I took a call yesterday from a woman in the southern tier. We get 2-3 of these calls in a typical week from all over the United States. Fortunately this woman lived only a few hours away—for the sake of this article we’ll call her “Bonnie”. I’m writing about her because her’s is a classic case of “late-onset-endometrial ablation failure (LOEAF)”.
Her endometrial ablation was performed 10 year ago with one of the commonly used ablation devices. She did well for nearly 10 years—which is great. Now, at age 39, she reports that beginning in the fall of 2016 she began experiencing a slight bout of abdominal pain.
By December her pain was intense and “like labor pains” lasting 5 days. For the first time she began experiencing spotting. She consulted with her gynecologist who’d suggested a hysterectomy—though he wasn’t able to explain why she was experiencing pain. Nonetheless he prescribed “hormones” which didn’t seem to improve her situation. As of today she’s had nearly a month of continuous pelvic pain which improves and worsens throughout the day.
The diagnosis could almost be made over the phone. Unfortunately, Bonnie’s situation is quite common and affects many women who undergo endometrial ablation. Bonnie, however, wasn’t prepared for this and so she became quite anxious that something dreadful was occurring.
Late-onset endometrial ablation failure is COMMON and affects at least 25% of women who undergo the procedure. Unfortunately women are rarely forewarned of this complication and often when they begin experiencing symptoms—delayed bleeding, pain or both—they’re caught off guard. These late-onset failures don’t mean that endometrial ablation is a bad procedure. It’s not! However, a few things are important.
- Women need to know what the likelihood of failure is for their particular age-adjusted group. For women under the age 35 the failure rate is nearly 40% with endometrial ablation.
- Women should be reminded–at EVERY annual examination–of the symptoms associated with endometrial ablation failure.
- At the first sign of a late-onset complication—pain, bleeding or both—a transvaginal ultrasound examination should be used to assess the uterine cavity.
- If possible, women who undergo endometrial ablation should have an ultrasound examination as part of their annual examination.
So what happened with Bonnie? Bonnie was nice enough to come in today. Her ultrasound examination revealed a uterine cavity filled with blood—a hematometra. What Bonnie had experienced was a “back-up” of blood from the uterine cavity that would not pass out the cervix—which was scarred nearly shut. The result was that her uterus contracted in an attempt to pass the blood—Bonnie experienced those contractions as “labor-pains.” Her ultrasound examination revealed something quite similar to what’s shown below.
The treatments for hematometra are limited. Hormone therapy is occasionally useful. Most women undergo hysterectomy and many can be treated with ultrasound-guided reoperative hysteroscopic surgery which removes the blood AND THE ENDOMETRIUM that causes the bleeding.