Post-ablation-tubal sterilization syndrome.
In Utah, over an 18-month period, clinicians at Intermountain Gynecologic Oncology Associates in Salt Lake City conducted laparoscopy and hysteroscopy on 6 women, 29-44 years old, who had undergone tubal sterilization 1-5 years before rollerball endometrial ablation and 6-10 months later developed sporadic vaginal bleeding associated with sudden severe cyclic pain in the lower abdomen. Ultrasound revealed fluid in the uterus in 2 women, and they did not have swollen fallopian tubes. All women who suffered pain on just 1 side had a fallopian tube swollen to 2 times its normal size. The swollen fallopian tube of 2 of these women was likely due to accumulation of blood. The fallopian tube or tubes of the remaining patients were rubber-like and swollen but were not bleeding. Physicians conducted unilateral salpingectomy in 2 women and bilateral salpingectomy in 3 women. They cauterized the fallopian tube in 1 woman. Bilateral procedures relieved the symptoms. Just 1 woman who underwent a unilateral procedure still experienced symptoms. The signs and symptoms returned within 6 months on the opposite side in woman who had undergone a unilateral procedure. Physicians performed a laparoscopic vaginal hysterectomy on this woman and found a swollen and rubbery tube. 2 women had acute or chronic inflammation. All women had scar tissue in the endometrial cavity. The horns of their uteri were patent and had small areas of endometrial tissue. 3 women had hematosalpinx or hemosiderin. These results suggested that women who undergo tubal sterilization followed by endometrial ablation are at high risk of developing an ectopic-like symptom complex. Salpingectomy seems to alleviate the symptoms. The physicians could not determine whether this symptom complex is a new syndrome or an association between sterilization and endometrial ablation.