Endometrial Thermoablation with Novasure？ for the Treatment of Abnormal Uterine Bleeding in the Obstetrics and Gynecology Department of the Hospital Center of Nevers, France from 2019 to 2022
Introduction: Anormal uterine bleeding is a situation that disrupts genital life. Extreme cases can be life-threatening. Several treatments are available, including thermoablation of the endometrium using the Novasure？ procedure. Objective: This paper aims to describe the results of treatment of anormal uterine bleeding with Novasure？ thermoablation. Method: This was a descriptive and analytical study which took place from November 1, 2019 to December 31, 2022 at the Centre Hospitalier de l'Agglomération de Nevers, France. All patients diagnosed with anormal uterine bleeding after ruling out an organic cause with a Higham score > 150 constituted the study population. Patients included in the study were those treated by endometrial thermoablation. Incomplete files and patients who continued postoperative follow-up in another health facility were not included in the study. A Novak cannula endometrial biopsy was performed each time. We were interested in the following variables: qualitative (profession, medical treatment received, favouring factors, endometrial histology, postoperative evolution), and quantitative (age, parity, intraoperative uterine cavity measurements). It should be noted that all patients no longer wished to have children. Results: During the study period, we selected 156 patients with HUF, including 17 (10.90%) treated by Novasure？ thermoablation. The patients were over 40 years of age in 64.7% of cases. Contributing factors were dysthyroidism, dysovulation and anticoagulant use (11.8%). Failure of medical treatment was the indication for thermoablation in 81.82% of cases. Patients were fully satisfied, with complete reversal of signs in 82.36% of cases. Simple glandular hyperplasia without atypia was present in 52.94% of cases. Conclusion: Endometrial thermoablation is an effective way of overcoming abnormal uterine bledding with very few complications. Anormal uterine bleeding can be stopped immediately, often with a marked improvement in quality of life. A large uterine cavity is a major factor limiting its effectiveness. The high cost of the device is the main factor limiting its widespread use.
References
[1]
Munro, M.G., Critchley, H.O.D., Broder, M.S. and Fraser, I.S. (2011) FIGO Classification System (PALM‐COEIN) for Causes of Abnormal Uterine Bleeding in Nongravid Women of Reproductive Age. International Journal of Gynecology & Obstetrics, 113, 3-13. https://doi.org/10.1016/j.ijgo.2010.11.011
[2]
Munro, M.G., Critchley, H.O.D. and Fraser, I.S. (2011) The FIGO Classification of Causes of Abnormal Uterine Bleeding in the Reproductive Years. Fertility and Sterility, 95, 2204-2208.e3. https://doi.org/10.1016/j.fertnstert.2011.03.079
[3]
Pourcelot, A.G. and Fernandez, H. (2023) Hémorragies utérines fonctionnelles. Elsevier.
[4]
Fernandez, H., Gervaise, A., Faivre, E. and Deffieux, X. (2008) Les hémorragies utérines fonction-nelles ou idiopathiques. Gynécologie et Obstétrique, XXXII, 261-274.
[5]
Beelen, P., van den Brink, M.J., Herman, M.C., Geomini, P.M.A.J., Dekker, J.H., Duijnhoven, R.G., et al. (2021) Levonorgestrel-Releasing Intrauterine System versus Endometrial Ablation for Heavy Menstrual Bleeding. American Journal of Obstetrics and Gynecology, 224, 187.e1-187.e10. https://doi.org/10.1016/j.ajog.2020.08.016
[6]
Marjoribanks, J., Lethaby, A. and Farquhar, C. (2016) Surgery versus Medical Therapy for Heavy Menstrual Bleeding. Cochrane Database of Systematic Reviews, No. 1, CD003855. https://doi.org/10.1002/14651858.cd003855.pub3
[7]
Bradley, L.D. and Gueye, N. (2016) The Medical Management of Abnormal Uterine Bleeding in Reproductive-Aged Women. American Journal of Obstetrics and Gynecology, 214, 31-44. https://doi.org/10.1016/j.ajog.2015.07.044
[8]
Critchley, H.O.D., Maybin, J.A., Armstrong, G.M. and Williams, A.R.W. (2020) Physiology of the Endometrium and Regulation of Menstruation. Physiological Reviews, 100, 1149-1179. https://doi.org/10.1152/physrev.00031.2019
[9]
Gallinat, A. (2007) An Impedance-Controlled System for Endometrial Ablation: Five-Year Follow-Up of 107 Patients. Journal of Reproductive Medicine, 52, 467-472.
[10]
Xie, H., Wan, Y., Yi, S., Zeng, F., Sun, X., Yang, Y., et al. (2021) Clinical Analysis of 2152 Cases of Abnormal Uterine Bleeding Treated by Novasure Endometrial Ablation. International Journal of Gynecology & Obstetrics, 158, 301-307. https://doi.org/10.1002/ijgo.13983
[11]
Cooper, J., Gimpelson, R., Laberge, P., Galen, D., Garza-Leal, J.G., Scott, J., et al. (2002) A Randomized, Multicenter Trial of Safety and Efficacy of the Novasure System in the Treatment of Menorrhagia. The Journal of the American Association of Gynecologic Laparoscopists, 9, 418-428. https://doi.org/10.1016/s1074-3804(05)60513-0
[12]
de Léotoing, L., Chaize, G., Fernandes, J., Toth, D., Descamps, P., Dubernard, G., et al. (2019) The Surgical Treatment of Idiopathic Abnormal Uterine Bleeding: An Analysis of 88 000 Patients from the French Exhaustive National Hospital Discharge Database from 2009 to 2015. PLOS ONE, 14, e0217579. https://doi.org/10.1371/journal.pone.0217579
[13]
Kroft, J. and Liu, G. (2013) First-versus Second-Generation Endometrial Ablation Devices for Treatment of Menorrhagia: A Systematic Review, Meta-Analysis and Appraisal of Economic Evaluations. Journal of Obstetrics and Gynaecology Canada, 35, 1010-1019. https://doi.org/10.1016/s1701-2163(15)30789-1
[14]
Bongers, M.Y. (2015) Hysteroscopy and Heavy Menstrual Bleeding (to Cover TCRE and Second-Generation Endometrial Ablation). Best Practice & Research Clinical Obstetrics & Gynaecology, 29, 930-939. https://doi.org/10.1016/j.bpobgyn.2015.03.011
[15]
Fergusson, R.J., Bofill Rodriguez, M., Lethaby, A. and Farquhar, C. (2019) Endometrial Resection and Ablation versus Hysterectomy for Heavy Menstrual Bleeding. Cochrane Database of Systematic Reviews, No. 11, CD000329. https://doi.org/10.1002/14651858.cd000329.pub3
[16]
Gallinat, A. (2004) Novasure Impedance Controlled System for Endometrial Ablation: Three-Year Follow-Up on 107 Patients. American Journal of Obstetrics and Gynecology, 191, 1585-1589. https://doi.org/10.1016/j.ajog.2004.05.020
[17]
Smith, P.P., Malick, S. and Clark, T.J. (2014) Bipolar Radiofrequency Compared with Thermal Balloon Ablation in the Office. Obstetrics & Gynecology, 124, 219-225. https://doi.org/10.1097/aog.0000000000000395
[18]
Penninx, J.P.M., Herman, M.C., Mol, B.W. and Bongers, M.Y. (2011) Five-Year Follow-Up after Comparing Bipolar Endometrial Ablation with Hydrothermablation for Menorrhagia. Obstetrics & Gynecology, 118, 1287-1292. https://doi.org/10.1097/aog.0b013e318236f7ed
[19]
Bofill Rodriguez, M., Lethaby, A., Grigore, M., Brown, J., Hickey, M. and Farquhar, C. (2019) Endometrial Resection and Ablation Techniques for Heavy Menstrual Bleeding. Cochrane Database of Systematic Reviews, 1, CD001501. https://doi.org/10.1002/14651858.cd001501.pub5
[20]
Mengerink, B.B., van der Wurff, A.A.M., ter Haar, J.F., van Rooij, I.A. and Pijnenborg, J.M.A. (2015) Effect of Undiagnosed Deep Adenomyosis after Failed Novasure Endometrial Ablation. Journal of Minimally Invasive Gynecology, 22, 239-244. https://doi.org/10.1016/j.jmig.2014.10.006
[21]
van den Brink, M., Beelen, P., Herman, M., Geomini, P., Dekker, J., Vermeulen, K., et al. (2021) The Levonorgestrel Intrauterine System versus Endometrial Ablation for Heavy Menstrual Bleeding: A Cost-Effectiveness Analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 128, 2003-2011. https://doi.org/10.1111/1471-0528.16836
