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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Difficulty in carrying out Novasure due to hard uterine wall with scar tissue. What could the cause be?

I went in today to have the NovaSure procedure done. After I came to, the Dr told me that she was not able to do the procedure because my uterine wall is hard and has scar tissue . She said this is uncommon and has only seen a couple of cases like this. I see her in 2 weeks for another ultrasound and to discuss options. Any thoughts or experience with this. I am 36 years old, have 1 child, and have heavy irregular periods.
Mon, 17 Sep 2012
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OBGYN, Maternal and Fetal Medicine 's  Response
Hello thejohnsons327,
In my experience there can be failure to perform this and other similar endometrial ablation procedures e.g uterine balloon therapy when the instrument has not entered the uterine cavity at all. Sometimes, by mistake, it remains in the cervical canal without negotiating the internal opening of the uterus called the internal os. Naturally the mesh or balloon won't open up as the cervical canal tissue is less elastic and distensible than the uterus tissues.
This dificulty in entering the main body of the uterus can occur if the cervical canal is tortuous or angled sharply in front of behind (acutely anteverted/anteflexed or retroverted/retroflexed uterus). Or else the cervical canal may be tightly closed/stenosed.

However, if one is alert to this possibilty and endeavours to negotiate the canal with patience and progressive dilatation, it is possible to overcome this difficulty. Another try under general anaesthesia in the operation theatre rather than as an Out Patient Procedure may be worth it.

Rarely the uterus may be inelastic due to more fibrous tissues than muscles due to previous surgery on the uterus or infections in the past or very rarely may indicate an underlying collagen tissue disorder like Systemic Lupus Erythrematosis (SLE). There is no real way to overcome this problem to ensure a successful endometrial ablation procedure.

Heavy, irregular periods generally are due to PCOS (Poly Cystic Ovarian Syndrome) and both - the heavy period and the irregularity can be corrected by use of hormones - progestrogens alone or in combination with estrogen as in the contraceptive pills. Newer medications like Ormeloxifene help greatly in reducing the flow but do not correct the irregularity. In that sense Novasure too can decrease the flow but cannot make the periods regular.
Hope this answers your queries adequately.
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Difficulty in carrying out Novasure due to hard uterine wall with scar tissue. What could the cause be?

Hello thejohnsons327, In my experience there can be failure to perform this and other similar endometrial ablation procedures e.g uterine balloon therapy when the instrument has not entered the uterine cavity at all. Sometimes, by mistake, it remains in the cervical canal without negotiating the internal opening of the uterus called the internal os. Naturally the mesh or balloon won t open up as the cervical canal tissue is less elastic and distensible than the uterus tissues. This dificulty in entering the main body of the uterus can occur if the cervical canal is tortuous or angled sharply in front of behind (acutely anteverted/anteflexed or retroverted/retroflexed uterus). Or else the cervical canal may be tightly closed/stenosed. However, if one is alert to this possibilty and endeavours to negotiate the canal with patience and progressive dilatation, it is possible to overcome this difficulty. Another try under general anaesthesia in the operation theatre rather than as an Out Patient Procedure may be worth it. Rarely the uterus may be inelastic due to more fibrous tissues than muscles due to previous surgery on the uterus or infections in the past or very rarely may indicate an underlying collagen tissue disorder like Systemic Lupus Erythrematosis (SLE). There is no real way to overcome this problem to ensure a successful endometrial ablation procedure. Heavy, irregular periods generally are due to PCOS (Poly Cystic Ovarian Syndrome) and both - the heavy period and the irregularity can be corrected by use of hormones - progestrogens alone or in combination with estrogen as in the contraceptive pills. Newer medications like Ormeloxifene help greatly in reducing the flow but do not correct the irregularity. In that sense Novasure too can decrease the flow but cannot make the periods regular. Hope this answers your queries adequately.