Endometrial ablation and tubal ligation are common surgical procedures usually performed at the same time.
Many women will regret their decision to have these procedures and will inquire about the possibility of tubal reversal and pregnancy after ablation. We have created a series of informative articles to provide readers more information on pregnancy after endometrial ablation.
This fourth article in the series provides advice to readers who want to become pregnant after an endometrial ablation and who wonder if they are candidates for tubal ligation reversal after uterine ablation procedures.
Readers should familiarize themselves with our previous publications:
Pregnancy After Endometrial Ablation: Menstrual Period?
Tubal ligation reversal and pregnancy can be possible for women after an endometrial ablation if they are having normal menstrual periods. The possibility of pregnancy and tubal reversal after ablation depends in large part on the regularity and quality of the menstrual period.
Endometrial ablation is effective in reducing the amount of bleeding with a menstrual period.
Endometrial ablation is not very effective in totally eliminating menstrual bleeding and many patients will have resumption in menstrual periods within five years of an ablation procedure.
Tubal Reversal and Uterine Ablation: No Period
If menstrual periods have ceased after endometrial ablation, then this indicates that most of the endometrial lining has been removed during the endometrial ablation procedure. In this situation, the uterus will not be able to sustain a normal pregnancy. Pregnancy is unlikely after either tubal ligation reversal or with in vitro fertilization (IVF).
No Menstrual Period: Advice
Medical evaluation may indicate other causes of the absence of menstrual periods (amenorrhea). Women should consider having their follicle stimulating (FSH), prolactin, and thyroid hormone levels checked to make sure they are not menopausal or have abnormal prolactin or thyroid hormone levels as the cause for absent menstrual periods.
If a woman is menopausal then natural pregnancy is not a feasible option. If thyroid or prolactin tests are abnormal, then these could be treatable medical conditions and after treatment menstrual periods could return.
Women should be aware the absence of menstrual periods after an ablation is very likely due to the ablation procedure; however, one can never know with certainty, which is why the above testing should be considered.
Uterine Lining After Endometrial Ablation
Women should also have an ultrasound to evaluate the uterus, uterine cavity, and the endometrium. During the ultrasound exam, the thickness of the endometrial lining is measured- this is termed the uterine, or endometrial, stripe.
Normal endometrial thickness ranges from 4-10 millimeters, depending on where a woman is in her cycle. If the ablation was effective then the endometrium (and the endometrial stripe) will be absent or minimal (less than 4mm).
There is also a possibility the endometrial lining is normal and the menstrual periods have remained inside since the ablation. This condition is called a hematometria and can be a complication of endometrial ablation. This condition is usually associated with monthly, crampy pain when the menstrual period should be occurring.
Hematometria can occur when the ablation causes the inside of the cervix to scar closed and menstrual periods will not be released.
With this complication, the endometrial lining is functioning, but menstrual periods cannot escape. This can occur without symptoms but most women will have severe cramps during the time when they should be having their period.
Tubal reversal and pregnancy after endometrial ablation could be possible if women are not having periods after the ablation – but only if the reason for the decreased periods is due to a hormonal imbalance or to cervical obstruction. Realistically, women should be aware before they request this testing that the most likely reason for absent periods is because of a successful ablation procedure.
Tubal Reversal After Ablation: Advice
We will continue our advice in the next article. The next article, Tubal Reversal After Ablation: Pregnancy Advice, will focus on patients who have light or normal menstrual periods after endometrial ablation.
More Information About Tubal Reversal
More information about tubal reversal can be found on the website of Chapel Hill Tubal Reversal Center. For personal stories about women who have had tubal reversal and pregnancy, readers are advised to visit the Tubal Reversal Message Board and Tubal Reversal Blog.