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Melissa
Melissa, B.S. Biology/Psychology
Category: Health
Satisfied Customers: 1335
Experience:  B.S. Biology/Psychology - University of Georgia
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I had endometrial ablation 1 year ago and I was ...

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I had endometrial ablation 1 year ago 6 months after I had sever abdominal pain and bleeding I contiuned to have a light period for about 3 months and the last 3 months cramping that has gotten worse and now has lasted for 3 weeks I have been to my doctor and all he seems to worry about is the fact the surgery was done right well over time the fatigue that the ablastion was supposed to cure has gotten worse I really feel like I need to push something out I have taken a pregancy test and it was negative. Instead of haveing pms for a couple of days it now last 7 to 10 days the surgery hasnt done anything but make things worse. I want it reversed. I know if you take the hormone progesterone that it can thicking the lining of the uterus enough maybe that I could have a D and C to remove the scarring and get my periods back. Would this work would you please help me I refuse to have a hysterectomy because of this Please help me No price it to large . Thanks Misty (Med lab Tech)
Submitted: 7 years ago.
Category: Health
Expert:  Melissa replied 7 years ago.

Hi foxtrot,

Specifically, what symptoms are you having, then and now?

Are you saying you don't get your period at all anymore?

Were you diagnosed with endometriosis or any other pelvic/reproductive disorder?

Also, how old are you?

Customer: replied 7 years ago.
Reply to Melissa's Post: my symptoms before my ablation was fatigue from the heavy bleeding mild to moderate cramping that would go away with in a couple of days my doctore talked me into haveing the ablastion then for a month I spotted all was fine for a little while right at the 6 month mark I was awaken by a extreme pain in right where my uterus I had a bad want to push but it just made the pain worse I went on into work which I work in a hospital so I went to the ER and had a ultrasound which revealed that my uterus was thicker than it should be for haveing had the ablation. My doctor pretty much dismissed it and wasnt happy that I had a period for 3 months after now for the past three months my periods have stopped which is what my doctor wants but for the past 3 weeks I have been cramping that has gotten to be more and more severe. I feel like something is trying to come out and I have a neg HCG so I dont know what is going on. MY biggest question is can I have the ablation reversed? by taken hormones I know that it would thicken my uterus enough to have a D and C enough to remove the scarring from my uterus and Endometriosis was suppected but never had a lap to confirm it but that was along time ago and I dont have any kind of pain in that I have alot of problem with my left ovary haveing cysts. I am 29 years of age.
Expert:  Melissa replied 7 years ago.

Hi,

The endometrium is the living lining on the inside of the uterus that produces, stores and builds up blood and nutrients that would be needed in the event that an egg is fertilized and implanted in the uterus.

Under the right circumstances (and assuming the procedure was successful), endometrial ablation is not something that can be reversed, as the endometrium, or lining of the uterus, is usually destroyed during the procedure (for the most part) and replaced with scar tissue. This scar tissue does not allow regrowth of the endometrium, even when taking medication to thicken the uterine lining. However, it is sometimes possible for some areas of the lining to regrow due to tissue being left over from an incomplete ablation, or a condition known as adenomyosis, where the endometrium lining has grown into the walls of the uterus (in which case, an ablation would not be effective for curing heavy bleeding). You can read more about adenomyosis here: http://www.heavybleeding.com/adenomyosis.htm.

A D and C procedure may be useful for removing any pieces of endometrium that have regrown, but can't remove scar tissue, and isn't likely going to be a permanent solution to your problem. Despite what your surgeon is suggesting, it seems as though his ablation was not successful if your uterus has thickened after ablation. Many young women have to undergo repeat ablations in this case, preferably after taking a course of gonadotropin-releasing hormone analogues to thin the lining of the uterus.

Other than a repeat ablation, your options to treat severe bleeding and associated fatigue are:

  • Medications: oral contraceptives and some forms of ibuprofen can help reduce bleeding significantly
  • Progesterone intrauterine device (IUD)
  • Look for and treat any other uterine problems that might exist and lead to bleeding, such as polyps and fibroids and cysts
  • Hysterectomy: the only way to "cure" this problem with certainty

A laparoscopy and/or and imaging studies are advised to see if endometriosis and/or adenomyosis are the reasons your ablation failed, and whether a repeat procedure is indicated here. From the description of the pressure, you may also be having a secondary problem, such as uterine prolapse or fibroids, that is causing this sensation, and would need to be evaluated and treated for this as well.

You can read more about heavy bleeding and treatment options at these sites:

http://www.heavybleeding.com/causes_of_heavy_periods.htm

http://www.heavybleeding.com/Treatment_menorrhagia.htm

I hope this helps!

Melissa, B.S. Biology/Psychology
Category: Health
Satisfied Customers: 1335
Experience: B.S. Biology/Psychology - University of Georgia
Melissa and 7 other Health Specialists are ready to help you
Customer: replied 7 years ago.
i am sorry but how come another women i read about was treated for scarring of the uterus and that the endometrium was growing back nicely if there is any of the endometrium left it would grow back but i also know that a d and c scrapes it away well then how does it grow back then and so it looks like if the scarring was removed it would allow the edometrium to regrow has anyone ever tried this at all if not how do they know it wont work. I would rather try and fail than to never try at all.
Expert:  Melissa replied 7 years ago.

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:

  1. the surgery wasn't entirely successful and some of the original lining was left behind... or-
  2. 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.

 

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