Effectiveness of thermal balloon ablation versus NovaSure endometrial ablation in different age groups

Abstract

The aim of this study is to compare the frequency of amenorrhoea, overall satisfaction and hysterectomy after thermal balloon ablation (TBA) versus NovaSure endometrial ablation (NA) in women at different ages, being the commonest ablation devices used currently in the UK. It is a retrospective review of women who had endometrial ablation, using TBA or NA, at the Pennine Acute Trust, between 2009 and 2012. Patients were grouped into two cohorts: those aged up to 45 years and those of 46 years or more. A telephone questionnaire was used to assess patient’s pattern of bleeding after the procedure, and if they needed further management including medical or surgical intervention. It also looked at the overall satisfaction. In group A (45 years old or less), the amenorrhoea rate was 44 % after NovaSure and 23 % after TBA. Satisfaction was equal at around 80 % in both groups. Hysterectomy rates were 23 % in the TBA group and 20.8 % in the NovaSure group. In group B (46 years old or more), the amenorrhoea rate was 57 % after TBA and 50 % after NovaSure. Satisfaction rates were similar. However, hysterectomy rates were 10 % after TBA for persistent heavy periods and 8 % after NovaSure. In conclusion, NA ablation is more effective than TBA in achieving amenorrhoea in younger women and should be the preferred treatment option. Failure of ablation and/or hysterectomy rates were higher in younger women, especially those with dysmenorrhoea and after TBA. This highlights the necessity for careful selection of the treatment modality especially for younger women with HMB and for clear patient counselling.