Could this be ectopic or tubal pregnancy?

I have always had long, heavy, painful periods & due to migraines, I am unable to take birth control pills.  I also have had several ovarian cysts.  I have had 2 healthy children both delivered by c-section with the last being in April 2006.  At this time, I also had a tubal ligation.  My periods returned to what they normally were.  Last November, I had the Novasure/ablation procedure.  This did not stop my periods, but they were much lighter.  Last month, I experienced lots more cramping that what I have been having since the ablation & more & brighter bleeding.  This month, it was excruciating pain on my left side and even heavier & brighter bleeding.  Now, 2 weeks since my period, I am having some heavy brown discharge with clots.  I can't get in to see my doctor for a few days & since everything seems okay right now, I'm not going to the ER.  Did the ablation not work?  Can the uterus lining grow back?  Could I be pregnant?  If so, would a normal over the counter pregnancy test show positive if it's a tubal pregnancy?

[Elaine Brown, MD]

Hi!
I'm sorry for the delay in response--was very ill for awhile

A pregnancy test is a good idea--the home tests DO turn positive in most cases of ectopic pregnancy.  Pregnancy could theoretically occur after an ablation/tubal, although it should be quite rare!

It sounds to me as though you have post ablation syndrome. This occurs in women who have had the same combination of surgeries that you have had.  A small amount of endometrium is left behind in the "corners" of the uterus near the tubes, and continues to cycle.  Sometimes scar tissue prevents the blood from discharging and swelling and pain occurs.

If you were my patient, I would probably do an ultrasound to see what was up.  I would probably offer you some options such as another ablation, or hysterectomy depending on how severe the symptoms were.

Hope this helps!
Dr B