Predictors of Long-Term NovaSure Endometrial Ablation Failure

Study Objective: Endometrial ablation using the NovaSure system (Hologic Inc., Marlborough, MA) is 1 of the treatment options for heavy menstrual bleeding (HMB), which has a reported success rate of 81% to 90%. We aimed to identify predictors for NovaSure endometrial ablation failure. This will contribute to a more effective and individualized preoperative counseling. Design: A retrospective multicenter cohort study (Canadian Task Force classification II-2). Setting: One university hospital and 1 large teaching hospital. Patients: Four hundred eighty-six patients with HMB who had undergone NovaSure endometrial ablation between 2008 and 2014. Interventions: The NovaSure endometrial ablation system for patients with HMB. Measurements and Main Results: In total, the required characteristics of 486 patients were collected and analyzed. With a median follow-up of 45 months, 19.3% (n = 94) required a secondary treatment and thus were considered NovaSure failures. Multivariate logistic regression analysis showed that younger age (p = .019). a history of sterilization (p = .002), the presence of dysmenorthea (p < .001) and the presence of an intramural leiomyoma on transvaginal sonography (p = .005) were independent predictors of NovaSure ablation failure. Preoperative hysteroscopy appeared to be a protective factor (p = .001). Conclusion: Within a median follow-up of 45 months, 19.3% of patients required a secondary treatment. Identification of specific predictive factors for endometrial ablation failure is important in preoperative counseling and patient selection. In the current era of personalized medicine, doctors and patients will ideally choose the therapy that results in the highest chance of success in the individual case. (C) 2018 AAGL. All rights reserved.