Women's Health Community

Dear ravensummer: By all means go back to the GYN who did your procedure. It sounds like you had the most appropriate work up (hysteroscope and D&C before ablation) and then a thorough ablation of the lining. While she did say to give it a couple of months you need to let her know that you are still having a very heavy flow and severe cramps.

Can we identify specific women who might not have as good an outcome based upon her medical history or personal anatomy? You may have read that large fibroids sticking out into the uterine cavity can impede the correct placement of NovaSure, or that a very large uterine cavity (e.g., greater than 5 inches) can be harder to treat.

Physicians from the Mayo Clinic reviewed the outcomes of 816 women who had an endometrial ablation (EA). Factors which seemed to predict successful stopping of all bleeding ("amenorrhea") included: age 45 or older (menopause would be kicking in within 5 years or so), a thin uterine lining of less than 4 mm, normal size of uterine cavity (less than 9 cm), and use of NovaSure type rather than heated balloon. Patient characteristics linked to treatment failure were: age younger than 45 years, five or more pregnancies (leads to larger uterine size), prior tubal ligation, and history of bad menstrual cramps (thought to suggest adenomyosis of the walls of the uterus). You mentioned that your uterine lining was found to be thick in the initial work up.

As you may have read, some women will require a repeat procedure. A small percentage of those women will ultimately go on to hysterectomy. I sincerely hope that you are in the majority, not this minority.

Yours,
Jane

Thanks for the response. I had a couple of small fibroids that she said shouldn't cause any problems and a polyp that she removed. On the positive side: I am 48. I did have a thickened lining, but i don't recall how thick. It was NovaSure.

On the negative side, I have bad menstrual cramps. I have had 8 pregnancies with 7 miscarriages and a tubal ligation.

I certainly hope this works too. I saw the pictures and it didn't look like anything could be left of a lining. She has been a GYN for over 30 years and has done thousands of these procedures and felt like I would be a good candidate. I guess I will have to go back. When I first saw her, the first period wasn't anywhere near as bad as this last one. The fact I got the clots back and the heavier flow this last time is what made me somewhat hesitant about whether or not it worked.

Dear ravensummer: I concur, you really need to go back given the heaviness of this last flow. It sounds like she is very competent and will investigate to see if there is still a structural problem (eg small fibroids) which might be the culprit. She might also offer some hormonal medication to see if you can get through the next couple of years until menopause.

Would you be so kind as to write us back if you receive an explanation? Other women may benefit from your experience as your outcome was so unexpected.

In Gratitude,
Jane

Most definitely. She said to give it at least 3 months, so I will wait until after my next cycle around the 5th of June before I go back to see her since that will be my third period since the surgery. Thanks again for your help. You told me a few things that she didn't before the surgery (the number of pregnancies and the bad menstrual cramps which I have suffered with since age 14) and I wish she had addressed them. I was just given 4 choices and she went through them, the Mirena, NovaSure, hormones, and hysterectomy that were on a comparative chart. I asked her what her opinion was and she said to go with the NovaSure. I was especially excited about it because she said that she herself had had the procedure done.

Dear ravensummer: It would be great if by the third cycle the bleeding abated--keep us informed.

Lastly, I am even more convinced about the competence of your GYN if she had a chart made up to discuss the pluses and minuses of all the options for heavy bleeding. It would be of benefit if we could know which was going to be the best for that individual patient. The Mayo Clinic study I quoted was an attempt to isolate any predictive factors. Yet, like all statistical studies, the variables used may not apply to a specific, individual woman. I laud your GYN for taking the effort to present all the options not just push for hysterectomy at the outset.

Yours,
Jane

I finally talked to my GYN after having an even worse cycle starting June 5th (which was month 3 post ablation). She decided that since I am a smoker and 48, the only thing she could really try next is Provera oral to be taken starting on day 16 of my cycle each month until my next appointment in February. She said if that doesn't fix the problem, the only alternative I have left is hysterectomy. She was still absolutely astounded that I have gone back to not only as bad as I was before the ablation, but my cycle is actually getting longer each month with an extra day of heavy bleeding and pain. I used to have 5-6 day cycles with 2 days of heavy bleeding, pain, and clots and I now have 7-8 day cycles with 3 days of heavy bleeding, pain, and clots. She said I am officially in the 1% of total endometrial ablation failure and she has personally not come across it in her 33 years in practice. All I can do now is pray that the Provera lessens the bleeding. She said I might even stop bleeding altogether in a few months, but she was hesitant to say that I would since the ablation didn't take. Only hysterectomy will solve all the problems which of course means time off from work I can't afford plus the cost of the surgery. I think she is afraid to tell me anything anymore that should happen with any of the other available treatments LOL.

I had the Novasure procedure in February, 2012, and had almost your identical experience.

During the summer of 2011, I was diagnosed with a 4 cm submucosal fibroid and, after extensive research, agreed with my, very reputable, GYN that Novasure was the best option for me. The pre-op and surgery went flawless, but, unfortunately, nothing changed.

I have since followed up with two other specialists. The first said my fibroid was too large and that's why Novasure didn't work. He offered to do a myomectomy and then wouldn't schedule. I think the second specialist was as surprised as my original GYN and suggested the Mirena IUD.

Because I'm almost 51, every doctor I've seen thinks I should be on the verge of menopause and this will all be over soon. However, my cycles are never less than 10 days and are insanely heavy. My current cycle is at 3 week with no sign of stopping. I regularly pass large clots--usually the size of oreos, but one was as big as my hand.

Maybe I should consider Provera. I've resisted all the drug therapies, after reading about their side effects. I'm scheduled to see a new GYN at the end of the month, but I question if there is anything new she can suggest.

If you get a chance, please let me know how you're doing now and, especially, if the Provera has helped you. If so, I may try that next, too. Thank you!

Here's a PubMed Health link about diagnostics and treatment options for heavy bleeding - http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015963/. This link only contains the Table of Contents. You need to click on the section you want to access to see its contents. Section 8 addresses pharmaceutical treatments (hormonal and non-hormonal) and their effectiveness based on studies. Section 8.2.1 addresses LNG-IUS (e.g., Mirena).

I'm 58, only kids are twins I had at age 38 with IVF help. Went through menopause about 3 years ago, had hot flashes, etc., and started bio identical HRT, with many adjustments along the way. This Dr. wrote a book on these types of hormones, and how they can help you stay healthier and live longer.

I then had spotting, had a D&C. More spotting, another D&C and ablation. That was 3 months ago. Afterwards had spotting, then none, then a 10 day heavy period, then spotting, and now about 6 weeks later, another heavy 10 day period. I am SO OVER having periods at my age!!! The Dr. says I just have a problem uterus. Maybe I should have never messed with Mother Nature and not taken HRT.

What's your guess with my future of periods? Will they gradually go away? I don't see how you can even grow a lining and bleed with your uterus has been sealed off.

Any thoughts? Thanks so much.

I agree - messing with mother nature whether it be taking HRT or having a procedure can lead to trouble.

It can be tricky to tweak HRT to both feel good and keep from bleeding. Estrogen (E) will build the lining so it's necessary to take a progestin or progesterone (P) to protect the lining. Taking the P continuously seems to keep bleeding at bay for most women but P can cause fatigue and low mood in some women. Cycling it may help but then you're stuck with having a bleed.

Have you stopped the HRT? It may take some time for your body to adjust but once it does, it seems the bleeding should stop.

I've read situations where bleeding ceased for years post-ablation and then started back up. This would seem to be rare though in women who're truly menopausal (as determined by FSH and estrogen level vs. 1 year cessation of periods).

I can relate with you I actually had the NovaSure procedure done in April 2008(at the time I was 36 years old ), then I had to have a touchup (is what the doctor called it) as well as cryoblation in March 2009. It has helped some I still have periods every month, and cramping really bad and into my lower back. The bleeding is not as bad as it was prior to the surgeries. But my doctor told me that " you should see a dramatic difference and around 90% of women stop having periods altogether" obviously I am in the 10% that still do.I do not have the huge clots like I did prior to the surgery, but the cramps are as bad as they were prior to the surgery. I am not anemic anymore since the surgery. I feel I was mislead somewhat by doctor and I would not have a third procedure done if it came to that. I would have a hysterectomy (my mother had to have one at 39 yrs. old). However, I do hope that your surgery will be sucessful and you will get the results that you was looking for.

Sorry to hear you were misled about ablation. I had a hysterectomy and regret it daily. It's changed my figure and my bladder and bowel function. Although I haven't had the typical post-hysterectomy weight gain and am actually underweight, I'm stuck with the hysterectomy induced spine compression and back pain along with the thick midsection and big belly. And the hormonal effects have been pretty devastating too even though I'm on HRT.

With procedures, you're stuck with the good and the bad. At least with medications, you can stop taking them if the side effects outweigh the benefits.

According to this study titled "Probability of Hysterectomy After Endometrial Ablation" http://journals.lww.com/greenjournal/Fulltext/2008/12000/Previous_Tubal_Ligation_Is_a_Risk_Factor_for.6.aspx, the younger a woman is at the time of ablation, the greater the chance that it will cause problems that lead to hysterectomy. For women under age 40, this risk is 40%.
"Probability of hysterectomy 8 years after endometrial ablation was 12% for women aged older than 50 years at time of endometrial ablation, 19.8% for women aged 45—49.9 years, 31% for women aged 40—44.9 years, and 40.6% for women aged younger than 40 years....Overall, type of endometrial ablation procedure, setting of endometrial ablation procedure, and presence of leiomyomas were not predictors of hysterectomy."