Ask an Expert: Ablation, cervical stenosis and hysterectomy?

Women's Health

Ablation, cervical stenosis and hysterectomy?
04/27/2009

Question:

I had an endometrial ablation in May 2008. Cramping gradually increased from July on, leading me to the doctor in December 2008. An ultrasound showed blood backed up in the uterus due to stenosis of the cervix. I have had the cervix dilated and the blood removed 3 times in the doctor`s office. Cramping continues and is worse, occurring almost daily and I am having to take ibuprofen and vicodin to alleviate the pain. My doctor is recommending a hysterectomy to relieve the pain and return a good quality of life (no more pain), which she says is being caused by an "irritated uterus". Your thoughts?

Answer:

Endometrial ablation, a procedure in which the lining of the uterus is destroyed by burning or freezing, is a good way to treat excessive menstrual bleeding. Unfortunately, it is nearly impossible to destroy the entire lining, and so most women will continue to have small amounts of bleeding each month.
When there is scarring of the cervix after the procedure, sometimes this small amount of bleeding gets trapped inside the uterus with no way out. The uterus can then get distended with blood, a condition called hematometria, which can be quite painful.
If the cervical scarring cannot be reversed, for example by dilation, then a hysterectomy (removal of the uterus) is a reasonable way to deal with this condition. Depending on what other factors are involved, it would also be reasonable to use medical therapy to try to stop the bleeding, either with a hormonal medication (progestin) or an intrauterine device.

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Response by:

Jonathan A Schaffir, MD
Assistant Professor
Division of General Obstetrics and Gynecology
Department of Obstetrics and Gynecology
College of Medicine
The Ohio State University