Under normal circumstances, the endometrium can't grow back, as the purpose of an ablation was to detroy the lining permanently. When the cells that produce the lining of the uterus are destroyed, there's really nothing you can do to reverse this. As I mentioned above however, the endomentrium does occasionally grow back after an ablation in some cases, but only as a complication when:
- the surgery wasn't entirely successful and some of the original lining was left behind... or-
- the patient has adenomyosis, where the endometrium has infiltrated the walls of the uterus, so that even after the normal lining is removed, some of the cells that produce it still exist in the uterine wall
And I believe it's fairly certain, with what you've told me, that one of the above has occured in your case, so further treatment is necessary to correct this.
Also, and ablation can result in a lot of scar tissue on the uterus that will cause pain. You can have some of this scar tissue removed with a simple laparoscopy (not a D&C), and this will probably help reduce pain, but removing scar tissue doesn't bring back that healthy endometrium that was destroyed from the ablation. Yes, if some tissue was left behind inadvertently after your ablation (and this seems to be the case), some of it is going to grow back, but this will require another ablation, and not a D&C procedure.
A D&C is a simple superficial scraping of the contents of the uterus. Removing endometrial tissue with a D&C procedure is just like mowing your lawn... you're not removing any of the cells that produce the thick endometrium, but just some of the extra thickness and the blood so that, when you do menstruate, it's not as heavy. And like mowing the lawn, it's going to grow right back after the procedure. D&C is only a very temporary solution to heavy bleeding problems, and is usually only done when bleeding needs to be controlled, but when the woman is still planning to have children in the future (the endometrial lining is crucial for nourishing a pregnancy, of course). Sure, you can always have a D&C to control heavy bleeding, but unless you have a successful ablation, you're going to have to get repeated D&Cs every few months or so to keep this problem under control. On the other hand, when successful, an ablation is more like a permanent D&C... you're not just "trimming the grass," so to speak, but removing the roots and seeds of all the grass on the lawn so that it can never grow back and cause an overgrowth again.
Your treatment needs to be as follows:
- Evaluate for possible adenomyosis or other abnormal uterine problems (fibroids, adhesions, etc). This can be done with an ultrasound or MRI. Remember, if you have adenomyosis, an ablation is not going to work on a long-term basis because the endometrium-producing cells are within the wall of the uterus and not just in the uterine lining. The only way to permanently solve this is with a hysterectomy, though medical therapy with GnRH-a (Lupron, Zoladex or Synarel) treatment can help control it, if you prefer not to have a hysterectomy at this time (and I wouldn't blame you).
- If adenomyosis is not found, you need a repeat ablation procedure. Any scarring or adhesions from the first procedure can also be removed at this time to help with pain. The need for a repeat ablation is pretty common, espeically in young women. About 10% of women who get an ablation will need a second one to complete the job.
- Also, consider a LUNA procedure for your pain (laparoscopic uterine nerve ablation), which is a very simple procedure and can be performed during a second ablation. This involves simply cutting one set of nerves to the uterus, and will GREATLY reduce any uterine pain and cramping you're having. A LUNA doesn't really affect the uterus at all, but just eliminate some of the sensation you have from that area (pain, cramps, etc). I had this done myself, and the difference in pain is like night-and-day. Honestly, it literally changed my life, because my uterine pain was very debilitating prior to that procedure.
Aside from this, your only other treatment options are going to be medications, which will control the symptoms, but not cure the problem, or a hysterectomy.
I hope this helps, and feel free to ask any more questions you may have.