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Pelvic Pain 101

December 7, 2017

 

A Cure For Post Endometrial Ablation Syndrome

 

Post Endometrial Ablation Syndrome is an increasingly common condition of unexpected pelvic pain that occurs after a woman has had an endometrial ablation. In many cases the cure means more surgery, but there are alternatives to surgery for the condition of post endometrial ablation syndrome. 

 

Pelvic Pain After an Endometrial Ablation

 

If you have had an endometrial ablation and have developed symptoms of pelvic pain, painful intercourse, chronic infections, irregular bleeding, or painful periods, you might have post endometrial ablation syndrome. The procedure of ablation destroys the basal layer of the endometrium which is the lining tissue of the uterus. Should that endometrium regrow, however not have an egress out of the uterus, it can accumulate in the uterus as a hematometra.  Post endometrial ablation syndrome is a constellation of symptoms due to this entrapped blood or even retained or infected tissue within a uterus that has previously undergone an endometrial ablation.

Diagnosis of Post Endometrial Ablation Syndrome

 

 We are able to diagnose this at Women's Health Practice through a systematic set of tests that is designed to rule out infection, uterine tumors or polyps, or hormonal issues. Occasionally, even in women who have had a uterine ablation, we determine that  other conditions are causing similar symptoms. Other complications of endometrial ablation, that are not specifically related to an ablation, include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterine wall itself, or adenomyosis (internal endometriosis). If you have had a tubal ligation then it is possible that the condition could be related to issues with the tubal sterilization. In other cases post ablation women go off their oral contraceptives which were providing gynecologic benefit and the problem is not the new procedure, but the withdrawal of the hormonal control those oral contraceptives provided. 

 

The Best Prevention is A Complete Ablation

 

.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 every month. Remember the process of having an endometrial ablation does not change your hormones and the cycles persist as they were before you had the procedure as the ovaries are not treated

 

Fallopian Tubal Pain Can Cause Post Endometrial Ablation Syndrome

 

 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 within the fallopian tube may become infected, and this could produce symptoms as well. If this is the cause tubal removal may be best.

 

The Syndrome Post Endometrial Ablation May Be More Common in Women With a Prior C-Section

 

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, pick a different part of the cycle to test. 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.

 

The Cure

 

It is not likely that the cure is a self cure, but there is no harm in trying a short course of ibuprofen or other mild pain medication. The cures depend upon the cause. Most women can be treated successfully without surgery. Drainage of the entrapped blood is the best first step, and this is done by an experienced gynecologist . Next treatment for infection. Hormonal management to re-thin the lining is also a great strategy. 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. http://www.gynogab.com/2014/01/post-endometrial-ablation-syndrome.html

 

 

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