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QUESTION: Hello Edward,
I am not getting anywhere with my gyne who says my symptoms not related to endometrial ablation with novasure.  My questions are, how would I know if I had a perforation to womb during procedure or burning to my bowel, and what would my symptoms be?  Also, if the device does not fit properly in the womb, will the novasure still let the procedure be safely carried out (ie if even contact were not made)  Could it be possible for one side to be ablated more than the other?

Thank you,

Regards,

Lou

ANSWER: Hello Lour from the U.K,

If you had a perforation and/or injury to the bowel, you would have severe abdominal pain.  Burning and performation of the bowel turns into a severe problem rather quickly, usually within 72 hrs and can be fatal if not treated quickly and properly.

In terms of the question regarding complete contact with Novasure, I believe that part of the cavity can be ablated but as I do not use this device, it is something you'll need to ask the company.  If the procedure is incomplete, i.e. the entire cavity is not ablated, then you would continue to have periods or abnormal bleeding.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

---------- FOLLOW-UP ----------

QUESTION: Thank you Edward, that is helpful.  Could you tell me therefore what may be causing pressure,burning,stinging pain from inside right side only of back passage and along right side of vulva since having this op.  It doesn't seem to be an infection, but is permanently there.  Could it be related in any way to the epidural? I am very distressed by this and my doctor doesn't seem to know. The consultant who performed the ablation, said nothing to do with procedure and doesn't want to help! This seems to coincidental not to be related, as I have never had this problem before.  The nurse had said he ablated the right side fully but not the left as womb slightly enlarged.  When I asked him, he said no, it was a straight forward procedure!
Thank you.

ANSWER: Hi,

As you probably realize, I can't make a diagnosis via the internet because there is no capability to do an examination.  Normally, I would not expect such symptoms from an endometrial ablation.  The symptoms are similar to nerve pain and certainly could be from nerve trauma/injury from the ablation or the epidural.  Those are only possibilities.  Since your physician is not willing to pursue this, I would go see a different Physician to undergo a careful examination and evaluation.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate



---------- FOLLOW-UP ----------

QUESTION: Edward Thank you,

I have an appointment to go and see someone out of the area privately this week, so really hope this helps me.  It is interesting you mention nerve damage, as the last doctor I spoke to mentioned this also.  Can I ask you, does nerve damage get better? I am so worried this may be a permanent thing, and seriously it is so uncomfortable I don't know how I could manage it.  I understand that this may be something you cannot possibly know, but I know nothing really about the consequences of such a thing.  Do you think if it is that having a hysterectomy would help at all? Thank you once again.

Answer
Hello Again,

I cannot answer the question about the nerve damage because it can go either way.  In some cases the nerve can heal, as long as the irritant is removed or no longer present.  However, in some cases the nerve is permanently damaged leading to chronic pain.  Without knowing if this is the exact cause of your pain, or which nerve might be affected, we can only discuss this in generalities.  Hopefully, this is not the source of your pain.

At this point, I do not think that hysterectomy would change anything, but that is a total guess because I do not have the ability to do a full evaluation on you.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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