Dilapidating hematoma

If the blood backs up into the fallopian tubes it’s called hematosalpinx.

Hematometra and hematosalpinx can cause acute and chronic pelvic pain.

So although ablation can have the desired effect of reduced or even absent bleeding, it can be a double-edged sword.

This relief from heavy bleeding may, in the long-term, be overshadowed by chronic, debilitating pain caused by the ongoing, monthly attempts by the uterus to build and shed the lining. The younger a woman is at the time of ablation, the greater the risk of long-term problems that can then lead to hysterectomy.

A 2008 study in Obstetrics & Gynecology found that 40% of women who underwent endometrial ablation before the age of 40 years, required a hysterectomy within 8 years.

Similarly, 31% of ablations resulted in hysterectomy for 40-44.9 year old women, ~20% for 45-49.9 year old women and 12% of women over the age of 50 years required a hysterectomy after the endometrial ablation procedure.

With all the adverse effects associated with endometrial ablation, especially the need for hysterectomy later, one must question whether women are informed about those risks.

As I have found when investigating this topic, there are few long term studies on endometrial ablation.

It is an increasingly common procedure used to treat heavy menstrual bleeding. Here are the short-term complications for endometrial ablation reported in Pub Med: pelvic inflammatory disease, endometritis, first-degree skin burns, hematometra, vaginitis and/or cystitis.

Another study, reported a similar link between endometrial ablation and hystectomy.

“On the basis of our findings one third of women undergoing rollerball endometrial ablation for menorrhagia (heavy menstrual bleeding) can expect to have a hysterectomy within 5 years.

The procedure is premised on the notion that if the endometrial lining is destroyed – ablated – bleeding can no longer occur. A search of the FDA MAUDE database included complications of thermal bowel injury (one resulting in death), uterine perforation, emergent laparotomy, intensive care unit admissions, necrotizing fasciitis that resulted in vulvectomy, ureterocutaneous ostomy, and bilateral below-the-knee amputations.

Additional postoperative complications include: Endometrial ablation to block menstruation.

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