When Painful Periods Return after Ablation
Uterine ablations done by destroying the uterine lining to treat heavy periods, are now both common and have been shown to significantly reduce the rate of hysterectomy.
The younger you are when you have an ablation, and the more years you have before menopause, you may be more likely for the ablation to fail.
If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome, and you need an in person gynecologic examination.
Post-endometrial ablation syndrome is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation.
Pain after an ablation, even one done many years ago may be a new infection, uterine fibroids, endometriosis, uterine prolapse, or one of a number of gynecologic conditions. Post endometrial ablation pain, also be due to scarring.
We have experience in the treatment and the diagnosis of these, are able to diagnose this at Women’s Health Practice but occasionally other conditions are causing similar symptoms.
Women with post endometrial ablation pain may need a hysterectomy, and we can provide non-invasive, outpatient, hysterectomy with a goal to get you back to full activity as quickly as possible.
Other complications of endometrial ablation include unintended pregnancy (ablation is not contraception, you might still get pregnant), risks from pre-existing conditions that weren’t treated such as a polyp, a fibroid, an infection of the uterus. It would be very rare to have a uterine lining cancer after an ablation.
If you have had a tubal ligation, as well as an ablation, then it is possible that the condition could be post-ablation tubal sterilization 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
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. 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.
You want to get evaluated if you are having symptoms of pain or painful periods after you have had an ablation. 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 blood trapped with in the uterus called hematometra, so you may need the ultrasound repeated at different parts of the cycle. If an ultrasound fails to make the diagnosis your gyno may want to consider getting an 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.
