|Dr. Suzy Hall M.D. OB-GYN|
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
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)