Predictive Factors Affecting the Success of a NovaSure Endometrial Ablation

Abstract

Objectives: Menorrhagia is a common disorder worldwide. It affects approximately 22% of otherwise healthy women. In Hong Kong, 9% of all gynaecology admissions were due to menorrhagia, for which hysterectomy was the main surgical treatment. In 2007, the National Institute for Health and Clinical Excellence guideline recommended endometrial ablation as a treatment option for benign menorrhagia, using second-generation techniques. In this study, patients who received NovaSure endometrial ablation in a local unit in the United Kingdom were analysed. The aim was to identify factors affecting its cost-effectiveness and predict the rate of success, so that the analysis could be applied to the Hong Kong population.
Methods: This retrospective study was performed within Poole Hospital, a district general hospital in the United Kingdom. Patients who underwent a NovaSure endometrial ablation for dysfunctional uterine bleeding between July 2009 and June 2010 were included. Several factors that might affect the effectiveness of the procedure were studied in detail. Success rates, failure rates, and amenorrhoea rates were studied after 12 months of follow-up. Success was defined as satisfaction expressed after the procedure and a subjective reduction in menstrual flow. Failure was defined by recourse to subsequent medical or surgical therapy during the same 12 months of follow-up.
Results: During the 12-month period, 32 patients underwent a NovaSure endometrial ablation in the unit. Treatment satisfaction and reported reduction in menstrual blood flow was expressed in 84.4% of patients at 12-month followup. Amenorrhoea was noted in 17 (53.1%) of the patients. Overall, five (16%) patients warranted extra management, four of whom underwent a hysterectomy. Having a previous Caesarean section was a factor that showed a trend towards failure of a NovaSure ablation, but this result was not statistically significant. All other factors demonstrated no association with outcomes.
Conclusions: A history of Caesarean section showed trend towards failure of NovaSure endometrial ablation. The majority of patients were satisfied with the procedure and complication rate was down to 6.3%. Promotion of this technique in Hong Kong may lead to greater patient satisfaction, reduce costs, and minimise hysterectomy rate and outpatient clinic attendance.