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Q&A with Australian Health Practitioners
Can your endometrium grow back after ablation but no bleeding?
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I had a Novasure endometrial ablation in 2010 because of heavy periods (following trying D&C, colposcopy) and have not had any periods since then. For about 18 months I have been experiencing pelvic pain and discomfort. In September 2015 I had a bleed for 3 days. My GP referred me for a scan. The scan said uterus was bulky, small fibroid and endometrium thickness was 6mm. I have not bled since, but continue to have discomfort and increasing nausea. My GP said it was nothing to worry about but I am uncomfortable. Last smear test (Oct 2015) was normal. I am 49 years old but hormones suggest at least 4 years away from menopause. Should I book an appointment with a gynaecologist? -
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Thanks
Dr Joseph Jabbour
Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician
Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile
Your presentation warrants a referral to a gynaecologist especially if you are uncomfortable with your GP's reassurance.
The bleed and the Endometrial Thickness may suggest a new pathology that may be causing your symptoms. Pelvic pain for 18 months is abnormal as well. A gynaecologist would take a proper history, do a pelvic examination and assess whether you would benefit from endometrial sampling to exclude any endometrial abnormalities. This sampling most likely would require a Hysteroscopy and biopsy of the endometrial lining. This is day surgery and involves inserting a camera into the uterus through the vagina and cervix to visualize the endometrial lining. You would have had a hysteroscopy prior to the Novasure ablation.
A bulky uterus on scan and the presence of a fibroid may suggest you have endometriosis and/or adenomysosis. This may warrant a laparoscopy as well. Although this diagnosis is unlikely in the absence of other symptoms and does not typically present at 49, if you have been suffering from chronic pelvic pain in the absence of other causes, a diagnostic laparoscopy would be warranted.
I hope this answers your question. Good luck.
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Dr Yogesh Nikam
Gynaecologist, Laparoscopic Surgeon, Obstetrician
Dr Yogesh A Nikam is a Specialist Gynaecologist, Laparoscopic and Robotic Surgeon who understands that no woman’s body or experiences are the same, which is … View Profile
Hi
Sorry to hear that you are experiencing bleeding and pelvic pain following a uterine ablation. You are not alone. Many women experience such an event. Unfortunately, any bleeding following an 'ablation' may be from a new pathology that warrants evaluation via a Hysteroscopy ( visualization of the uterus via a camera) and biopsy of the endometrial lining. This is essential to rule out endometrial pathologies such as a uterine endometrial hyperplasia ( a pre-cancerous condition ) or Endometrial cancer. A Hysteroscopy may be difficult after an ablation as the uterine wall can adhere to each other and close off the cavity. This may be a tricky scenario as the endometrial pathology then can't be ruled out completely.
The pain that you experience could be a combination of a new pathology or because you may have prior uterine adenomyosis. Pelvic pain can worsen if a woman with adenomyosis undergoes ablation, however, ultrasounds are not good at identifying adenomyosis.
Hope this helps. Please see a specialist. Good Luck
Dr Yogesh Nikam
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