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.
50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy. These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V). Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected. In those affected, the symptoms usually manifest by the 9th week of pregnancy.
Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP). Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.) Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)
At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?” The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly period. Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’. The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?
As a Gynecologist, I now know the significance of the menstrual ‘cramps’. In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month. At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.) On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.
Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy. Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)
Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater. Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy. Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.
If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them. With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’. I counsel women on their risks nearly every day.
I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation. I already knew that there is decreased ovarianreserve (fewer fertilizable eggs remaining in our ovaries) as we age. I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...