NovaSure® treatment for heavy periods at Tees Hospital

What is NovaSure treatment?

NovaSure is a treatment for heavy periods that permanently removes the lining of your womb (the endometrium) using a short burst of radiofrequency energy. It's a quick, one-off procedure carried out through the vagina and cervix, without any cuts. (NovaSure is a registered trademark of Hologic, Inc. and its affiliates.)

What conditions does it treat?

NovaSure treats heavy, prolonged or irregular periods, sometimes called abnormal uterine bleeding, that are affecting your quality of life. It's generally offered once other options, such as hormonal or non-hormonal medicines, haven't controlled your symptoms.

What are the benefits?

NovaSure works well for most women with heavy periods. Around 9 in 10 return to normal or light bleeding, and roughly 4 in 10 stop having periods altogether, with more than 90% satisfied with their results.

It can avoid the need for a hysterectomy in the large majority of women, with estimates ranging from around 86% to 90%. It also avoids the need for long-term medication and doesn't require any hormone treatment beforehand to prepare the womb lining, unlike some other ablation methods.

It's quick: the energy delivery itself takes about 90 seconds, and the whole procedure is normally done within 10 to 20 minutes. There are no cuts, it can be carried out at any point in your cycle, even during a period, and most women return to normal activities within 1 to 3 days.

Are there different approaches?

NovaSure can be delivered in two different ways, depending on the hospital and your own preference. Many centres now carry it out as an outpatient procedure under local anaesthetic, using an injection into the neck of the womb plus gas and air; others prefer a day-case theatre setting under general anaesthetic.

NovaSure itself is one specific technique for endometrial ablation, using an expanding mesh electrode rather than, for example, a heated balloon. If NovaSure isn't suitable for you, your doctor can discuss alternative ablation methods, medical treatment, or a hysterectomy.

What happens before the procedure?

Your doctor will check the procedure is right for you. You need to be certain you've had all the children you plan to have, since the effects on the womb lining are permanent.

NovaSure isn't suitable if:

• there's any chance you could be pregnant
• you have, or might have, cancer or pre-cancerous changes in the womb lining
• you have an active genital, urinary or pelvic infection
• you have an IUD (coil) or a metal implant in the womb
• fibroids or a birth abnormality have left your womb cavity an unusual shape or size.

You'll usually need an endometrial biopsy and a pelvic ultrasound scan beforehand, alongside a hysteroscopy to check the shape and size of your womb cavity; you may already have had some of these. A urine pregnancy test is done just before the procedure itself, and if you have a pacemaker or other electrical implant, it's important to tell your doctor beforehand, since the treatment uses electrical energy.

What happens during the procedure?

1. A hysteroscopy: a small telescope is passed through the vagina to check your womb is a normal shape and size.
2. A doctor gently opens your cervix and passes a slender wand, carrying a folded triangular mesh device, through into your womb.
3. The mesh opens out to fit the size and shape of your womb cavity.
4. Precisely measured radiofrequency energy is passed through the mesh for about 90 seconds (ranging between 30 and 130 seconds), automatically stopping once the lining has been removed.
5. The mesh is folded back into the wand and withdrawn; no part of the device remains inside your body.
6. The hysteroscope is passed once more to confirm the treated area.

You'll be given pain relief appropriate to your setting, ranging from paracetamol and ibuprofen beforehand with a local anaesthetic injection and gas and air during the procedure, to a full general anaesthetic. The whole appointment usually takes 10 to 45 minutes depending on the setting, though the energy delivery itself is brief.

What does recovery look like?

In hospital

What happens straight afterwards depends on the anaesthetic used. Under local anaesthetic, many women go home the same day, sometimes after 30 to 60 minutes of monitoring if they feel dizzy, sick or sore, and always with someone else driving.

Under general anaesthetic, you wake in a recovery area with a drip and oxygen mask before returning to a ward, feeling drowsy or a little nauseous at first, and usually go home later the same day; occasionally an overnight stay is needed. Your doctor will explain the findings before you leave.

A routine hospital follow-up appointment isn't usually arranged. Contact your GP with any problems, or the emergency department if it's urgent.

At home

Cramping and a discharge similar to a period are normal and usually settle with regular paracetamol or ibuprofen. The discharge can last anywhere from a few weeks up to about 2 months as the treated lining sheds, and may come and go, sometimes increasing after activity.

Most women feel back to normal activities within 1 to 3 days. It's worth giving your body around 3 months to fully settle before you know what your periods will be like going forward.

Contraception is still needed afterwards, since NovaSure isn't a sterilisation method; pregnancy after the procedure is uncommon, at around 0.7%, but carries a high rate of complications if it happens.

Seek medical advice if you develop a fever, worsening pain that simple painkillers don't ease, heavy bleeding, an offensive or greenish discharge, or feel generally unwell, dizzy or short of breath.

What are the risks and complications?

As with any procedure, NovaSure carries some risks:

• period-like bleeding and discharge for up to 6 weeks: common and expected
• cramping pain during and after the procedure: common, usually eased with regular painkillers
• infection, causing fever, pain, offensive discharge or heavy bleeding: uncommon, may need antibiotics
• a hole in the womb (uterine perforation): rare, about 1 in 10,000, more likely during the initial hysteroscopy; NovaSure has a built-in check that detects this and stops the procedure, and it usually heals by itself
• in very rare cases (less than 1 in 10,000), a perforation can damage the bowel, bladder or a major blood vessel, needing keyhole or open surgery to repair, sometimes with an overnight stay
• the procedure not being possible, or not working: rarely, the instrument can't be passed or doesn't function, and even when everything goes to plan, heavy periods return for a small number of women
• risks related to anaesthetic, if a general anaesthetic is used: generally very safe, though conditions such as high blood pressure, heart disease, diabetes or asthma will be discussed with the anaesthetist beforehand
• a blood clot in a vein (venous thrombosis): can follow any surgery, though less likely after a short procedure like this, and the risk is reduced by staying mobile afterwards.

Taken together, serious complications, such as a hole in the womb, significant bleeding, infection, a slowed heart rate, or injury to nearby organs, are rare, reported at less than 0.05%. Tell your doctor if you have a cardiac pacemaker or other electrical implant before your procedure.