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Pain and Bleeding Post Endometrial ablation

November 12, 2018

 

At Women's Health Practice we have offered endometrial ablations since the 1980s when the technology was invented. We have successfully performed hundreds of procedures, using many technologies and have a vast experience in the follow up of these patients. We welcome second opinions regarding any symptoms you are having post an endometrial ablation

 

An endometrial ablation can be an effective treatment, but they are not necessarily protective against all gyncologic pain or bleeding and careful follow up monitoring may be necessary

 

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.

 

Endometrial ablation is not a contraceptive method. One complication of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy.

 

Many women with symptoms of pelvic pain after an ablation have actually also had a tubal sterilization procedure. 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.

 

Infections can often be the cause of any gynecologic pain. 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.

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