for joining the discussions and we all hope you have a successful conclusion!

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  69. I had a unterine ablation in May, 2009. I had bleeding so heavy there were days I literally could not leave the house. It hit its peak in December of 2008 when I began bleeding and it didnot stop until the ablation in May, 2009 which was done instead of a hysterectomy. I also had numerous fibroid tumors that apparently resembed a field of crops. Since then I have had sporatic periods which I do not mind since nothing compares to my misery before but I just had a veeery light period but accompanying it were cramps and pain so severe on my let side that I was in tears for two days. It hurt to stand up straight, cough, sneeze, or even go to the bathroom. It seemed like the pain was coming from my left ovary. This light period followed 4 months of no periods. Should I be worried?

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  70. first of all I try to remind women that the use of uterine ablation technology is not specifically an FDA approved treatment. That being said, as with many medical conditions often thoughtfully recommended treatments are not within the specific guidelines of the product. Uterine linings can still be treated by an ablation in women with fibroids, but relapses in the way of bleeding with or without cramping may be more common. I love the "field of crops" analogy for your fibroids, but if a gyno was doing a consultation in her office, actual pictures, measurements, and fibroid locations would need to determine the extent of the fibroids and how they might impact on the long term success of your ablation. The recurrence of bleeding after an ablation is relatively common, in fact, on average, only about 4 out of ten women will not be bleeding at all at the end of a year after the procedure. Pain with bleeding is always more concerning, but menstrual cramping can be strong and perceived of as a significant amount of pain. See your gyno for actual diagnosis.

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  71. I too have been "somewhat" diagnosed with PAS.
    Can't wait to get a HYSTERECTOMY!!!!!
    I have been in EXCRUCIATING cyclic pain, for about 5 months / 2years post ablation, 10 years post tubal ligation.
    I do believe that endometrial tissue (blood) is being trapped in my uterus and my right fallopian tube. (A U/S confirmed fluid pockets in my Uterus.)
    Not sure why the ablation failed. I have read where it is more likely to fail if you've had a tubal ligation or endometrial problems prior to the ablation.
    My right leg, front thigh area, and lower back are in pain, also.
    I would love to know just what the failure rate of this procedure is, and why this is not discussed upon consultation prior to the procedure.
    I think as more ablations are done, there will be more reports of these adverse effect, especially since pre-testing for endometrial issues are not always conclusive as a contraindication for this procedure.

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  72. All products used for ablation do have package inserts, patient handouts, and their typical success rates listed on their websites. So hopefully most women are getting the benefits and risks laid out for them so that they can make a good choice when choosing ablation. Success rates are very high, in the over 80% range for most women, and your own physician can help you understand factors in your case that would make you more likely to have a successful outcome. Even for women who some day need a hysterectomy they can delay that hysterectomy through other important times in their lives. Good luck in your surgery.

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  73. At first, total endometrial ablation seemed extremely safe in the short term. However, as time passed, certain unique long-term complications became evident. The problem is that after this procedure, intrauterine scarring and contracture can occur. Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and cause problems such as central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde menstruation, and potential delay in the diagnosis of endometrial cancer. The incidence of these complications is probably understated because most radiologists and pathologists have not been educated about the findings to make the appropriate diagnosis of cornual hematometra and postablation tubal sterilization syndrome. This review will thoroughly discuss how to diagnose and treat these problems. Possible ways of preventing these long-term complications will also be discussed.

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  74. Excellent discussion, am I talking to another gyno? B-U-T this Gyno Gal has been around a long time, and we have to realize, while NovaSure, HTAs, Cryoablations are relatively new technologies...rollerball, rollerblade and resectoscope ablations have been done since the 1980s and thus there is a lot known about the potential long term issues. The newer devices have fewer complications and better success rates. Like other technologies we have them being applied more widely, on some candidates that may be less than optimal and that will lead to less than optimal outcomes. I agree that ongoing studies, continuing improvement in technology and provider education are very important. Thanks for your comments!

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  75. So in other words. Dr's are performing these procedures on patients who may not be great canidates for the procedure. Somehow this sounds like MALPRACTICE to me!

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  76. Sadly, that is a response I have to take major exception to. I certainly hope you find a physician you can be open and non-threatening with, and that you get the best care possible in all situations. You have to understand, there is research, and those studies use "the most ideal candidates". And then there are patients who need care. Patients don't have ablations because they have no symptoms at all, they have a spectrum of symptoms, they have a variety of medical problems, and they have choices. Certain patients, depending upon their case findings, will have a bit more success than other patients. Communication is always important, and I have to admit, short snippets of advice or comments can be very dangerous to quote out of context of a discussion of this length.

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  77. I agree that patients have choices. I also believe that some physicians are not completely up front about ALL the possible long term adverse effects, mainly because they are not fully aware of them.
    I do think more testing and research needs to be made, before these procedures are performed so widely. I guess they call it practising medicine for a reason.

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  78. Well maybe doctors should then ONLY perform these procedures on "the most ideal canidates" or better yet, do prior research studies, performing these procedures on "not so ideal canidates " so that would give a fair conclusion to the possible outcome of the procedure in each scenario.

    My point is, it seems that Dr's are using an ablation as an "all in one" treatment. Unfortunately, many ablations are therefore not being performed on patients that are ideal canidates, which in turn causes many patients unnecessary suffering caused by mis-information the physician provides.

    I am not a professional, BUT my physician is supposed to be. It is his/er information and knowledge that helps me decide on making an informed decision. Why should I have to be my own health advocate?
    Before having any surgery/procedure, I guess the days are long gone where you can trust your physician 100% on being a professional and discussing ALL the facts prior to commitment. That's unfortunate!

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  79. Again, your comments do not seem to fully appreciate the spectrum of this gynecologic issue. I am very sorry for your anger, and hope that you find a physician you can trust and one who can be trusting of you. Most patients value their ability to be their own advocate and participate in their care. Endometrial ablations are not first line therapy, they are not even the majority of the treatments for heavy bleeding, and they certainly are not applied for all gynecologic conditions. I do hope that none of our discussion has lead you to that conclusion. If you read on other medical sites, and my posts on Heavy Menstrual bleeding, or go to a library and search gynecologic organizational guidelines (like American Congress of Obstetricians and Gynecologists) for treatments of heavy menstrual bleeding you will realize that is the case. Again, be in peace and feel reassured, many fine physicians are taking good care of their female patients.

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  80. Thank you for your response. I am angry, because I was a patient who was misled by a physician that I completely trusted. An ablation WAS his first line of treatment for my heavy bleeding. He performed my tubal ligation 10 years prior. I have been his patient for 19 years, so he knew my complete gynocological hystory.
    I am now suffering with extreme pain due to this failed procedure. Failed, because NOW, after researching endlessly, I most likely was not a good candidate for this line of therapy. So now what? What should I do? Take his advice and have a hysterectomy and most likely have my horribly inflamed and diseased tube removed, also? Is that the right line of treatment? How will I know this time?
    Sorry that I am in this angry place now. The anger is not directed AT you.
    I don't feel alone in my current grief, as it seems apparent by so many PAS forums, MANY patients are winding up in the same boat and I am just curious as to WHY?
    Why with all the info the physicians should have prior to doing these ablations, why are there so many adverse reactions now showing up?

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  81. Anyone faced with a medical dilemma needs to have a second opinion, there are many experts in all parts of the country that can give a patient a straight set of answers and some choices. It's time you organize your records and get a real hands on opinion, about your prior care, and where to go next. For patients hoping to avoid hysterectomies there are often diagnostic procedures that can offer answers as well as pave the way for alternatives. It's important to focus on your own healing, both physically and emotionally, and then you can take a more objective look at the bigger issues.

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  82. Wow, nice to know I'm not alone... I'm 51,had two c-sections, tubal in 1993 and ablation in 2007 which appeared successful because haven't had a period since. Problems started about 18 months ago..Incredible pain, docs kept thinking kidney stones but always came up negative, ultrasounds look fine, frequent UTI's but I can say for sure that is not the cause of this crazy pain..Quick question, am I correct in assuming once I'm in Menapause, if this is Ablation Syndrome, that the pain will stop without any intervention? And, if so, without a period, how do you know where you are in the process? Thank you

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  83. hi, i had the ablation in March of 2009 due to severe bleeding, cramping. I also have the MTHFR Dna gene mutation which adds to the issue as i am on lifelong coumadin therapy following blood clots and a very large PE. My last visit to my obgyn i told her i have some form of light spotting nearly every day of the month. she is concerned, and having me track this for a month. Is a hysterectomy on the horizon for me or is this normal to have daily bleeding post ablation?

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  84. Uterine involution (shrink) is a common feature of menopause as women pass farther into the post menopause and have less circulating hormone. It very well may completely resolve post endometrial ablation syndrome. Menopause for women who have had ablations can be diagnosed by hormone testing, although those tests have some errors and require some interpretation and may require additional monitoring or repeat tests.

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  85. I had a cryo-endrometrial ablation in February 2010, due to years of heavy and prolonged menstrual cycles. My gynecologist noted that I had one small cyst during some pre-ablation tests, but he told me that it was not problematic. He also told me that he could not remove the cyst during the cryo-ablation; because freezing wouldn't remove it. In addition,he told me that I was ovulating irregularly and that this may have been the cause or my heavy menstual bleeding. Prior to the procedure, I was diagnosed by my Hematologist as being a carrier of Hemaphilia. I am currently at a 31% clot rate. I bled heavily right after the ablation and then had a watery pink discharge for about 4 weeks afterwards. Although my menstual cramps have basically vanished, I still have my menstrual cycle and sometimes twice a month. The day to day bleeding during the cycles are not as heavy, but the length of the cycles are longer. I even had two months of bleeding for over 21 days straight. I have developed headaches; which I almost rarely had before and I get sharp pains in the inside of my thigh, or my lower left abdomen which sometimes switches over to the right. These pains are sometimes very sharp and are irregular and sporadic. My Hematologist has not suggested getting clotting treatment because I am not at a clot rate that is serious enough. Could these continued problems be caused by my symptomatic carrier status or did the ablation fail? Thank you in advance.

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  86. You definitely have a cause for slightly increased bleeding from your hemophilia, but the hematologists usually are right when they say when to treat based only on the clotting perspective. This is a term applied to women who have a deficiency of the blood clotting factor...VII in the case of hemophila A and IX in the case of hemophilia B, the two most common types. These are genetic disorders and other family members should get tested in cases where someone has just had a diagnosis. The American Congress of Obstetricians and Gynecologists recommends that all adolescents with severe menstrual bleeding, all women with severe bleeding in whom another cause cannot be found, and pre-hysterectomy for severe bleeding. It is more commonly diagnosed at younger ages, but often it is not. Any bleeding hemophilia patients have, will likely be a bit heavier. You have had some success, a physician making actual recommendtions would likely have to decide how much endometrium is still functional and what could be done to still improve the outcome. Most cases with continuted periods will come to re-treatment at some point, and that is often the best course. Endometrial ablations do not treat hormonal cycle irregularities in that the ovary will continue to function as it did pre-ablation. In women with ovulation symptoms, frequent cycles, and irregular episodes of shedding other methods of regulating the cycle might be considered. For instance use of progesterone or another method like birth control pills can regulate the hormones and potentially thin the lining so that your bleeding is even more successfully controlled. New onset headaches likely are not directly related to the ablation, and may be a refelection of what is currently going on with your cycle. As for the part of your story regarding the cyst, that is usually a term applied to the ovary, not the uterus, so you may want to review your case with your provider so you know exactly what was going on with respect to the cyst. Your case is not straight forward, you and your gyno will figure out what is the best next step. Thank you for sharing your interesting case.

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  87. Thank you Dr. Trupin for responding to my post regarding my continual bleeding and Hemaphilia Carrier status. I am glad that my headaches have nothing to do with my ablation procedure. I am not sure if I am going to opt for another ablation or get a hysterectomy; as I am unsure if a second one would solve the problem since I have a bleeding disorder. I had my hormone levels checked out by my Hematologist prior to my ablation. My hormone levels were normal. I do not want to take birth control pills because I am a smoker (I know I should quit) and 41 years of age. I don't want to get an IUD either.

    I just want to clarify that the cyst I mentioned was, in fact, located near my ovary in a pre-ablation ultrasound. I didn't mean it to sound as though I thought it was in my uterus. I just stated this because I know some gynecologists remove cysts when a patient goes in for an ablation. I just don't know how much of a role that cyst is playing in the continual bleeding or if the bleeding is caused by my carrier status or possibly just an ablation that did not work as well for me.

    Interestingly enough, to my knowledge and my mother's knowledge, no one in my family has Hemophilia or are carriers. I have two brothers without bleeding issues, my father is on blood thinners and my mother has never had an issue. My Hematologist told me that 1/3rd of all women with a carrier status get it through a genetic mutation. So, I guess I am a mutant :)

    I will wait a few more months before talking to my gynecologist and Hematologist again about what avenue is best to take. Thanks again for the information you are providing to others. It is much appreciated.

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  88. What percentage of ablations (novasure) fail to the point of needing a hysterectomy? If considered successful, is this indefinately?
    I read that ablations will always cause complications in time, because of contracture of the uterus. So why do them at all? Especially if long term, they can obscure cancer, and cause painful complications needing a hysterectomy afterall?

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  89. Obscuring cancer is theoretically an issue, but no large series has occurred. Hysterectomy also is not a common outcome, but when we look at stats we have to know...age, medical history and treatment goals before giving a better figure. Will try to add system to ablation page, thanks

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  90. I had my nova sure ablation in Oct. 2007 and was extremely happy with it until Dec. 2009 when I started to experience severe cramping...it felt like I was in labor...back pain, leg pain, bloating. ( I do have to say I have a wonderful ob/gyn who did tell me that the ablation may not 'work' forever) Anyway, I had a vaginal u/s and everything was normal. I was also tested for a uti...which was negative. My dr. said I most likely have PAS and should probably have a hysterectomy b/c she said I'm not a candidate for a second ablation. My questions for you are...
    1. Where does the excess blood go when I have my 'phantom' cycle? Is it trying to be reabsorbed into my tissue/muscles and that's what's causing the pain?
    2. If I have a hysterectomy she said it would be done laparoscopically instead of vaginally b/c I've had 3 c-sections and she doesn't want to interfere with the bladder. Is it more advantageous to include the cervix in this surgery? I'm confused on this issue.
    Thanks for your insight!

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  91. Women with PAS may or may not have 'excess blood'. Excess blood could take several forms, it may be within small segments of the fallopian tubes if one has had a tubal ligation, it may be within the uterine cavity, it may be within the wall of the uterus like the natural condition of adenomyosis that is a typical aging phenomenon of the uterus where the glands get trapped within the wall and thus the blood in those glands isn't released directly into the cavity. Or the sensation one feels may be due to cramps generated by other medical conditions that are not excess blood, endometriosis would be one cause. Urinary tract injuries occur in 1-2% of all routine hysterectomies and it is estimated that the risks are higher for women with prior surgeries of this region, of which the repeat c-sections constitutes. Injuries in this region however, can be diagnosed, repaired and have excellent long term outcomes. As for the decision to leave the cervix. In the USA we feel most women benefit by surgical removal, and long term follow up is easier; but for individual low risk women, this decision could be made directly with one's physician.

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  92. Endometrial ablation not terminate pregnancy but the pain that is to be taken by the woman in the monthly cycles. Mostly women suffer from a lot of blood loss during their monthly menstrual cycle. This heavy bleeding during the menstrual cycle can actually cause a lot of pain along with the anemia and low iron.

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  93. Poster named "endometrial ablation" I'm not sure what you mean. "mostly women suffer from a lot of blood loss during their monthly menstrual cycle" is inaccurate, mostly women do not loose a lot if you go by anemia. And pain from menstrual cramps. per se doesn't equate to anemia from blood lost. Also we have come to realize that a more natural state for many women is to not have cycles as many hundreds of years ago women had many fewer cycles in their gynocologic lives.

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  94. This is a great blog and your answers are fabulous, in reading I am not sure if I saw the answer to my question or not, so at the risk of being a repeating rita I'll ask anyway :-D
    I had tne ThermaChoice ablation on Oct 12, I know a recovery period is normal and I'm feeling pretty good, however I'm still having some pain in what feels like my CSection scars. I was wondering if this was common and how long would it last?

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  95. Most women say "C-section scar pain" and mean "their abdominal incision area where they can actually see their incision hurts." Of course when a C-section is done many layers are cut through. We wind up with incisions in the abdomen, the underlying fat, the sheaths around muscle, the muscle, the layer entering the abdomen, and finally the uterine layers that are entered. All those layers do have nerve endings that are cut. New onset of pain in women that have had C-sections could mean many things depending on what the patient is actually referring to. In a case where the pain began exactly at the time of an ablation, that would be one possible set of issues, in a case where it's a a worsening of a pre-existing issue, that's different. Your question is coming in on the 17th when you say your procedure was the 12th (I presume this year? 5 days ago???), cramping and discomfort is part of the healing process, but concerns in the immediate post-operative period have to be handled by your own gyno! Thanks!

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  96. I suffered from heavy periods for years. I tried about 7 different birth control pills of which I continued to have break through bleeding. My last resort was to try the Depo shot which I was told would stop my periods instead I bled continuously for 3 months! It came time for my 2nd shot and I had a allergic reaction that landed me in the emergency room. They couldn't determine what caused the severe allergic reaction, so I stopped all birth control.

    I had laproscopy in 2005 that revealed I had microscopic cysts inside my uterus but no endometriosis. The gyno told my mother while I was in recovery that I would need a hysterectomy by the time I was 40.

    In 2006, I had Nova Sure along with a tubal litigation. When I went back for my 30 day follow-up, the gyno was reading my file to me and said that he drained a cyst on my ovary. That was news to me! I didn't know I even had a cyst on my ovary. They did an ultrasound that was negative before my procedure.

    It has been almost 5 years since my surgery. I am 36 now. Since the Nova Sure procedure, I have had no periods or spotting for 4 years. Recently I have been gaining weight, having mood swings, feeling like I have bad PMS and having severe cramps every few weeks. I have spotted blood two different times in the last 5 months. After having no spotting to having spotting, I was a little alarmed. I have been having discomfort in my pelvic area along with lower back pain. My breasts become swollen and tender. The pain was pretty bad and I had to take pain relievers and remain lying down. I have never had children so I have not experienced actual labor pains but I swear some of the cramps and back pain had to have come close. I have even thought about taking a pregnancy test. I sure that I can't be pregnant, but I feel something is out of whack. I thought that maybe I was having IBS symptoms or maybe a cyst has filled and returned. After reading the posts here, I feel like I may have PAS. What tests should I ask my gyno for?

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  97. Ultrasounds are very accurate for diagnosing ovarian cysts so that would be a good place to begin. Urinary tract infections can also be the source of new onset pelvic pains and simple tests can be done for those as well. Both would be good places to begin. PMS symptoms with cyclic breast pains are more difficult to diagnose with the timing of the discomfort relative to the phases of a cycle or to a temperature chart one way you could try to diagnose what the cause might be. I hope that is a beginning of a diagnosis. Thanks.

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  98. One thing that seems to be a common symptom with PAS/PATSS is the "extreme" cyclic pain that it causes. If you have never experienced this, you really have "no idea" what any one is talking about. For those who are now or have been there, it is truly horrific!
    I am one week post op.. Davinci Robotic Assisted Laproscopic hysterectomy for suspected PATSS. I have a post op appt on Nov 22 where I will learn more about my diagnosis/prognosis but as of now, the Dr did remove a very enlarged and blood filled fallopian tube in addition to my uterus and cervix. I will further report the pathology when I get the results.
    PAS/PATSS is a miserable complication of endometrial ablation. I would love to know what the "true" long term success rate of this procedure really is?

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  99. Long term follow up of surgical procedures are always important studies to report. It will be interesting to know the pathology. Years ago we always removed the uterus with the tubes in cases of infected tubal abscesses, now tubal conservation is sometimes possible, it will be interesting to see if some women can have successful cures from tubal removal alone rather than removal of the whole uterus. Thank you for sharing your story of endometrial ablation follow up.

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  100. Hi Gyno Gab
    I am 43 and had over 70% of my liver removed due to having a hepatic adenoma in 2006 which was thought to have been caused by long term use of oral contraceptives. I then had a PE a month after surgery. I was no longer allowed to use the pill and my periods became extremely heavy and very painful, lasting up to three weeks in a month. I was not allowed to use the mirena because of the hormones in it and other IUD's were not recommended because I have never had children.
    My gyno attempted a novasure ablation in September but wasn't allowed to proceed as apparently my cervix was not long enough (I think that is what they said, it was about one mm too short to safely use the tool).
    On Oct 8 I had another ablation (my gyno said this was an old fashioned one where he scraped the lining manually) and a tubal ligation and since then my bleeding has reduced significantly though I am still bleeding each day but I have excruciating cramps which are not being relieved with any medications I have been given.
    I was told that the procedure was very difficult to perform due to the significant scarring and adhesions I have internally and that I also have a very large fibroid which had not been picked up in my most recent scan.
    I can't get in to see my gyno until next week so was wondering if you have any advice or ideas on how to manage the cramps until then and if this is normal almost one month out from surgery.
    The next option would be an abdominal hysterectomy however due to my past liver surgery, the scarring and also the past PE I am trying to avoid this if possible.
    thanks very much

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  101. Many women who have contraindicatios to combination birth control pills do not have absolute contraindications to progesterone only methods. Have your physician check all current CDC guidelines. Cramping like other pain can be managed in some cases by heat, alternating pain medications like Tylenol and ibuprofen and some exercise. Will try to address more in future posts.!

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  102. Having battled severe cramping and 8+ days of bleeding for years, I recently asked my doctor about Endo Ablation. I am 42 with a family history of breast and ovarian cancer,delivered our only child via c-section followed by a tubal ligation several years later. I also went under the knife for what dr.'s thought to be a hernia - which turned out to be a 'chocolate pocket' causing a very painful lump and diagnosed as endometriosis, which I never knew I had. Fast forward many years, tired of the cramps & bleeding and don't want to risk taking birth control. Due to my c-section and a possible 'fold' in my uterus from surgery, they are recomending I try Lysteda to control my bleeding, but I am still concerned with the 16 hours of cramping I experience. After reading many of the comments here today, I have decided to start with the prescription and see how I make out. I can elect to have this procedure in the future.

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  103. Im not a Dr. anonymous, but I would not only walk away from an ablation I would RUN!!!! Don't do it!!!! A fold in your uterus? endometriosis? C-section? All sound like contraindications to an ablation. Don't let the Dr tell you otherwise. Go for a hysterectomy before you waste your time, money and health on an ablation!
    I know first hand...DON'T DO IT!!!!!!!!!

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  104. In response to the last two women who posted: For women who have heavy menstrual bleeding and not tried the non-surgical alternatives, often those are both successful and have other benefits. For women contemplating hysterectomy verses endometrial ablation do weigh your alternatives. It is simplistic, but very true that a hysterectomy can always follow an ablation, but a hysterectomy is a very permanent step. Like the game we play that has become both a metaphor and such a perfect way to teach children: House of Cards, pulling away one card can have a drastic consequence on the others around it. For instance, having major surgery can permanently affect the pelvic floor as well as has the potential to case internal scaring. For women who have had C-section deliveries, most can safely have an ablation, it is not a direct contraindication. Some women who have had C-sections have to have their incisions placed in places that heal less well, but most women actually have the C-section scar placed in the cervix: tissue that is not treated when an ablation is done. It sounds like you have both been doing your reading and you are having a dialog with your physician and that is what is important leading into any surgery.

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  105. Could a ligated fallopian tube rupture due to being engorged with blood from complications of PATSS? If so, what would be the consequence?

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  106. Most likely you need to see your own gyno to discuss your case. Various factors could produce that sort of consequence. Cause and effect is not really possible to answer in a forum like this. For instance it might depend upon what exactly you mean by "ruptured"; how that rupture was diagnosed; it would depend on the type of ablation, the timing, and the timing of the tubal ligation relative to the ablation. And then the "consequence" would have to do with what the current pelvic findings were, what the physicians did to treat. Not sure this helps, but perhaps this gives you things you can discuss with your physician!

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  107. My question was simply could a fallopian tube actually rupture due to PATSS? At what point could it rupture if at all? Are there any cases that you are aware of this actually happening due to PATSS?

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  108. So as I understand it, you are wondering if a fallopian tube, filling with blood from the consequences of post endometrial ablation syndrome, could possibly 'rupture.' The quick answer would be "possibly" the equally quick answer is "unlikely" and the more correct answer would be that "most likely a fistula or small opening would occur rather than a rupture. And the more truthful answer is "this has not been reported to my knowledge." To devel into this further: Blood filled fallopian tubes are termed medically hematosalpinx. Much has been written about the entity of hematosalpinx, and this short discussion would not begin to cover the whole topic! In the past the most common cause of hematosalpinx was a tube closing from infection that then accumulated retrograde menstrual blood. In those cases the amount of menstrual blood that would possibly egress into the tube would be larger per cycle than the volume of blood accumulating in the case of a typical patient who had an incomplete ablation. The most common cause of a tubal rupture is that of a tubal pregnancy (ectopic pregnancy). When fallopian tubes "rupture" with ectopic pregnancies they are actually not just bursting with blood, although that is a secondary issue, they have had placental tissue growing into the wall and eroding the integrity of the tube. When wondering both how it could occur, and what force it would take to rupture a tube post ablation one would have to know the character of the tube: very short, what segments (anatomically the segments vary), the thickness of the tube, and critically over what time sequence did the blood occur. Slower blood accumulation into a tube would most likely expand the tube to a point of discomfort prior to a condition of rupture, but that is mostly a theory. Are you aware of a case of tubal rupture secondary to an ablation?

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  109. Thank you for your response.
    A few more questions and points to discuss with you.
    If the bleeding that occurs with regenerating endometrial tissue collects in the ligated tube, but does not go completely reabsorb month after month because it can't escape...would this not eventually accumulate regardless to it not generating as much bleeding as normal menstruation?
    And if a ligated tube developed a fistula and not necessarily rupture, would this pose a serious concern or not? Would a rupture by PATSS pose a serious concern as ectopic pregnancy, being that the contents may only contain blood and fluid rather than placental tissue?

    So you feel that a rupture is indeed possible but it would depend greatly on the size and condition of the tube (structure) what degree of expansion the blood is causing and the time between the tubal and ablation.
    which raises another question.....How would having had the tubal closer to or farther from the time of ablation affect the risk of rupture with PATSS? Does tubal ligation on its own pose a long term risk of tubal problems?

    I am presently not aware of any cases of rupture. Just curious.
    Thank you for your discussion!

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  110. We don't think that women who have had tubal ligations are all at risk for post endometrial ablation syndrome. If the patient has bleeding that is accumulating it could become a concern, if the blood has a chance to be absorbed or tracked into the abdomen, that's what happens naturally with retrograde menstruation, and it may not necessarily pose a problem at all. The patients who get older may likely enter menopause, and patients who have tubal ligations that were done a long time ago have a statistically greater chance to have now developed infections or other issues that would lead to fistulas on their own. So lots of "theories", but we're not sure which ones are valid! Have a healthy, happy, and safe Thanksgiving weekend.

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  111. I agree that not ALL women who have had tubals are at risk for PATSS. Nor are ALL women who have had ablations are at risk for PAS. Only women who have not had complete destruction of the endometrial tissue or had prior reasons to not have an ablation would be at risk, correct?
    Just trying to grasp why ablations fail and to what degree of complications arise as a result of this.

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  112. Can a tubal ligation increase the development of endometriosis, adhesions, ovarian cysts and/or PMS?

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  113. Addressing the question regarding Post Endometrial Ablation Syndrome: the question is who is at risk for this syndrome? A simplistic answer as to who will get this complication is that anyone who both has cycling endometrium and a place that the blood from that endometrium to become trapped. Incomplete tissue destruction that can flow out like a menstrual period is not likely to produce the syndrome It is important to understand that many women who have had complete destruction do reform endometrium in small areas over time. So technically it can occur in a variety of circumstances. Women with a previous sterilization operation that left a segment of tube might have a tissue area that would provide the location for blood entrapment. It can occur in other areas as well, areas of the uterus scared so that egress is blocked. These cases exist, and yet are so uncommon that we do not have exact statistics nor full physiologic understanding of the entity yet. Let's hope that newer data and techniques will continue to refine the procedure for women so that these cases will become even more rare!

    And the writer who asked about tubal ligations and the subsequent risk of endometriosis, adhesions, ovarian cysts and/or PMS. If a fallopian tube is ligated via laparoscopy pelvic adhesions are a known possible, but uncommon occurrence. If a woman has an Adiana or Essure procedure it is not possible to have pelvic adhesions if the device stays within the cavity of the uterus. If a woman is taken off contraceptive pills because she is sterilized she is more likely to suffer from PMS, ovarian cysts and endometriosis, but the sterilization processes themselves do not lead to these complications. Becuse the Adiana and Essure procedures do not cut into the abdomen they are preferable to the techniques performed in the abdomen unless there is a compelling reason to use laparoscopy. It is what we tell our patients at Women's Health Practice and welcome consultations.

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  114. I'm not sure I agree that the tubal ligation cannot cause PMS/endometriosis problems.
    What about "post tubal sterilization syndrome?"
    Prior to having a tubal I never experienced such raging PMS symptoms...cystic ovaries, pelvic pain and weight gain as I had several years post tubal. Then I had an endometrial ablation due to heavy periods (which now I understand could have been a result of tubal ligation syndrome) and then subsequently developed PATSS which during hysterectomy revealed stage 4 endometriosis in addition to the PATSS complications of a very enlarged fallopian tube, engorged with blood.
    So which came first? The endo or the possible "post ligation" complications causing the endo and heavy bleeding (which I then had the endo ablation for, but then caused more complications??????

    Looking back (10 years) prior to the tubal, I had almost non existent PMS, very light periods with only slight cramping on the first day of my cycle. I did ask my Gyne after the tubal ligation procedure if I had endometriosis, he said NO! Only a little bit of adhesions from a prior lap procedure when I was 25.
    I never had children, and never took birth control pills. I was 40 years old when I had my tubal which was done laproscopically and was done by cutting and cauterization.

    I wish I knew then what I am learning now...but my Dr NEVER discussed any of these possible complications with me prior to doing these procedures!
    Hind sight is truly 20/20. Too bad I had to go through 10 years of my life not knowing what was going on inside my body even after discussing these concerns with my Gyne. I suffered so many bouts of depression and anxiety too, which resulted in three hospitalizations.
    I'm glad in my worst cases of this I didn't kill myself or someone else. It truly got that bad.

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  115. For the woman who wrote that she developed a variety of symptoms after her tubal ligation including PMS, endometriosis, depression, anxiety, it's important to not just look at one case, but to actually look at the studies that look at a large number of cases. After the age of 40 can be considered a difficult time to diagnose PMS as opposed to perimenopausal hormonal changes. PMS diagnosis is often a presumptive one and not based on the three months of logs we like our patients to keep before we make a firm diagnosis. Depression and anxiety has many etiologies, hormonal factors play a role, secondary medical conditions play a role, but other unknown causes are often part of the etiology. Developing primary endometriosis in one's 40s is not typical. It's been argued that statistically there is less menstrual blood to leak into the pelvic cavity after a tubal ligation, so that the typical thought has been that we'd see less endometriosis, not more. Hopefully most women will be able to get a diagnosis and treatment more quickly than 10 years after the onset of a problem, but in atypical cases these stories exist. Depression and anxiety that are severe do need treatment, hopefully those out there reading these posts recognize that if those symptoms occur, you need to work with your physician to get treatment.

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  116. I have had crazy periods since I was 40, some were heavy and others lasted for weeks. Now I am 50, had a D&C 3 years ago, and stayed on the BCpill, till it didn't work to stop it anymore. I had a US, that showed a thick lining. Two weeks ago, I had a D&C & thermachoice ablation together, the doctor tried 3 times the ablation, he said the machine would shut off after 4 minutes and did not heat up to the required temp, because my uterus is too large. He said it did get hot, so I may have some benefit, I am having a dirty and clear discharge this week, after bleeding quite heavy the first week home. I also have 2 fibroids. He says I will bleed again and suggests a hysterectomy. What do you think of the attempted ablation?

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  117. In answer to the question about a balloon abation perhaps not working with a large fibroid uterus here are my comments: When women have endometrial ablations with uterine fibroids, they will have a successful treatment if enough of the lining has been removed so that clinically they have normal or less bleeding during future menstrual cycles. Women who have endometrial ablations who are in their late 40s and 50s may also be approaching menopause and the success of the procedure is thus enhanced if only a few periods left! So it is an excellent choice to try to avoid a hysterectomy if the plan is to alleviate bleeding. It cannot reduce the size of the uterus or tackle all fibroid issues. ThermaChoice balloon ablation has settings which will stop the procedure for various safety issues, such as when the tissue heat gets to a certain point, or if the balloon inflation level reaches a trigger point. In and of itself a procedure that is intermittent may not mean it won't work. Myosure fibroid treatments or resectoscope treatments or myomectomies are alternatives to a hysterectomy for some women with the right type of fibroids.

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  118. I'm just worried. I had a first EA 4 years ago and a second 3 months ago, after 14 day post surgical loss, I had a bad smelling loss which was treated with cephalexin for 7 days things went fine for a month, and then I had a day of pain, which i thought was wind pain and treated it accordingly (peppermiint , hotwater and parecetamol 1g) this eased by the following day, during the night I woke up to a bright red bleed,which subsided in volume over a week to an ongoing brownish redish loss, 2 weeks ago I had what felt like a period, my loss had increased and prior to this I had premenstual symptoms I have always experienced. 2 weeks later I am still bleeding. I have a post op abalation Out patients appointment on the 14th December 2010, Do you think i should be contacting the Hospital consultant before this,as somehow i dont think this blood loss is going to ease up, and i dont want to become anaemic again....please help I am worried.

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  119. Women who have pain and bleeding post endometrial ablation need to be evaluated. Chronic blood loss through irregular bleeding and bloody discharge can cause anemia, even if occurring slowly, and especially for those who limit or do not eat meat, iron pills will help to avoid being anemic and improve iron stores for those who may still have a period. Worrisome signs of anemia are being light headed or actually fainting or having a pulse over 100. Fevers of over 100.4 F and discharge that have a pus component (yellow, green), and pains that persist in daily being sharp, are reasons to be seen promptly. Many offices, clinics and hospitals have triage nurses that use similar criteria for determining when to work patients in sooner for visits. Let us know how you do and if this second ablation works to control your bleeding. We wish you well.

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  120. I'm confused about all I've read on endometrial ablations. I understand this:

    An ablation is done to control heavy bleeding.

    During the procedure, the endometrial lining is reduced. If enough is reduced completely, periods most likely would stop all together.
    If some lining remains, then a period will persist, albeit lighter.
    Is this the desired outcome?
    What causes lining to remain or regenerate?

    Is incomplete destruction of the lining what eventually leads to post ablation complications?

    Is the damage caused by the ablation, ie. severe scarring of the uterus and possible contracture, safe in the long run?
    What percentage of E.A require future hysterectomies?

    What type of pre- ablation testing needs to be performed to select candidates for ablation procedures?

    Any help is appreciated.
    Thank you...

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  121. Excellent questions, and yes, these are the things one's gyno has to discuss with you. But there are so many excellent resources on the web. If you go to the sites for the various techniques: like the NovaSure, my favorite technique for mose: http://www.novasure.com/novasure-now/request-brochure.cfm
    or the HTA system I also use: http://www.bostonscientific.com/templatedata/imports/collateral/Gynecology/pat_hta_1in5.pdf you can get the patient literature, and then there is also good information on the ThermaChoice site. Read those basic product information sheets. Those contain the FDA submitted statistics for approval, so can give you an idea of what you might be facing. Remember, the procedure is intended to avoid hysterectomies. So that without these procedures most of these women would have had hysterectomies to begin with. In my office very few women who have an ablation have a hysterectomy, but exact statistics will depend upon patient selection, and other factors. Thanks

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  122. HI,
    I too had a ablation do too very heavy bleeding, I was getting anemic. I had my ablation last oct. My dr. told me after I had it that my uterus was too big to get the whole thing done so it probably would not work. Also, the camera she took pics with just happened to break that day. so no pics. Well, she was right, I bled after it really heavy still. But then 5 months later my period was due and that day I s tarted to get cramps and no period, just spotted a bit. The cramps got so bad, that I seriously could not leave the couch and I crawled to the bathroom. I could just lay with a heating pad on. This went on for 3 days straight. I didn't go into the hospital. it was over the weekend , of corse. so i would have gone to the e.r. I had called my regular dr. after and told her what had happened and she had no idea. Well, the next month it happened again. I was scared to death!! Finally i called my ob gyn and left a message to get back to me asap. She never did so finally on the 2nd day I went into the E.R. they had to do emergency surgery. They didn't know what was going on either but my blood count was super high. They did exploritory. They found out I had retrograde bleeding inside which in turn infected my appendix. So they had to take out my appendix and ballooned up my uterus in hopes that would work. My ob gyn called me AFTER i got home from the hospital asking what happened. I told her what I knew, which wasn't much at the time. She said seh would call me back after she found out more, within 2 weeks forsure. I didn't get a call within 2 weeks, so I called up he office. They told me that she had left the country and wasn't coming back. Nice! Needless to say. I found out that the ballooning didn't do the trick so the next month, there I was back in the hospital in pain. I had to set up an apt. for a hysterectomy. which was done on Aug 11th. So I ended up having to go thru 2 surgeries extra because of the ablation. I don't know if the dr. was at fault also or not. She isn't around anymore. I do think that this is not safe and also they do NOT put this side affect on their brochures either. thanks

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  123. Endometrial ablations can be performed with many techniques. Experienced operative hysteroscopists can also do fibroid resections in individual cases to enhance the procedure's effectiveness. Women with a large uterus may be better treated with methods like the HTA technique, but this has to be decided in individual consultation. Most of the products have fairly complete information with the statistics of needing hysterectomy incorporated into their information. Pelvic infections may have many sources, and the ablation is one possible cause. Once a patient does have a hysterectomy after an infection, the pathology report can reveal information regarding the exact cause of the bleeding and pain issues a woman was having. You might consider having your gyno review this report with you. Thank you for writing, and we hope you have an uneventful recovery from your hysterectomy.

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  124. In your opinion, what do you see as pros and cons of hysterectomies? Hormone replacement therapy vs no hormones. I have a significant family hx of breast and ovarian cancer on my maternal side and cardiac disease on my paternal side.

    Thanks

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  125. Lots to write about the pros and cons of hysterectomies! Won't be able to give you a complete answer. So lets just talk about your question of hormone therapy after a hysterectomy, that is a question of removing the ovaries, not the uterus. The uterus doesn't provide hormones that control menopause, the ovaries do. Women who have ovarian removal at the time of hysterectomy, who are not previously in menopause, have to consider hormone therapy. If one is prior to the age of natural menopause when you have your ovaries removed it's considered a surgical menopause. The weight of evidence for a women with ovarian disease then the ovaries probably should be removed: for instance PID that involves the ovaries or endometriosis that involves the ovaries, or ovarian masses. But for every premenopausal women who has ovarian removal then she is going to face the conditions that menopause entails and potentially need therapy. That therapy may entail estrogens, or the therapy may entail other solutions. It is very individual. If a woman has risk for breast cancer and has osteoporosis, then she may want to consider a SERM like Evista rather than an estrogen. Women have about 1/70 risk of cancer of the ovaries, that risk goes very low with ovarian removal. The decision to remove one's ovaries prior to age 65 for no reason at all, is no longer regarded as the standard of most care. The important issue is: how healthy are your ovaries and how much function do your ovaries still have before you make the decision to get them removed. You and your gyno do have some things to discuss! Thanks for writing!

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  126. I had balloon ablation 4 days ago and was told I'd be back to normal the next day. I have had abdominal, back, and inner thigh pain ever since. It's worse when I am standing. Why would this happen? I was under the impression that most women have little to no pain after. Is there anything I can do?

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  127. Acute pain after an endometrial ablation that is not treated by the medication your MD has provided for you needs to be evaluated by your provider. Infections are uncommon but could account for the problem. Uterine perforations, burns or other issues are even more rare, but could account for referred pain (like leg, back and abdominal symptoms) after an ablation.

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  128. I had an ablation done in Nov.09. I am going to be 48 next month. I thought the procedure was a success as I only had very light periods that only lasted a couple days after the procedure, up to recently. This past two weeks I have had a dark brown discharge (period?) that continues to this day (about 14 days now). Am I to assume my periods are going to start again. I was so hoping they would not start. I also had some lower aching just before I had two days of heavier discharge, usually asprin or ibuprofen would help with this. I could sure use some advise. Thanks!

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  129. At 48 you maybe perimenopausal and estrogen dominant, so think about being checked for a polyp or other change that would occur. 14 days of bleeding is too long to ignore. Thanks

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  130. Thanks, will do. I have a friend who's a nurse and works for a local doctor. He said that "regrowth" can occur which gives the same symptoms that I have and the procedure needs to be done again. From what I've read, regrowth happens more in younger women, not so much my age. Due to my mother having post-menopausal breast cancer, my doctor doesn't want me to take anything that has estrogen in it, like birth control, so sounds like I may have to have the ablation again. 14 days isn't really unusual for me, my regular periods would last anywhere from 7 to 15 days or so anyway. Just thought it was strange as up to this point, for the past year my periods have only lasted about 2 - 5 days at best.

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  131. Women who don't have their periods completely eliminated after a first ablation are the most likely candidates for needing a second ablation. If a woman has cycles that bleed for more than 10 days, by definition it is abnormal. If you do not become anemic, if there is no pathological cause for the longer cycles to be treated, and they aren't bothersome, then they can be watched. But having them evaluated is still important now that you are post ablation and the cycles have returned due to some lining regeneration.

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  132. Thanks so much for your input. I will put a call into my gyno after the holidays!!

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  133. I had a uterine Ablation done in Oct 06, I still have heavy periods, my doctor says its because I have a tilted uterus. Also when I am not on my cyle, I have a yellow discharge that sometimes gushes out and recently it had blood mixed in it, is this normal?

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  134. I am a healthy 43 year old woman who had a C-section at the age of 21. Over the past year my periods, which were normal, became irregular (every two weeks, every six weeks) along with increased abdominal pain, heavier bleeding and a very foul odor even when I wasn't on my period.

    My doctor diagnosed fibroids and recommended an ablation and tubal ligation (I did not want any more children). I had the procedures done on 10/26/10 with no complications. A polyp was discovered during the procedure and successfully removed. They also found a good deal of endometriosis but as it had not been giving me any problems, no treatment was given. My post-op discomfort was very mild.

    I had a reddish/brown discharge for a few weeks then a normal but very light period right on schedule. I had my normal light period in December but a week later I started bleeding/spotting...not like from a normal period but bright red blood. I also have abdominal bloating with mild pain and seem to be gaining a little bit of weight even though I exercise 6 days a week and watch what I eat.

    It has been almost two weeks and I am still bleeding. It stopped for a day and a half but started right back up. HELP!!! What is wrong with me?

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  135. For women with uterine polyps medical treatments with progesterone may be helpful at resolving the overgrowth of the lining of the uterus. Ablations haven't been as extensively studied in women with polyps, while they may work, it's more likely you you need treatment of the lining still. As for weight gain: women who get bloating, cramping and bleeding the lack of proper full activity and the tendency to retain salt and water may add some weight, but ultimately seeing a nutritionist or your gyno about diet management may be more helpful to turn that around. Thanks for writing.

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  136. I posted above about needing a re-ablation due to my last 14 day period in December. As I feel that I am now all off schedule with my period, and I am going away in a week and a half, I'm wondering if I should go on a pill until I get in to see my gyno which could be months. If I go on a "continuous" pill, i.e. Seasonale which you only get a period every 3 months, would this alleviate me getting my period while I'm away? I started my last period on Dec. 14th and finished Dec. 28th. Going away on Jan. 18th and don't want to run into getting my period while I'm away. Due to the scheduling and length of my last period, I'm not sure when it's going to show up again! I was fairly regular the last year after having my ablation and they only lasted about 3 days, very light. If I start on a pill this weekend, will it stop my having a period the week of the 18th? Help!

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  137. Menstrual cycle control with oral contraceptives is possible, so that women who are on oral contraceptives can delay or eliminate menses as to their desired schedule. You can do this with a long cycle pill, or do this with instructed manipulation of other formulations. New start contraceptive users may be able to enjoy contraceptive control as well, but it's less predictable with in their first (or even first few) cycle as one's own hormonal cycles are not reliably suppressed that rapidly by the available pills. Furthermore contraceptive pills are contraindicated in women with undiagnosed genital bleeding. No one can get specific diagnostic advice without being examined. You need a consultation, we welcome new patients at Women's Health Practice, but we understand that most of these readers are not our patients.

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  138. I had an ablation in July of 2010 (thermal balloon method). I have had semi regular cycles since, i think i may have partial skipped a month. My periods are lighter and now just one week instead of continuously here and there. I am curious does this mean my "wall" is regenerating? I'm concerned about what is going on. Is there a way to tell? Should I see my dcotor and have another internal ultrasound complete? If it has regenerated is it possible to become pregnant successfully?

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  139. This comment has been removed by the author.

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  140. Women who resume regular cyclic bleeding after an ablation do have some regenerated endometrium. No special tests are necessary if there is no pain, or other clinical reason to do them. Hysteroscopy, hysterosalpingograms, ultrasounds and endometrial biopsies can all contribute information as to the extent of endometrium if it should be done. Endometrial ablations are not reliable contraception and you need to use protection. At Women's Health Practice we discuss Adiana or Essure for women who have had ablations. Thanks for writing.

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  141. Thank you very much I appricate your response. Since my cycle is much more regulated I'm not overly concerned but I did not want to return to the dr. the completed my ablation since he pretty much told me my next option was a hystorectomy .... i'm only 28 so it is not an option in my mind. Also, my husband just told me this weekend he wanted to have kids.....kinda 7 months to late... lol :)
    Thanks again for you input, it really puts me at ease.

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  142. Hello, I am 44 yrs old an I had an ablation in March of '09. My doctor at the time found a fibroid an said that the ablation would get rid of this. Now I had no idea after the ablation, now that its been a few years that I would still have the fibroid. I also am having alot of problems. Like back pain, pain on my right side that Advil will not even touch. I recently I have seen a new Ob doctor, she gave me a sonogram an found that she thinks that I have blood accumulating in behind where I had the ablation. I am also real bloated that I dont want to eat anything. My stomach looks awful. My jeans hurt to wear an they really dont fit like they use to. I recently had a biopsy an the doctor said my cervix was fused together from the ablation. She tryed to cut it open, that hurt so very bad (this was done in her office) I had to stop her because the pain was so bad from her trying to open me up. So the biopsy was a no go. I have to go back for another sonogram this Friday. She mentioned a D & C but I just dont no how this is going to be. I dont no what else she's going to want to do. Although I am so fed up with just sitting all the time I think that if she would tell me that she would want to take my female organs out I would say do it at this point. Does anyone have any suggestions? Thank~you

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  143. For women with uterine fibroids there are many treatments other than a hysterectomy. These treatments range from surgical myomectomies, done with minimally invasive techniques like the hysteroscopic resectoscope, or the MyoSure device; or medication like Lupron which shrinks fibroids. Other techniques like uterine artery ablations (UAE) also shrink fibroids, just to name a few of the alternatives available to women. For women who need a uterine biopsy there are medical and surgical ways of relieving blocks in their cervix, so your physician may have suggestions on how to proceed or perhaps a consultation with another gynecologist may give you the answers that you are seeking. The average age of menopause is 51 and it is possible to test to see if you are near the perimenopausal time. For people with pain, also consider infections as a possible cause. Thanks for writing.

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  144. Thank you so much for the response. I am is so much pain that I'm hoping that she (my doc) does something soon. I will talk to her about these suggestions. I dont know how the sonogram is going to turn out this Friday. Is it dangerous to bleed behind the ablation that I had? I was wondering because my cervix is completely close (fused) shut, is why my biopsy wasnt successful. I was just wondering, because I have cramps like its my period, but I dont see any blood. I will ask my doctor the next time I see her. Im just going for the sonogram Friday they told me I wasnt going to see the doctor. So I have to suffer alittle longer that I have to find the strength somewhere to do. Thanks so much for listening to me, I feel like I need to get somethings out.

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  145. Hello, I wrote the post above. I hope I make some sense. Im on heavy meds to get rid of some of the pain that Im having with all this. Im so sorry if it doesnt make any sense.

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  146. Yes, I do understand the questions you have posted about your uterine fibroids, but of course solutions really involve an exam and then treatment, and the internet hasn't evolved that far! Medical therapies like contraceptive pills or Lupron or a UAE to stop bleeding against a closed cervix may indeed be the best way to stop cramps. Getting a successful opening to your cervix may also be the solution to prevent blood from backing up into your uterus. Small dilators like silver wires are used by some gynecologists to help open a really tight cervix.

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  147. I had the novasure proceedure March 2008. Before I had irregular cycles where I could go several months without period and then have a heavy one that would last almost a month. I was also severely anemic. I had previously had D&C for a uterine polyp. Was told I do not ovulate regularly.

    I refused birth control because of how I felt while taking them. Was offered the Novasure and a tubal ligation. I never had a period after this. Oct 2009, I had two weeks of terrible cramps. They would come and go through out the day. I had ct scan and sonograms and nothing abnormal found. Went to gastro dr and had colonoscopy and still all ok. Pain left, and then came back 3 months later in Feb 2010. Gyno did test for Intercistyl cystitis but did not react to instillation of bladder. He offered a Hysterectomy, but I decided to try a chiropractor since back pain can refer to pelvic area as well. Well, I thought that worked, but Late December 2010 I started having the cramps again, but was able to take over the counter pain meds to control. Then the second week of Jan 2011 pain was so horrible I went to ER. They did sonogram and found two cysts in the muscle wall of my uterus. Went to gyno and is doing Hysterectomy. He said one of the cysts was there the last time but was sure that could not be cause of my pain. Said I could have scar tissue from proceedure and some lining still there behind it. Or possibly Adenomyosis. The pain feels like labor pains and the vicodin from the ER does not touch it! Again the pain is not constant. But is comes on everyday. I just do not know when. I feel that I had a good 18 months period free, but if I had know the pain to come I would have just asked for a hysterectomy. I am counting the days until I have it done.

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  148. Often women who are severely anemic from heavy bleeding are not able to have a hysterectomy until the anemia is corrected. From your case story it sounds like at least the NovaSure may have gotten you to a point when you are healthy enough to undergo the hysterectomy.

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  149. Hello, I have a question. First off I had a ablation March of 09'. I haven't had any problems til now. I am bleeding black blood with alot of pain, it feels like labor pains and pressure. I went to see my OB doctor an she gave me sonograms and tempted to do a biopsy. She said that my cervix was fused shut. This has been going on for awhile now with the pain an bleeding.Since be for Christmas. The bleeding isn't a flow just spotting, with alot of pain. My question is: When you have an ablation does it or is it suppose to fuse the cervix closed? I am worried that I have something going on behind the ablation that is infected. Oh and my doctor says that there is a tiny hole in the cervix so its not completely shut.But for the most part its closed. Do you have any suggestions? Thank you.

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  150. I had an edometrium ablasion in 2008 and continued to have issues concerning my cycle and fibroids, with no resolution from my GYN, I chose another GYN (this time female) and took my records with me. When I walked into the office she had already read my records and she did the annual female exam and discovered I already had a enlarged uterus, she suppected larger fibroids. She informed me from my medical records I was not a candidate for the surgurey in the first place and should have had a hysterectomy back then.Now I am paying for a second procedure when I should have been given the right advice in the first place. When my cycle comes on its like being kicked in the stomach my a bull and the migraines are debiliting for 3 days of my 5 day cycle. My suggestion is get a second opinion.

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  151. Had emergency C-Section in '03 (twins) w/tubal ligation. Early PPH after delivery and bells palsy the next day - horrible! Developed heavy bleeding, cramps, etc for two yrs following tubal; worse w/ea monthly. In '05 OB/GYN did US and found two small fibriods, put me on birth control. Bleed non-stop for two months, so performed endo ablation in '06. I felt great for the first year but have had cramping, bloating, constipation, shooting pain on my right side and bleeding for 7-14 days. Oh, forgot to mention clotting especially after being intimate w/my husband. I find myself using the heating pad daily again. Went back to my PA this week and had a transvaginal, which revealed 1-2cm ovarian cyst (left side) and 3 cm fibroid. She suggests that I go back to OB/GYN and see gastro for bloating and cramps. I feel like my uterus is dropping. I'm tired of going back and forth to the same set of dr's. I'm concerned after reading the posts that maybe I should have never been considered a candidate for ablation since I had C-Section and Tubal prior. Family history (grandmother, aunt & mother): endometriosis, breast and colon cancer. Should I not worry about the cyst and fibroids as suggested by my PA? And, why would I continue to bleed, cramp, bloating for four years post-ablation?

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  152. oops, forgot to mention that I have a clear jelly-fish looking discharge after my "monthly". Never had this prior to ablation...

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  153. In most women with irregular bleeding the presence of an ovarian cyst on ultrasound that is in the range of 1-3 cm only needs follow up to check on resolution. Uterine fibroids need more continual management and monitoring. Size, location and accompanying symptoms are all important considerations when determining the amount of time in follow up, and it would be best to follow the advice of a midlevel provider and get a consultation with an obstetrician-gynecologist. For women with ablations who wore not ideal candidates to begin with, the need for repeate procedures and/or medical management in the future is relatively common and the current problems can be handled well by thse treatments.

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  154. These answere are due to the two readers who posted on 2/2: For women who have an endometrial ablation, the goal of the procedure is to significantly reduce or remove the endometrium which is the lining of the uterus. It is harder with an enlarged or irregular uterus, but not impossible, and there are types of ablation that are designed to cope with the variety of uterine cavities that gynecologists deal with on a regular basis. If a physician has given you an opinion but hasn't had a chance to review the whole record, it may have been an "editorial comment' rather than a complete opinion. It would not be easy to judge from this amount of information. The cervix has a small amount of lining tissue, that is not targeted for treatment. If the cervix is treated, either due to the nature of the utrerine configuration or due to the technique, there is risk of inadvertant scarring partially or completely. It is thought that as long as there is an open cervix that the menstrual blood that one still has can pass through it is not considered dangerous. It is possible that a mostly scarred closed and rigid cervix can cause additonal cramps when the menstrual blood passes through. Sometimes a closed cervix can be opened, but that is for the examining physician to decide. Thanks

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  155. I had an edometrial ablation 4 yrs ago after a c-section and tubal ligation 4.5 yrs ago. I was having heavy periods and my doctor reccommended the ablation. I did not have a period until this past summer and I started to notice some light spotting which has increasingly gotten heavier every month. It still is nowhere as heavy as it was prior to the procedure. I would like to have another child now that my life circumstances have changed. I can afford to reverse my tubal ligation. What else should I do to increase my chances of getting pregnant?I am aware of the risk of miscarriage and dangerous bleeding at the birth. Both are risks I am willing to assume. Any advice?

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  156. Planning a pregnancy after a prior C-section, and planning a tubal reeversal and planning a pregnancy after an ablation are all separate tasks that should be tackled in the context of one's age, current medical conditions, and in consultation with your gynecologist. That's not even thinking about the family's current needs in terms of the others in the family, and the social consideratios physcians rarely discuss with their patients. For many women IVF is a better solution than a tubal reversal. For some women who have regular menstrual periods after an ablation healthy pregnancies have occured, for others it may take medical management to make their lining more healthy. And of course it takes two to make a baby, so making sure the potential father has a current healthy sperm count is the most basic step for one considering so many alternatives. Thanks for writing.

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  157. I had an ablation done in 2008 for heavy bleeding and severe anemia. The first year I had light bleeding, but within the last year the bleeding has gotton heavier and more frequent. Last week when I went in for my pap, I explained to the doctor about the changes and she order bloodwork. The results came back as having mild anemia. So she put me on iron pills and told me to come back in three months to see if the anemia gets better. My doctor said that if I was still concerned about the bleeding and my anemia doesn't improve then she would consider referring my back to the gyn doctor that did the ablation. I was
    wondering if it would be a better idea to be seen by the gyn now to look at next steps vs waiting to see if the iron pills work. I just don't want to have to get to the point of having to get iron infusions again.

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  158. Endometrial ablations do fail, and the incidence of recurrent heavy bleeding is known to be about 10-15%, but the pattern of recurrence of that bleeding has not been well worked out. Generally women have to be treated Anemia can have several causes, and heavy menstrual bleeding is one of the most common causes. For those in whom the bleeding is relatively manageable in terms of their daily symptoms, some supplemental iron should correct the anemia. Women who regularly avoid red meat may also have a dietary reason to have mild anemia, and again a short course of relatively low dose iron should correct it. Anemia that doesn’t correct relatively rapidly when iron is used may also need to be checked for other causes. Women who have had a recurrence of their heavy bleeding, when it’s been treated in the past, whether that treatment involved an ablation, a resection of fibroids or an endometrial polyp will need re-evaluation if the bleeding pattern continues for a few months or if they remain anemic. If you are young, it’s more likely you will have worse and worse bleeding once the bleeding resumes post endometrial ablation. Women who are near menopause may experience only a few heavy cycles which resolve. Of course a gyno appointment can help you determine where you are in the periomenopausal process. Thanks for talking about your questions and good luck with your care.

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  159. Hi, I am 40 years old and had a Novasure ablation in June, 2010 due to periods that were extremely heavy (gushing clots). For history, had 4 healthy children, and 2 very early m/c's. After the ablation, I then had what I would consider a normal period, though the blood still seemed almost black and thick. During my periods I still feel dizzy as if I was bleeding tons as in the old days. Anyway, during my last 3 periods, things have changed significantly. The blood that is coming out is far less, but I now have excruciating pain, the kind where I can't even catch my breath and I'm practically shaking. I took 2 advils which did absolutely nothing. I recently had 2 u/s's which showed my uterine lining to be 12 mm, and then 1 cm. I also have a 1.7 complex cyst with septation on one of my ovaries. I am concerned that I have that much lining, and the pain scares the daylights out of me. Also my ca-125 went from 10 last year to 45 this past month. What do you think? Any ideas on what is happening and what I should do? Thank you so much.

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  160. Women who have had an ablation but incomplete removal of the endometrium may even cycle normally and have normal endometrial lining thickness. Women who still cycle can have endometrial linings in the 1-1.5 cm (10 to 15 mm is same) range without abnormalities. Small cysts are not likely to be serious, but the cut off for normal CA 125 is 35, and women who are over this number and have a cyst need to consult their physician. The cyst and the recurrence of bleeding after an ablation are not likely related, but they could be. So follow up appointments can help you discuss some alternatives which I have suggested in some of the other posts, thanks.

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  161. I am 49.5 yrs old. Had Novasure on 10/22/10. Still having the watery pinkish bloody discharge everyday, and sometimes a few spots of thicker, bloodier stuff. It has been 16 weeks!
    Had ultrasound 2 weeks ago. Nothing unexpected found. Doc said this might stop, or continue until menopause. She's just not sure. Am on the pill (continuously) for severe hot flashes.Says I can have hysterectomy if it doesn't stop in 3 more months. Dreading that idea, esp the recovery. Would be open abdominal, due to 2 c-sections. I feel frustrated, stuck between a rock and a hard place! Any ideas or suggestions? Thanks for your input.

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  162. We prefer to see our perimenopausal patients for a consult to see if they are likely to be crossing over to menopause soon and decide if the irregular bleeding pattern is due to any influence of perimenopause. Also BTB on birth control pills is common and can be managed by several strategies as well, and that is the approach we would take in our office. As for women with prior c-sections who need a hysterectomy, some surgeons may consider beginning laparoscopic routes, and you may want to seek a second opinion regarding the type and need for hysterectomy if you would ever need one. Thanks.

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  163. Thanks for your reply. I am the lady with the 16 weeks and counting of post-ablation discharge. I did not mention in my first post that I had been bleeding so heavily beforehand that in July I was so anemic I needed a transfusion of 2 units packed cells. My hematocrit was only 22!
    I was in a pattern of about 3 weeks of flooding every 2-3 months. My last period sarted on Sept 10, and was so bad that neither provera or tripple doses of lo ovral stopped it. At that point I had an ultrasound and a large polyp was found. Even on regular doses of lo ovral I continued to bleed (lightly) until the ablation
    almost 6 weeks later. So I definately needed it!
    Also, I'd like to stress that most of what I am passing is NOT regular menstual blood. It is thin, watery, and when dry leaves only a light tan stain. It happens nearly all day every day. This is what my doc says may not stop. I suspect I could be the first patient she's had with this particular outcome. I have thought about a second opinion too. However, until now she's been the best doc I've ever had, and I have always had complete confidence in her. There is a doc here who does the da vinci hysterectomy, but I had such a bad experiance with her (she delivered my youngest) that I don't want to be her patient again. My doc only does two kinds of hysterctomies, open or vaginal. And she won't do vaginal on a patient with prior c-sections do to the chance of damaging the bladder. This does make sense to me. Anyway, its the watery discharge, not the occasional spotting that bothers me. Thanks for "listening"

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  164. Women with thin watery discharge after an ablation may have an infection, the residual of healing post ablation, or other causes of a watery discharge. Only an examination with culture tests as necessary can determine the actual cause. Once a cause is determined a treatment can be selected. For women with severe anemia, correction post ablation to only a discharge may be enough of a cure to be a tolerable side effect. Thanks for writing and good luck with your care.

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  165. I had the Novasure procedure 2 weeks ago and cont to have abdominal pain that increases with sitting and walking. Abdominal CT scan and blood work show no problems except for 1 small cyst on each ovary. My gyn feels that I'm ridiculous and states she will do another ultrasound in a month to see if the cysts have changed. She did note that I did have a prolapse when she did the procedure.
    My husband and I had sex last night and he stated that it felt rough and different and today I'm having mild bleeding with a nickle sized clot.

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  166. As a general piece of advice to our patients who have pain and bleeding are not encouraged to have intercourse until the conditions are diagnosed or treated.
    Women seeking brief consultation by phone can call 217-356-3736, cost is $25, 8AM to 5PM, Central Time, US.

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  167. She indicated that everything was healed and she had no idea what was causing the pain. But it "not something she had done" the procedure was successful. The bleeding did not start until this am.

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  168. I have a question....I have recently started having very heavy bleeding...I'm 47 so I guess its perimenopause/menopause. Anyway, I have also been suffering horribly from persisten migraine as well as mood swings, etc. I went to the obgyn and she suggested doing an ablation. Is this standard without first doing blood tests to meausure your hormone levels and make sure you are treating underlying issues which can be causing other problems as well? I mean, if you get an ablation, will that affect your hormone levels or only lessen the bleeding?
    Are there other treatments for heavy perimenopause bleeding other than ablation? My obgyn has not indicated that there are any and I'm wondering with a surgery scheduled next week if maybe I need a more thorough clinical exam before committing to this procedure. I'd love to not have periods, but that's not my only issue with my current health dillema. It seems like alot of things are going on at the same time and I don't know what I'm dealing with....

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  169. Endometrial ablation treatments are designed to treat heavy menstrual bleeding. They do not fundamentally change any of the hormonal activity of the ovary, they are treatments of the uterus alone. To the extext that any mood or physical symptoms are due to the physical cramping of the bleeding or the breakdown of the uterine lining tissue, which releases substances that can have some effects, endometrial ablation can change some accompanying symptoms. There are many treatments for Heavy Menstrual Bleeding, if you look at some of the other answers to these posts. Ablations do not require extensive work ups but most gynecologists do evaluate the lining tissue and simple work ups to make sure that an ablation is not contraindicated this often involves an ultrasound and a blood count, but doesn't necessarily mean expensive hormone testing in every case. The pre-treatment work ups really should be individualized.

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  170. Last week I had a large endocervical polyp removed in office. The path report showed CIN I/II. My doctor then sent me for a d and c, Novasure, and Essure two days ago. The path report from my D and C showed again CIN I/II, with polyp fragments. The doctor told me nothing to worry about, no further treatment for the CIN. Should I be concerned with the CIN diagnosis.

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  171. I had a novasure ablation 2 yrs ago. Now Im having bad problems that consist of endometrial stripe thickening and cysts on both ovaries with real bad pain, like Im giving birth again. the pain is unbearable at times. My family doctor and a surgeon put me in the hospital where I seen a infectious disease doctor that had told me that I have a real bad infection on the other side of my ablation, the lining. My white blood cell count was really high so they put me on strong antibiotics there an sent me home with 2 antibiotics that is now giving me a yeast infection. The ob doctor that Im seeing wants to do either a hysterectomy, or put a scope in me to see what is going on, but they want to get the infection under control first, like wait for 1 to 2 weeks first. I still have alot of pain an the pressure is horrible. Is there anything that you would suggest for me to ask my doctor? Im also seeing black blood, but not all the time and its not a flow just a spot here er there. Im hoping Im making the rite choice to have everything taken out thats if he wants to do the procedure. This has been going on since before Christmas and has gotten worse. Thanks so much for taken the time to answer and reply. sincerely, ablation gone bad.

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  172. For women with menstrual pain and irregular bleeding after an endometrial ablation or a NovaSure procedure having a "scope procedure" or a laparoscopy (looking in the abdomen) or a hysteroscopy (looking in the uterus) can be both diagnostic and potentially curative. Sometimes an infection of a tubal segment could be removed simple through the operative scope without the extensive surgery a hysterectomy would involve. Although infection is more likely the cause of pain than cysts of the ovaries would be, it might be helpful to consider getting ovarian suppression so that the cysts quiet down as well (birth control pill can do this).

    I'm going to answer the question about finding CIN on a D and C with a post on the main page, it's a very important question!

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  173. I to have always suffered from heavy periods. After 2 miscarriages, 3-c sections and a tubal ligation, I was told by my gyno that I was a good candidate for Novasure abaltion. The whole procedure, which was done in her office, took almost 2 hours. The Dr. was having problems getting the machine to "turn on". She also informed me she generally didn't do the procedure but the girl that did was out that day. After finally successfully inserting the wand, I was informed that my uterus was too long so she was not able to finish the procedure completely. I had the usual post procedure cramps and continued to have spotting for about a year or so. Until about a month ago I got a full blown red-blooded period that lasted for 4 days. I too have had the brownish, old blood discharge which to me has a kind of "burnt flesh" smell. Not to be gross or anything. My gyno annual came and went in October without any problems being brought to my attention. Should I request an u/s or other tests to see if I am retaining blood or have a fused cervix too?

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  174. For women reading about other's experiences with NovaSure it's important to note that most of the procedures take 90 seconds. Unless the device is seated correctly and passes it's internal checks it will not fire. So most longer procedures are due to other steps being taken and not a long firing of the machine. For anyone who has questions about her specific surgery either needs to schedule an appointment with her own physician or a second opinion consultation with the records in hand. Most women who have had a NovaSure ablation and then have no problems on annual exam do not need any care other than routine care. If symptoms arise it will be up to your gynecologist to decide what, if any, testing you need. Thanks.

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  175. I'm 43, had suffered horribly heavy periods and bad cramping for over a year. I had the Novasure ablation done 5 weeks ago. I have some discharge which ranges from watery/clear to brown, pink, or bloody like a period. On and off mild cramps. But my main concern is the bloating. I was insanely bloated for the first two weeks after the procedure, which they told me was normal and would go away. It has gone down some, but I'm still really really bloated all the time. I have always been thin, around 123 pounds and 5' 5" and physically fit. So I'm really frustrated with this large protruding belly! I cannot fit into pants that I wore before I had the ablation. Is this normal? What causes this? Will it go away? I'm really concerned.

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  176. Post endometrial procedure side effects can vary in women from very mild spotting, to more intense cramping, bleeding, and abdominal symptoms including bloating. The women who have more intense symptomless may have had more lining tissue that was treated, or more prostaglandin release, or some adenomyosis or other gynecologic conditions that may be compounding the normal side effects. For women who have these symptoms their individual case may have made this more likely, and that would be discussed on an individual basis. The time course for the symptoms is variable, but usually lasts approximately until healing. Intense symptoms get less as you heal, typically over the first month. Intense symptoms post endometrial ablation that are persistent warrant consultation with your gynecologist to be sure there is no infection or other issue that might require treatment. To attempt to treat bloating by avoiding caffeine and carbonation may be helpful. Thanks, for most women, when they heal, they are very glad they had their procedure, even if the immediate post operative course was rocky.

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  177. Hello, I had an eblation Dec 2009. The reason for the operation was due to the fact I had a cervical erosion and because I was 40 and had children he offered me an eblation. I never really suffered from heavy periods and because of an intolerance to the pill had been using the mirena coil for a number of years, which made my periods very light.
    Since the eblation I have not had any bleeding until over the last couple of months I have had a littls spotting (in frequent) and experiend post-coital bleeding (now and then). I went to the consultant a few weeks back where he said my pelvis was inflammed. He gave me 3 types of anti-biotics to kill any known infection and took some swabs. All swabs came back negative and I am still suffering with lower back pain, bloating and some bleeding after intercourse.
    I have spoken to the consultant who is scheduling a Laproscopy.
    When I was 23 I had ovarian cycsts and was wondering if I am susceptabile to them? It is hard to tell if my hormones have changed as I do not have periods and never (before and after) experience "time of the month" symptoms....I was very happy regarding no periods but the low dukll back pain is making me feel very low !

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  178. Endometrial ablations are designed to treat uterine lining issues. Women with cervical erosion have a problem that needs to be treated in another way, so for the reader who is saying that her erosion was treated by an ablation, you may have only had cryosurgery of your cervix. Sometimes understand important information from your gynecologist is difficult and it is helpful to bring a friend to the appointment to make sure you are clear on the discussion. Ovarian cysts are a third issue that some women are susceptible to. Most women can rule out a cyst with an ultrasound prior to needing a laparoscopy.

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  179. Sorry I meant to add that the erosion was cauterised. Whilst he was doing that he performed the ablation at the same time. I'm seeing him next Tues prior to the laproscopy

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  180. I'm 44 and had an ablation done almost 3 years ago. NO problems, NO bleeding -- everything was great! About 4 weeks ago, started having thick yellow-green discharge. I've been married for 20 years, in a monogamous relationship, but started to wonder if I had Chlamydia. Was tested and treated presumptively with 1 gm zithromax. Cultures all negative. Discharge has actually increased, copious. Went to get Pap 2 days ago, OB was impressed with amount of discharge. He did wet mount, found small amount of yeast, high pH, negative cultures again. I've been wearing a tampon for the past week due to the discharge, and find the tampon is actually painful. I haven't had intercourse since this started. The OB said he believes it's related to my ablation, some sort of reservoir of fluid that has somehow “broken free”?? He ordered an ultrasound, but not scheduled for 3 weeks. I'm an NP, and have done multiple medline searches. I can not grasp the anatomy, nor pathophysiology of this. I suggested a D&C, and his response was that I may require a hysty. No follow up has been scheduled, and I'm at a loss for a differential diagnosis at this point. Do you have any thoughts?

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  181. Many women have vaginitis/cervicits/endometritis that is not diagnosed by standard testing. There are some new probes that I am using in my pratice that are helpful, when we see patients for second opinions. Ultasounds can find retained pockets of menstrual blood, or hydrosalpinx and are less specific for hematometra or endometritisa, but an actual endometrial biopsy sent both for culture as well as for pathology can help diagnose intrauterine infection if a woman has an infection after an endometrial ablation. I hope that helps. Know of any NPs that want a job in Champaign Illinois?!

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  182. Thanks so much for your prompt response. I think the OB's response sounded a bit "wonky", for lack of a better term. I did leave a message for the OB that did the procedure --and think I should follow up with her. I've been through a whirlwind of emotions -- doubting my husband to thinking I'm nuts!! What other organisms have you seen that can cause a cervicitis/endometritis?
    We have Kaiser, and I'm just frustrated at the length of time everything is taking. I am not entirely convinced it has anything to do with the ablation. Of note, no bleeding or spotting, and no real pain except with tampon use. Just really copious thick yellow discharge. I'm driving myself a little crazy!
    I'm on the west coast, and spent 10 crazy years in the ED before settling into a delightful occupational health clinic!! My niece is at Northwestern and she assures me that the Midwest is great!! I believe I read that you do some phone consults -- I may take you up on that.
    Diane

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  183. Hello, I'm sorry I didn`t really no where to post this. I just had a hysterectomy, not completely total, he left my right ovary. I had an ablation 2 yrs ago for what my doctor at the time said that I needed one due to the fibroid that I had. I didn`t have alot of bleeding with my periods just bad pains in my back. An now since the 2 yrs has past I have had nothing but troubles due to the ablation. Now this is just strictly my situation. I have had infectious cysts, cysts that were on my left ovary that would not go away along with adhesion's that had glued my left ovary to my uterus. Along with my right tube because I had a tubal 18yrs ago and with the ablation that I had, it was really messed up, (my right tube) it was oozing blood from the little nub that was my tube. So now that I'm all cleaned out in there with just my right ovary, and I`m 44yrs old I pray I don`t have any more problems. My biggest problem and this is scary to me is that I haven`t moved my bowels since the morning of the surgery, which was Monday. I`m on pain meds Ultram I didn`t think that they were real strong where they were guna mess with me like that. I`m guna wait to see what happens. I had my hysterectomy done laperscopicly. I haven`t too much of the gas rise either. Shud I be bracing myself for the morning I get up? And also I haven`t been able to get too much phloem up from my chest. I`m waiting fer that to come up too. Am I expecting too much too soon?? Thanks so much for listening to me an reading this. =)
    Time to Heal

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  184. I recently had an Endometrial Ablation, a TVT sling procedure and an Essure procedure done. It has been almost two weeks since the procedure. I would like to know what kind of side effects I can expect. Also I have been experiencing painful lumps in the area of the surgery. Is this normal? Will I gain weight as a result of the surgery?

    Sincerely,

    Concerned

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  185. It's interesting that in our multitasking lives, we've begun to multi-task our surgeries! More combined operations are being studied and done safely, but we have to remember, the more we try to accomplish at any one time, relatively more difficult recovery always is. When women write and discuss the consequences of a particular operation we typically quote studies, and to my current knowledge I cannot site any studies that have combined the three procedures you have described all together. I don't even know of any FDA registries that follow the outcomes of more than one operation combined with another, but I would need to look into that more. Of course, it's always best to seek post op advice from one's own physician who would know your individual case scenario. Women who have had an endometrial ablation will typically have a 2-4 week recovery period before one can say that the "healing" phase has completed. If a woman who had an ablation had been on contraceptives, or used other treatments for heavy periods, then stopping those treatments may also have an initial effect on any subsequent menstrual bleeding patterns. The post operative course of sling procedures for pure stress incontinence is typically rapid, as is the course for a tanscervical sterilization procedure. But how the postoperative course of one would affect the other, to some extent would be conjecture due to lack of a lot of scientific literature.

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  186. Thank you for your quick and informative response. I just wanted to get a second opinion about the procedures I have received. I asked my physician some of the same questions and he just kind of brushed it off as being realitively safe. Since that time, I have begun to do research on my own to see if I could find out any other information that was not disclosed to me prior to surgery. I like to be proactive in my own health care by way of research and asking questions. I think you answered most of my questions, thank you. I do have one more question. I asked my doctor at my follow up appointment two days ago, if there is a chance that heavy bleeding could occur. He stated that the chances are slim to none however , with me being in my early thirties, it is possible to resume normal periods. Is this true? Could you shed some light on the situation? Before the procedure, I suffered from extended periods, severe anemia and stress incontinence for a number of years. I hope that all goes well with my recovery and I won't have to see the inside of a hospital room anytime soon.

    Sincerely,

    Concerned

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  187. Women in their thirties who have endometrial ablations are more likely to have a recurrence of menstrual bleeding than women in perimenopause. In these discussions we have quoted statistics, and all the endometrial ablation devices have statistics as to their success rates. Any woman who has a recurrence of her periods after an ablation may be more likely to have heavy menstrual bleeding. But then a woman who has had an ablation, is still more likely to respond to other treatments than had she not done that treatment.

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  188. My history includes, two c-sec, and one D&C due to a missed miscarriage. Had always had irregular but heavy and painful periods. I had Novasure ablation in July 06 and bleeding stopped completely. Had a tubal ligation with the last C-Sec in 05. In 2008 I started having irregular but very painful episodes of lower right abdominal quadrant pain. The pain lasts anywhere from 3-10 days steadily increasing. Sometimes I can go several months without pain but not more than 5. Twice the pain has been severe enough to warrant a visit to the ER. Last visit showed a cyst but on the left side not the side that was bothering me. The pain has increased steadily over the years and now also seems to radiate down the thigh. My gyn is very proactive in my opinion and would like to go back in and check for endometrial growth, etc, and if present remove them. At 35, he and I would rather not pursue a hysterectomy. The last episode occurred last month and included some spotting. I am currently severely anemic and the dr wanted that resolved before we could consider any gyn treatments. What do you think is going on?

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  189. When we approach a patient with intermittent pain who has also had an endometrial ablation, it's more likely to be due to endometriosis or other causes than the post endometrial ablation syndrome. I prefer to use our 3D ultrasound to check pelvic blood flow, and to image the fallopian tubes to try to get an answer. Women who had heavy menstrual bleeding in the past and now are still anemic would also be tested at Women's Health Practice for bleeding disorders (217-356-3736).

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  190. Thanks for answering my question (anon 8:27pm) so quickly. At this point is my only recourse a hysterectomy? I would rather not have another ablation with the possibility of repeating it again in the future. Oh and what other causes besides the endometriosis? I am dreading the episodes being that I'm irregular, they find me I'll prepared.

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  191. When women have questions that really go into depth regarding options, the only viable way to give advice is for an in person consultation. I understand over the web many of my readers don't live close, and thus they need to see their own physicians. Otherwise we hope to meet many of you some day! Thanks

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  192. I had an endometrial ablation feb 05. To date I still feel ab cramps, huge breast sorenes, moody-- like am having a cycle and no bleeding (that part yay). prior to the ablation I had a tubal 13 years my youngest was 2 or 3 and he is 19 this year. is this a case of phantom pains? is this normal and sometimes it is realllllly painful; especially breasts - just sitting in my bra.

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  193. I had a tubal 12 years ago, a endometrial ablation in 2002 or 2003. Up to three weeks ago I started with N/V in the morning mostly but last all day, especially around strong smells, breast are very tender. I took a pregnancy test it was negative, but my abdomen is tender. Don't know what is really going on in there. I'm not having a Gallbladder attack because it is my lower abdomen that is the issue. I don't know should I call my Gyne (who I'll never get an appointment with-you have to be pregnant or it will be a 3 month wait)or just call my PCP?

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  194. I'm getting ready to go see a fertility doctor next week because I'm in a new marriage, my husband and I want to have children but I don't want to use my eggs because of my age and our age differences. I want to use egg donations. I wanted to adopt but I really want our child to have his DNA. I also had an endometrial ablation in 2004 I spot here and there, nothing great. I'm currently doing accupunture and taking Chinese herbals to prepare my uterus. Do you think there is a high probablity this can work out for us or is this just a waste of our time? I don't want to get to the doctors office and they look at me like I'm crazy or give me that what was I thinking about look!!! I just don't want or have a surrogate to carry our child. Every female I know and trust is up in age with me also.

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  195. Women who have had an endometrial ablation have had successful pregnancies although it's intended to be performed in women not planning more children. The success of future pregnancies after an endometrial ablation will depend on the amount of lining tissue that has either regenerated on it's own or has been healed through medical and/or surgical management. Testing can determine whether a woman has enough endometrial tissue post ablation to attempt a pregnancy.

    For women asking specifically about PMS and breast symptoms post ablation, those are typically due to hormonal issues that are separate from the ablation, and would likely be approached that way by your physician. Thanks.

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  196. I had an ablation in 2007 and had very little flow following the procedure. About 1 year after the procedure my cycles began to get a little heavier and I began to have intense cramping in my lower right, sometimes lower left abdominal area. It is usually several days into my cycle, almost when I think I'm going to finish, and then I tend to have some clots after the pain. The pain is so severe and it's nothing like menstrual cramps, it's extremely sharp, intermittent, and usually lasts several hours until it resolves into just tenderness the next day. It also tends to come on without any real warning. This last time, I had a fever of 101 after taking Tylenol and of course chills. Again it resolved several hours later. These episodes don't last but are every month and becoming more severe each month. My flow is also becoming heavier each month and occasionally I have some spotting throughout the month as well. I have thought I had ovarian cysts, but now after reading these posts I'm beginning to wonder. I just started a new job and my insurance won't kick in for two more months, so I'm trying to hold off before seeing a doctor. My other concern is by the time I get into see a doctor, the pain has resolved.

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  197. Dysmenorrhea or menstrual cramping, that is resolved by ibuprofen is usually something that can be evaluated at your yearly check up. Menstrual associated fevers are potentially a sign of infection or toxic shock and typically warrant evaluation more promptly. Some women who have had prior jobs can get "COBRA" coverage to bridge gaps in their insurance coverage.

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  198. Had an D&C and ablation on 3/29. Diagnosed with ovarian cyst, polps, and fibroids. Bled/spotted for three weeks. I had 1 week of no bleeding and period started yesterday. It's a little better than before the surgery, just a little better and not the result I was hoping for. It's still gushy and clotty. Should I wait it out for a few monthys or call my dr.? I'm thinking it didn't work.

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  199. Your physician needs to know what you are experiencing if you are still having heavy menstrual bleeding the first cycle after an ablation. Your case sounds like you have other gynecologic issues that do not generally respond to ablation. At Women's Health Practice we would see you in follow up to determine if the cyst is still present and what size and location the fibroids are, and you need to have those polyps looked at carefully. Some women need resection of their polyps.

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  200. At age 32 I had an endometrial ablation due to heavy bleeding and cramping during my period. For about a year following this procedure everything was great no more bleeding at all or cramps. However, for the last year, I am now 34, I have started having severe pain in the lower right side, It feels like I'm being stabbed with an ice pick and then like my insides are being wrung out. The pain comes and goes it will last anywhere from a couple of hours to days. It is becoming more and more frequent. I have been in the emergency room twice, I thought I was having an appendicitis or something. They told me that they thought I had an ovarian cyst that had burst. I have had a transvaginal ultrasound that showed nothing. I met with my Gyn today, he is also the one that did the ablation, he doesn't seem to know what is causing this because nothing has shown up on ultrasound. Could I have post ablation syndrome? Should I bring this to my doctor's attention?

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