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Dr. Andrew Rynne

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Is vaginal bleeding normal post ablation procedure?

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Dr. Jacqueline Brown

OBGYN

Practicing since :1996

Answered : 1425 Questions

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Posted on Wed, 28 Oct 2015 in Women's Health
Question: I have had some irregular bleeding. Dr did novasure ablation of uterus a few years ago. She did ultrasound and said the bleeding is most likely due to a small amount of fluid collection (loculations from prior novasure procedure). What does this mean (loculation from prior novasure procedure)? Is that common to happen after an ablation?
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Answered by Dr. Jacqueline Brown 5 hours later
Brief Answer:
Loculations are caused by scar tissue in the uterus trapping fluid

Detailed Answer:
Hello, and I hope I can help you today.

Loculations are walled-off areas that form within the body that trap normally produced body fluid that accumulates behind areas of internal scar tissue, called adhesions. Adhesions are literally bands of scar tissue that stick two walls of organs together.

When you have an endometrial ablation, the inner walls of the uterus, because they are right next to one another, can literally get stuck together as they heal and if there is any remaining normal menstrual tissue behind the area where this scar develops, this band of tissue can trap the menstrual fluid in a pocket, which we call a loculation.

Most women, until their ovaries stop working, have some vaginal
bleeding after Novasure. If you never did before, it is possible that the blood there had been trapped for a while and scar tissue finally broke and let the blood drain. I do not know how old you are so if you are at an age where you should be menopausal, but this buildup of menstrual blood in a loculation that just began draining is a logical explanation for your bleeding.

Anyway I hope my somewhat long winded answer to your question is helpful. If you need any further clarification or help in any way, please do not hesitate to contact me.

Best wishes, Dr. Brown
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Jacqueline Brown 1 hour later
I just turned 51. I have still been having fairly regular periods (every 21-28 days - usually fairly light since ablation). This month however I had bleeding after intercourse (only 14 days after a period), spotted a couple days, then began bleeding similar to a period. This has happened to me a couple times since the ablation (bleeding after intercourse then starting my period). The dr was going to do an endometrial biopsy but had trouble getting beyond my cervix. She is going to have me take some medication to dilate my cervix then try to do the biopsy but her initial thought was that it was loculation due to my ablation.

Even before the ablation, I had episodes of light bleeding after intercourse - honestly for a long time (10 years maybe). So this isn't anything real new. This is however a new doctor so I think she is wanting to be thorough by doing the biopsy.

Any further thoughts based on those comments? And also, is there any need for treatment of this loculation (assuming my biopsy comes back normal).
doctor
Answered by Dr. Jacqueline Brown 7 hours later
Brief Answer:
If the bleeding isn't a new pattern I would not be concerntd

Detailed Answer:
Hello again, and I apologize for the delay in getting back to you. Thank you for the additional information.

If your period never stopped and you had some post coital bleeding even before the ablation, I don't necessarily think your bleeding has anything to do with a loculation unless your doctor saw a pocket of fluid or thickened tissue on an ultrasound of your uterus. It is going to be difficult for your doctor to get a biopsy even with medication to dilate your cervix because of the scarring from the Novasure. Irregular bleeding after menopause is concerning but in your case you aren't menopausal so if you were my patient I wouldn't necessarily even perform an endometrial biopsy at all unless the lining of the uterus looks abnormal on an ultrasound. The loculation again is just scar tissue from the Novasure and itself is not harmful at all so it doesn't need to be treated once the doctor makes sure that there is no dangerous cause for the bleeding.

So I hope this all works out but I am even less concerned with the additional information you have given me. I think the doctor is just being thorough by recommending the biopsy. And again, a loculation is just scar tissue that traps fluid in a pocket and is a common finding after endometrial ablation in a woman who still menstruates.

I hope this clarifies the situation better for you and that my advice was helpful.

Take care, Dr. Brown
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Jacqueline Brown 3 hours later
Ok I appreciate your detailed thoughts. One last thing I want to mention is that the doctor's summary says: "us with small fluid collection most likely related to loculations from prior novasure." So with that being said, what are your thoughts. You had said if it were loculations, you wouldn't be concerned but I think you said if it was a small collection of fluid, it might be concerning. Just wanting to ensure I understand. Thanks so much! Have a great weekend.
doctor
Answered by Dr. Jacqueline Brown 2 hours later
Brief Answer:
Since it specifically mentions a loculation I don't see a need for biopsy

Detailed Answer:
Yes with this ultrasound reading I do not see why your doctor wants the biopsy, especially because it is difficult to perform. Your situation is one of the common problems after ablation- it makes later sampling of the uterine lining difficult.

So I would not worry at all about the fluid or the loculation, and I hope the next attempt at the endometrial biopsy is successful so both you and your doctor can be reassured.

If you had a good experience with my advice and are done with this question dialogue with me, please post a star rating when you are finished.

I appreciate your using my services at healthcaremagic.com.

Sincerely, Dr. Brown
Above answer was peer-reviewed by : Dr. Raju A.T
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