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Tuesday, September 15, 2015

Post Endometrial Ablation Tubal Syndrome and Hematometra

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Women who have had an endometrial ablation, even if they have had a long period of time with no symptoms, who begin to have pain likely have a condition where blood is getting trapped within the uterus or fallopian tubes. It is more likely in some one who had a tubal ligation, it may be more likely in women who had a large uterus such as from adenomyosis at the time of their ablation. The concept of blood trap is easy to understand but the a gyno term, hematometra is. Pain, old  and dark, and foul smelling menstrual blood are both signs of this relatively uncommon problem. A hematometra from an ablation is iatrogenic from a surgical procedures, but there are some cases that are not associated with any prior surgery.  If a young woman has vaginal tract abnormalities that cause blood to back within the vagina, before backing up with in the uterus, the term is hematocolpos. If the fallopian tube (tubes) is dilated with blood as well, the term is hematosalpinx. If the condition is in the fallopian tube after an endometrial ablation it is called a post endometrial ablation syndrome. Many causes of this hematometra, or blood trap are due to infections, usually an infection of the cervix, but it may have been the whole uterus. Other causes are scaring, prior surgeries such as endometrial ablations (not a common cause of this), Ascherman's syndrome with scaring in side the uterus itself, tumors of the cervix, or even some cases due to radiation treatments after cancers. IUDs are not typical causes of hematometra. The symptoms are usually sharp pains, often in a cyclic timing, and they usually are located very low in the pelvis or the abdomen, right in the midline. Pelvic exam is helpful but the best tool for the first diagnosis is an ultrasound. Often the best treatment is just opening up the block, but physically looking into the cervix to see if pockets of blood can be released via a surgical proceudre. Some cases are more complex than this. The cause of the hematometra will potentially be a prevention of pregnancy and treatment of the underlying cause will help you conceive if that is the goal.

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