Women, Wellness, & Wisdom

Heavy Menstrual Bleeding: NovaSure endometrial ablation is an effective in-office alternative to hysterectomy

Heavy Menstrual Bleeding:  NovaSure endometrial ablation is an effective in-office alternative to hysterectomy

Heavy Menstrual Bleeding: NovaSure endometrial ablation is an effective in-office alternative to hysterectomy

By Vandna Jerath, MD

Menorrhagia is excessive, prolonged, or heavy menstrual bleeding.  Most women bleed every month (on the average every 28 days) for approximately 3-5 days with a blood loss of 25-80cc.  Periods that are heavy for more than 3 days or last longer than 7 days and have a blood loss of greater than 80 cc are considered abnormal.  Approximately 1 in 5 women are affected by heavy periods.  In the U.S., about 10 million women experience menorrhagia.

Heavy bleeding takes a physical, social, and emotional toll and disrupts women’s lives as it can lead to anxiety, depression, anemia, cramping, fatigue, missed work, limited social outings, confinement to home, and avoidance of sex.  Often these women do not realize that their symptoms are not normal despite a decreased quality of life and are embarrassed to talk to their healthcare provider or seek treatment.  Approximately 70% of women suffer in silence.

Heavy periods or abnormal uterine bleeding can be from a variety of causes including anatomical such as fibroids or endometrial polyps, a hormonal imbalance, dysfunctional anovulatory bleeding, bleeding disorder, or pathologic such as endometrial hyperplasia or cancer.  Although treatment options include medication, hormones, D&C, hysteroscopy, or hysterectomy, cases that do not have an identifiable cause requiring specific medical or surgical treatment can be managed with a minimally invasive in-office procedure such an endometrial ablation.

Endometrial ablation is a procedure that uses a medical device to burn, heat, ablate, freeze, or desiccate the endometrium, the inner lining of the uterus to treat heavy menstrual bleeding.  It is a great alternative to hysterectomy which is invasive, has increased complication rates, and is more costly.  The older devices such as rollerball ablation require highly skilled hysteroscopic surgeons, strict fluid management, and attention to increased operative risks.  The current global endometrial ablation devices have better safety and efficacy and can be done in the office setting rather than the operating room (OR) and have greatly decreased hysterectomy rates.

Currently, there are five FDA approved endometrial devices available –

Although all of these modalities have shown promise and successful outcomes, NovaSure proves to be safe, effective, easy, minimally invasive, ideal for the office setting, and my treatment of choice.  NovaSure is intended to ablate the endometrial lining of the uterus in pre-menopausal women with menorrhagia (heavy bleeding) due to benign causes for whom childbearing is complete by using radiofrequency upto 50 ohms.   It is not a sterilization procedure and the patient should have a contraceptive method.  The benefits of NovaSure include:

  • One time, quick procedure
  • Takes less than 5 minutes and on the average has only a 90 second treatment time
  • Can be performed in the office with local anesthesia and oral narcotics or conscious/deep sedation by in office anesthesia
  • Does not require any pre-treatment regimens or specific timing in the menstrual cycle
  • Requires no incision and is minimally invasive
  • Does not require uterine distension
  • Has a pre-procedure cavity integrity safety assessment
  • Minimal patient side effects – cramping and nausea typically resolve within 24 hours
  • Patients are recovered in 24 hours and can return to daily activities
  • Covered by most insurances

NovaSure facts, outcomes, and success rates are impressive:

  • Accounts for over 70% of all endometrial ablations
  • Over 10 million have been performed to date
  • 90% decrease in heavy bleeding or normalization of menses
  • 40-75% amenorrhea (no future periods) rates
  • 97% do not have pain or cramping at 24 hours
  • 60-70% reduction of dysmenorrhea and pre-menstrual syndrome (PMS) symptoms
  • Overall patient satisfaction rate of 95%
  • At 5 years, 98% effective with only 2-3% of patients requiring future hysterectomy
  • 97% would recommend the procedure to a friend

Steps of the NovaSure Procedure:

NovaSure: Heavy Period Treatment Step 1 The NovaSure electrode array expands to conform to the contours of each patient’s uterine cavity.
NovaSure: Heavy Period Treatment Step 2 A unique proactive safety test called the Cavity Integrity Assessment is performed. The NovaSure system uses a small amount of CO2 to verify cavity integrity prior to performing the procedure.
NovaSure: Heavy Period Treatment Step 3 The NovaSure endometrial ablation procedure delivers radiofrequency energy until tissue impedance reaches 50 ohms; on average, the procedure is completed in approximately 90 seconds.3
NovaSure: Heavy Period Treatment Step 4 The electrode array is retracted for easy removal, leaving the uterine lining desiccated down to the superficial myometrium.

Photo credit:  NovaSure

NovaSure is ideal for women between the ages of 35-50 and who are done child-bearing.  However, it is contraindicated in the following types of women:

  • Pregnant or desires a future pregnancy (can lead to miscarriage, prematurity, perinatal mortality, ectopic pregnancy, placenta previa or accreta)
  • Known or suspected pathology such as endometrial hyperplasia or cancer
  • Have an active infection such as a urinary tract infection, cervicitis, or vaginitis
  • Have an intrauterine device (IUD) in place
  • Have pelvic inflammatory disease (PID)
  • Have had a prior endometrial ablation
  • History of extensive uterine surgery such as a myomectomy or classical cesarean section (traditional low transverse cesarean section is not contraindicated)
  • Uterine cavity length <4cm or width <2.5cm or uterine sound greater than 10cm
  • Anatomic pathology such as fibroids or endometrial polyps greater than 2cm
  • Postmenopausal women

NovaSure side effects and risks although minimal include:

  • Nausea and vomiting (1-2%)
  • Cramping/Pelvic Pain (3%)
  • Vaginal discharge (2-3%)
  • Bleeding (1%)
  • Uterine perforation (<.05%)
  • Infection (<.05%)
  • Bowel or bladder problems or injury (<.05%)
  • Embolism (<.05%)
  • Pregnancy risks (miscarriage, ectopic, placenta previa or accrete, preterm birth, etc.)
  • Post-ablation tubal sterilization syndrome (rare)

See the Novasure procedure animation video –

Video Credit:  Novasure

I have been performing NovaSure endometrial ablations in my office and patients are extremely satisfied with both the procedure and results.  Most describe their experience as having a “hot” “cramping” sensation during the 90 seconds of the procedure which subsequently subsides quickly and completely resolves by 24 hours.  The patients have minimal side effects or symptoms.  The patients are very pleased with the results of decreased, normal, or no periods; happy they did the procedure in the office rather than the OR; and would recommend the NovaSure endometrial ablation to others.  NovaSure continues to be an effective in-office alternative to hysterectomy.

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