Women's Health Community

Dear Louise: A softened and enlarged uterus can be the result of adenomyosis (endometriosis inside the muscular walls of the uterus). This would be considered a chronic condition, and something not overtly impacted by an endometrial ablation/EA (which just destroys the tissue lining of the uterus).

Your nausea, fatigue, and sickness apparently began began about one month before the EA. Within the past month those symptoms have escalated to include vomiting, severe fatigue, and severe uterine cramps---hope I am tracking you correctly.

A number of women have reported pelvic pain after an EA (see our Popular Discussion called Endometrtial Ablation Side Effects in th right side bar). Physicians from the Mayo Clinic reviewed the outcomes of 816 women who had an EA. Factors which seemed to predict successful stopping of all bleeding ("amenorrhea") included: age 45 or older (menopause would be kicking in within 5 years or so), a thin uterine lining of less than 4 mm, normal size of uterine cavity (less than 9 cm), and use of NovaSure type rather than heated balloon. Patient characteristics linked to treatment failure were: age younger than 45 years, five or more pregnancies (leads to larger uterine size), prior tubal ligation, and history of bad menstrual cramps. Of note, 5% of their women had complaints of pelvic pain after their EA procedure. Among that 5% of women with persisting pain 40% had retained fluid within the uterus—referred to by the authors as "postablation syndrome."

One can have endometriosis which invades into the muscular walls of the uterus. This is called adenomyosis. It is very difficult to diagnose; most often it is identified after removal of the uterus. Adenomyosis is not well visualized on ultrasound; an MRI may be needed. Like endometriosis it can worsen menstrual cramps, create uterine pain, and even prompt bleeding problems. I began to wonder if there was a link between continued pain after EA and possible undetected adenomyosis.

I found a study of 190 women with known adenomyosis who had a rollerball EA. After an average of five years follow up, almost 87% reported reduced or no menstrual cramps. This leaves 13% who had continued monthly pain. In a smaller study of women receiving microwave ablation, 59 had known adenomyosis. After an average of five years of follow up, younger age and presence of adenomyosis, were found to be linked to unsatisfactory treatment outcomes.

Louise, it is difficult to know for sure if your current bad symptoms are a result of the EA or another medical condition (ge low thyroid). I would strongly urge you to go back to the GYN who did your EA for an evaluation. Be sure and ask them exactly what they meant by the enlarged and softened uterus.

In Support,
Jane

I've had this problem & still haven't gotten a definite reason why this happens. I chose to have a hysterectomy because of all the hemorraghing, cramping, & fatigue. It got so bad that I hemorrhaged on a daily basis. Talk with your doctor to see what options are right for you & I wish you the best.

Hi. I just read your reply. I had the NovaSure Ablation about 1 1/2 years ago. I get a terrible pain in my left side, on my belly, near my hip bone, every month for the past several months. It is getting worse each month. I am concerned it is related to the EA. What is postablation syndrome, and should I be concerned. This pain got so bad the last time, that I was nauseated.