Endometrial ablation (often spelled as oblation, or oblasion, or ablasion) is the process of destroying endometrium, the inner lining of the uterus, in order to solve a problem such as heavy bleeding, pain, exhaustion and so on. Novasure type of endometrial ablation is an electrode which is placed in the cervix, and which emits a short burst of radiofrequency energy, no longer than 90 seconds.
Who Is A Good Candidate For Novasure Endometrial Ablation?
You will be a good candidate if all of the following indications are met:
• you are not yet in menopause,
• you have menorrhagia (excessive bleeding),
• the causes of menorrhagia are benign, and
• you have completed your childbearing.
Contraindications for Novasure Endometrial Ablation
• The main contraindication is current pregnancy or a woman who wants to become pregnant in the future. In some cases, not the entire endometrium is destroyed, or even if it is, it may develop again, which makes it possible for the fertilized egg to get implanted. Such pregnacies must be terminated, since nobody knows what to expect, even if such a pregnancy were carried out to a full term.
• Known or suspected uterine cancer (endometrial carcinoma), or a pre-malignant condition such as unresolved adenomatours hyperplasia.
• Weakness of the myometrium, maybe as a result of previous classical cesarean section or transmural myomectomy.
• Active vaginal or urinary tract infection, such as cervicitis, vaginitis, endometritis, salpingitis, or cystitis.
• A patient with an intrauterine device (UID) in place.
• A patient with a uterine cavity length less than 4 cm. The minimum length of the electrode array is 4 cm. Treatment of a uterine cavity with a length less than 4 cm will result in thermal injury to the endocervical canal.
• A patient with active pelvic inflammatory disease.
How Novasure Endometrial Ablation Works
Novasure consists of an electrode with a sheath at the end; in the beginning of the procedure, the sheath is placed through the cervix. The electrode then expands and conforms to the shape of the uterine cavity. The device tests whether there is any rupture of the cavity and will not turn on if there is one. (As a safety measure, the device will turn itself off if 50 ohms of resistance occurs.) Next, a small quantity of CO2 inflates the uterus so that the device is placed properly. If everything is OK, a short burst of radiofrequency energy, for no more than 90 seconds, destroys the endometrium, and the whole procedure lasts for less than 5 minutes. The device will also remove the desiccated issue from the cavity. Most patients can go home within an hour of the procedure.
Besides speed, the main advantage of Novasure endometrial ablation is that there is no need to prepare the uterus with expensive or dangerous drugs such as Lupron Depot. Lupron not only costs $400 per shot, but has side effects such as hot flushes, sweats, effectively, introducing a termporary menopause.
Novasure endometrial ablation can be executed at any time of the woman’s menstrual cycle.
Types of Anesthesia for Novasure Endometrial Ablation
Usually, for Novasure only local anesthesia and sedation are needed, although epidural and general anesthesia are also an option in certain cases. With other types of ablation, cramps are to be expected and even feared, but with Novasure, there are cases of women playing competetive tennis matches the same weekend.
Practical Contraindications for Novasure Endometrial Ablation
The uterus has to be of fairly regular shape. Fibroids or large polyps should be done away with in some other way before Novasure could be applied. Actually, Novasure can be used even if there are polyps up to 2 cm large, and it can be even used to treat fibroids if they do not distort the shape of the cavity.
If the wall of the uterus is too thin, this type of ablation should also be ruled out.
As with all other types of ablation, if you want more children, this is not for you. After ablation, you should best be under some kind of contraception as there is a possibility of getting pregnant. As remote as it is, it is best it didn’t happen, since most of the endometrium — the very tissue that your eventual baby would be linked to under normal curcumstances — is almost all dead (“flamed up” in the case of Novasure, “boiled” with thermal balloon and so on, depending on the device used).
Other Methods To Treat Excessive Uterine Bleeding Due To Benign Causes
If you go to the medical doctor to help you combat excessive uterine bleeding, the drug therapy will be the first step. Failing that, a Dilatation and Curettage (D&C) will be next, as the first surgical step. After, that it may be a choice between hysteroscopic endometrial ablation, thermal endometrial ablation, laser ablation, electrosurgical technique (roller ball or barrel), Radio frequency ablation, Microwave ablation, and Cryo ablation. Failing all that, hysterectomy remains as the final choice.
Of course, there are many other ways to combat excessive uterine bleeding, please see the main energy healing page on this site for a list of possible alternatives.
The Effects of Novasure Endometrial Ablation
In tests that led to the approval of Novasure by the FDA, 93% of women were satisfied with the outcome of the ablation within one year and after 3 years, 44% of the women were amenorrheic. In other words, this is comparable and even marginally better than other types of ablation. However, the same objections apply to Novasure as to any other type of ablation — there can be watery and not so watery discharges for weeks after the procedure, and only after 3-6 months will you be able to tell whether it all made sense or not. For a small number of patients, all this will only prolongue their route towards hysterectomy.)