Novasure
Endometrial AblationLupron Depot
Fibroids
Endometrial ablation
Hysterectomy
Novasure
Novasure endometrial ablation is a "flame-thrower" amongst the devices for endometrial ablation. It 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 this system is that no preparation of the uterus need be done in advance. With other methods of ablation, the patient must receive several injections of Lupron Depot two months beforehand the scheduled date, the idea being to thin the endometrium so that the ablation can succeed better. One injection costs $400 -- you will need several of them, so it is very expensive. Not only that: it produces many unwanted side-effects, such as hot flushes, sweats etc. The procedure itself must be executed when the patient would not have her usual menstrual cycle.Contrary to all that, Novasure does not need thinning of the endometrium, so there is no need for preparation and costly injections, and it can be done at any time of the woman's menstrual cycle. Types of Anesthesia for NovasureEven being that fast, Novasure endometrial ablation still is an ablation, so there must be some kind of anesthesia. Usually, it is local anesthesia and sedation, 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.Whom Is It Not ForThe uterus has to be of fairly regular shape. Fibroids or large polyps will interfere with the placement of the device, so if that is the case, it would be best to eliminate them in some other way first, and then proceed with the ablation itself. 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 is also not for you. As with all other types of endometrial 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 best 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).The Effects of Novasure Endometrial AblationIn 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. Even if everything looks fine from the surgical point of view, you should still be looking for alternative kinds of healing.)
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