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Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist. Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.
As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:
1. How is the procedure performed?/What can I expect from my menstrual flow after the procedure…lighter periods or no period?
The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions. The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs. The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office. You should expect to be back to normal activities within a day or so.
Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure. Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.) It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.
Suzanne Hall, MD, FACOG
2. How long will results last?
Most studies done looking a long term results of the Novasure procedure followed patients out for a 5 year time period. From a practical perspective, most patients have continued to have satisfactory results that last. The return of heavy or abnormal menstrual bleeding (frequent bleeding, even if light) may require further investigation, and should be reported to your physician.
3. Is Novasure right for me if I’m not sure I’ve Completed Childbearing?
Since Novasure endometrial ablation involves surgical destruction of the lining of the uterus, pregnancy after an endometrial ablation is not recommended. Destruction of the uterine lining may result in an abnormal ‘attachment’ of a subsequent pregnancy (at implantation), increasing the risk for miscarriage, preterm birth, or placental complications. Appropriate candidates for the Novasure procedure should be certain that they have completed their desires for childbearing, ensuring effective contraception (most commonly by female sterilization or male partner vasectomy.) Some candidates may opt to have a female sterilization procedure (‘tubal ligation’) done concomitantly, at the same time the Novasure procedure is performed. The Novasure procedure itself does not protect against pregnancy. Women choosing Novasure for the treatment of heavy menstrual periods must ensure proper contraception.
4. If I’m not having periods after the Novasure, am I menopausal?
Menopause is defined as the cessation of menstrual periods for > 1 year (typically with the onset of hot flashes), due to a ‘naturally occurring’ decline in our ovarian hormone levels, usually occurring in women in our late 40-mid 50’s. While it is possible to ‘naturally’ become menopause at some point after having had a Novasure procedure, most cases of cessation of menses following the Novasure are likely due to the results of the procedure itself, rather than ‘menopause’. If your monthly period stops occurring, as a result of the Novasure procedure itself, this is not considered ‘menopause’, in that the lack of menstrual flow is based on the destructive process of the uterine lining, and not because of any decline in our hormone levels. The Novasure procedure cauterizes the uterine lining only, and does not affect our ovarian hormonal cycles.
5. How long after the procedure before I can have sex again?
After most procedures/surgeries involving the cervix and uterus, physicians usually recommend a period of ‘pelvic rest’ (meaning no douching, sex or tampon use) to minimize the risk of post-procedural infection while healing. That ‘wait’ time may vary according to different physicians, but is usually around 2-4 weeks.
Hopefully this Q/A helps you to better understand and to be more comfortable, if you’re considering the Novasure procedure for your heavy menstrual periods. Be sure to consult your own physician for your questions/concerns regarding the procedure.
Suzanne Hall, MD, FACOG
Eastside Gynecology Obstetrics, PC (Roseville, Grosse Pointe, Macomb, MI)