Hysteroscopy and NovaSure Endometrial Ablation
Information for patients and carers on hysteroscopy and NovaSure endometrial ablation
This patient information leaflet aims to give you some information about the hysteroscopy and NovaSure endometrial ablation and also to help answer some questions that you may have. It is a guide and there will be an opportunity to discuss the treatment with the doctor at your appointment. We hope by increasing your understanding of the treatment you will feel less anxious when you come to clinic.
Where are we?
The Hysteroscopy Clinic is situated in the Gynae / Antenatal Clinic at Furness General Hospital.
You may wish to bring a friend or relative to accompany you and take you home. They can be present during the examination if desired.
Why is NovaSure performed?
NovaSure outpatient treatment is indicated in women with heavy menstrual bleeding of benign cause who have had a recent (within six months) normal hysteroscopy and endometrial biopsy. Women must have no desire for further children. This procedure does not provide contraception and on-going effective contraception is required as any pregnancy following this procedure poses serious risk to mother and unborn child and is strongly advised against.
What is a hysteroscopy and NovaSure endometrial ablation?
A hysteroscopy is an investigation where a small telescope is
passed through the neck of your womb (cervix) to examine the inside of your uterus (womb). NovaSure is a procedure performed under local anaesthesia which allows your doctor to remove the lining of the womb. This is done by inserting the NovaSure device through your cervix and using high frequency radio waves to remove the lining. It does not require an incision (cut) and can be performed in an outpatient setting using local anaesthetic using local anaesthetic, gas & air (Entonox) or as an inpatient day case under general anaesthetic on another day.
Are there any alternatives to NovaSure?
If you do not wish to have Novasure endometrial ablation to treat your heavy periods there are medical alternatives that you may wish to consider. These include non-hormonal methods such as tranexamic and mefenamic acid and hormonal methods, including contraceptive pills and the IUS intrauterine device, Pros tap/ GNRH+add back therapy.
Alternative surgical options are:
- transcervical resection of the endometrium (TCRE)
- a hysterectomy.
These options should be discussed with your gynaecologist, prior to NovaSure appointment being booked
Prior to the appointment:
- If you are on blood thinning medication, please telephone gynaecology secretaries on 01229 402503 or speak to your referring clinician for advice.
- Patients with artificial heart valves or haemophilia require a haematology review before procedure.
On the day of the procedure:
- Eat something light before attending your appointment.
- You are advised to attend Ward 1 two hours prior to your NovaSure appointment.
You will be given:
- Simple analgesics (diclofenac rectal suppository).
- If you are allergic to aspirin / ibuprofen / diclofenac type medicines then you will be offered alternatives such as oral tramadol.
- Antiemetic (a medication used to prevent or reduce nausea and vomiting) - 50 mg cyclizine or ondansetron 4 mg injection.
- Bring a sanitary towel with you if you can. However, we can provide one if you do not have any.
- You may wish to bring a friend or relative to accompany you during the examination.
- It is important there is no risk of pregnancy when the procedure is carried out. Therefore we will ask your permission to carry out a pregnancy test before we start. This will mean you have to give us a urine sample before we start. Your procedure will be cancelled if there is a possibility that you might be pregnant. As a precaution, it is advisable to use contraception from the start of your period before the procedure, and continue using them after you have had the procedure.
If you have any worries or concerns before the procedure please call and ask to speak to a member of the hysteroscopy team.
What will happen during the appointment?
On the day of your appointment you will see the doctor before the procedure for assessment. This is a good time for any concerns or questions you may have to be answered as it is important to us that you are involved in any decisions about your care and treatment.
The doctor will need to gain your consent before starting the procedure so you will be asked to sign a consent form if this hasn’t already been done at a previous appointment. You will be shown into the treatment room. A nurse and a healthcare assistant will be with you to ensure your comfort and help the doctor doing the procedure. Please note that we are a teaching hospital so it is not unusual for trainee doctors or student nurses to be present during your appointment. If this makes you feel uncomfortable then do not hesitate to tell the nurse or doctor.
You will be asked to remove the bottom half of your clothing behind a curtain cubicle and to cover yourself with a sheet. You will be required to lie down on an examination couch for the procedure.
The doctor will insert a speculum into the vagina (similar to a smear test). This will enable access to your cervix.
A local anaesthetic is then injected into the cervix and the opening gently stretched. This is to allow the hysterscope to pass through the cervix and into your womb.
A sterile saline fluid is also introduced via the hysterscope into the womb to distend the cavity (enlarge the space) to make it easier for the doctor to see. You may feel some of that fluid coming out of your vagina during the procedure. This is normal.
What can I expect during the procedure?
The hysterscope has a camera attached and the images of the inside of your womb are sent to a screen by the side of the bed, which can be viewed by the doctor and yourself. Pictures may be taken at the time of the procedure as a record for your medical notes.
The NovaSure device is then passed into the womb then activated. The device will normally take a maximum of two minutes to remove the lining of the womb.
We are more than happy for you to bring a partner, friend or relative with you to the appointment for support and they can even sit with you during the procedure if you wish. It is important to note that you will be involved at all times during the procedure and if at any point you would like the doctor to stop or have any concerns or questions please say or ask.
In total your appointment will take about 45 minutes which includes the discussion with the doctor. However, as is the nature of hospital appointments sometimes we run late.
What are the benefits of NovaSure?
- It can be performed under local as an outpatient or general anaesthesia (GA) as inpatient on another day, 9 out of 10 patients prefer to have procedure as an outpatient
- More than 80% of women returned to normal, light or no periods following procedure.
- 40% reported that their periods stopped completely.
- Nearly 2 out of 3 women experience reduced premenstrual symptoms.
- It can be performed at any time during your cycle, but during menstruation is best avoided.
Are there any risks of the procedure?
There are risks with any operation, but these are small.
Possible complications are:
- Bleeding.
- Infection.
- Perforation of the uterus (making a hole in the womb). In most cases when a perforation occurs you may require admission and antibiotics treatment and this resolves without any further treatment. Rarely you may require further surgery to repair any nearby local organ but this is unlikely.
Occasionally symptoms may develop around 10 - 14 days following the procedure.
These will be discussed with you when you sign your consent form.
If you develop:
- high temperature or strong smelling discharge
- lower abdominal pain
- heavy bleeding that is worse than a normal period or you are at all concerned
then please contact your GP or Gynaecology Clinic for advice (contact details are at the end of this page).
Potential long-term complications of endometrial ablation
Late onset endometrial ablation failure (LOEAF) is where pockets of womb lining regrow after a period of months or even years. This may be seen in 1 in 4 cases in the 5 years after ablation.
These pockets can then cause:
- return of bleeding problems after the ablation after a short period of improvement.
- period type pain - with or without bleeding at any time of the month.
- severe cyclical pain at the time your period would have been due but without bleeding.
The chance of LOEAF is higher if you are less than 35, have fibroids, polyps, have a band of extra tissue in the womb (a uterine septum) or have a heart shaped womb (bicornuate womb), suspected adenomyosis, where the lining of the womb is found in the muscle of the womb or obesity.
Future assessment of the womb may not be possible. It may be difficult or impossible to have further hysteroscopies if there is scarring inside the womb after ablation. This may cause problems with future assessment of the womb lining if you have bleeding problems in the future. For this reason if you have had precancerous changes in the last 5 years, you can not have an ablation.
If there is scarring inside the womb, you would not be able to try the Mirena IUS (coil) once you have had an ablation. Ablation should therefore be considered as a last option before a hysterectomy and after all other treatment options have been tried.
After care:
There may be some slight bleeding over the next 6 - 8 weeks. This should not be heavier than a period and should gradually get less, becoming a brown discharge before it stops. You are advised to use sanitary towels rather than tampons while you have any bleeding or discharge.
You may experience some period-type pain for the next few days. We advise taking ibuprofen and paracetamol regularly for at least the first 48 hours after the procedure. These can be purchased over the counter.
You are advised to avoid vaginal intercourse until the discharge stops.
If you find you have an increase in temperature, pain, offensive vaginal discharge, or heavy bleeding, after the procedure, you should contact your GP or hospital for advice. Contact details are on the next page.
If you had a biopsy taken, we will write to you with the result, but it may take up to four weeks. If you require a further appointment, it will be sent through the post.
What should I do if I have a problem?
If you have any concerns following your treatment please do not hesitate to contact the hysteroscopy clinic team. We also advise you to contact your GP.
From Monday – Friday, 8:30am-4:30pm, please telephone us on 01539 716998 and ask to speak to a member of the hysteroscopy team.
For any queries out of clinic and surgery hours, we advise you to contact:
- Ward 16 at Royal Lancaster Infirmary – telephone 01524 583820
- Ward 1 at Furness General Hospital – telephone 01229 870870
Date of publication: 12/06/2019
Reference code: PIL127/IND043
Review date: 01/06/2028