Endometrial ablation is a gynecological procedure designed to reduce or stop heavy menstrual bleeding by removing or destroying the uterine lining (endometrium). This procedure offers an alternative to hormonal therapies and hysterectomy.
Understanding Endometrial Ablation
Endometrial ablation aims to lessen the amount of blood lost during periods, with many patients experiencing lighter flow or a complete cessation of bleeding. The procedure is minimally invasive, performed by inserting small tools through the vagina to reach the uterus. Methods used to destroy the lining include heat, extreme cold (cryoablation), or electricity.
After the procedure, patients commonly experience some immediate side effects. This can include mild, period-like cramping for one to three days. Light bleeding or pink, watery discharge is also expected and may last for a few days to several weeks, typically being heaviest in the first 48 to 72 hours. Most individuals can return to their normal daily activities within a few days.
Reasons for Bleeding Years After Ablation
Experiencing bleeding years after an endometrial ablation can be concerning and has several potential causes. The most common reason is endometrial regrowth, where the uterine lining can regenerate despite being ablated. This is relevant for younger individuals, as their bodies continue to produce hormones that can stimulate endometrial tissue to grow back.
Hormonal changes also contribute to post-ablation bleeding. Fluctuations during perimenopause or the onset of menopause can affect the remaining endometrial tissue, leading to irregular bleeding. Hormone therapy can also influence the uterine lining and cause unexpected bleeding.
Other gynecological conditions can develop independently of the ablation but still cause bleeding. These include benign growths such as polyps or fibroids within the uterus. Adenomyosis, where endometrial tissue grows into the muscular wall of the uterus, may also lead to bleeding or pain. New-onset bleeding years after ablation can also be a sign of more serious conditions, such as endometrial hyperplasia or uterine cancer.
When to Consult a Doctor
Significant or persistent bleeding years after ablation is a reason to seek professional advice. This includes heavy bleeding, defined as soaking through a sanitary pad or tampon every hour for two or more hours.
New onset of bleeding, or any bleeding occurring after menopause, should prompt a doctor’s visit. Other concerning symptoms include persistent pelvic pain, especially if severe or worsening. Foul-smelling vaginal discharge, fever, or chills can suggest an infection.
Medical Evaluation and Management
When consulting a doctor for post-ablation bleeding, a thorough medical evaluation will be performed. This typically begins with a review of your medical history and a physical examination. Imaging tests, such as a transvaginal ultrasound (TVUS), are commonly used to visualize the uterus and assess the endometrial stripe.
Further diagnostic procedures may include an endometrial biopsy (EMB), where a small sample of uterine lining tissue is collected for analysis to rule out conditions like endometrial hyperplasia or cancer. A hysteroscopy, which involves inserting a thin, lighted scope through the cervix to inspect the inside of the uterus, can also be performed to identify polyps, fibroids, or areas of endometrial regrowth.
Management options depend on the underlying diagnosis. If endometrial regrowth is identified, repeat ablation may be considered. Hormonal therapy, such as birth control pills or hormone-releasing intrauterine devices, can help regulate menstrual cycles and reduce bleeding. In cases of persistent or severe symptoms, or if more serious conditions are found, a hysterectomy may be recommended.