Long-Term Outcomes after Endometrial Ablation: A Cohort Study at the Medical University Innsbruck

Long-Term Outcomes after Endometrial Ablation: A Cohort Study at the Medical University Innsbruck | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 6 June 2025 V1 Latest version Share on Long-Term Outcomes after Endometrial Ablation: A Cohort Study at the Medical University Innsbruck Authors : Laura Strobel , Nina Gleirscher , Felix Hofbauer , Miriam Emmelheinz , Christian Marth , and Andreas Widschwendter [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174919883.37111736/v1 469 views 190 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Abstract Objective: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint that significantly affects quality of life and healthcare resources. Radiofrequency ablation offers a minimally invasive alternative to hysterectomy for the management of AUB, but long-term outcome data remain limited. Methods: This single-center study combined retrospective and prospective components to assess the efficacy and patient satisfaction after endometrial ablation. We analyzed data from 1,757 patients treated for AUB at the Medical University of Innsbruck between 2004 and 2022, including 609 patients who underwent radiofrequency ablation (NovaSure) between 2014 and 2018. Patient-reported outcome was evaluated through standardized telephone interviews. Results: NovaSure was the most commonly used method (63%), followed by ThermaChoice balloon ablation (29%) and hydrothermoablation (1,6%), due to its reduced treatment times and minimal post-operative discomfort. The median patient age was recorded as 46 years. Hysterectomy was required in 13% of cases, but only 7.2% were due to persistent or recurrent AUB. Among 431 patients contacted for follow-up, 90% reported satisfaction (74.5% very satisfied, 15.5% satisfied), 64% experienced complete amenorrhea, and 83% required no further surgery. A hysterectomy post-ablation was mainly associated with fibroid-related bleeding. Long-term follow-up confirmed sustained bleeding reduction and high satisfaction levels, consistent with prior studies. Conclusion: Endometrial ablation is a highly effective and well-tolerated treatment for AUB, achieving high patient satisfaction and significant bleeding reduction over a long follow-up period. Careful patient selection and preoperative assessment are crucial to optimize outcomes and minimize the need for secondary interventions. Keywords: endometrial ablation, radiofrequency ablation, patient satisfaction, hysterectomy Long-Term Outcomes after Endometrial Ablation: A Cohort Study at the Medical University Innsbruck Laura Strobel + , Nina Gleirscher + , Felix Hofbauer, Miriam Emmelheinz Christian Marth, Andreas Widschwendter Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. + authors contributed equally to this work * Correspondance: Andreas Widschwendter (MD) Department Gynecology and Obstetrics Innsbruck Medical University 35, Anichstrasse A-6020 INNSBRUCK Austria Objective To evaluate the long-term effectiveness and patient satisfaction following endometrial ablation for abnormal uterine bleeding (AUB), with a focus on radiofrequency ablation. Design Single-center study with retrospective and prospective components. Setting Department of Obstetrics and Gynecology, Medical University of Innsbruck, Austria. Population or Sample 1,757 patients treated for AUB between 2004 and 2022. Among these, 609 underwent radiofrequency ablation (NovaSure®) between 2014 and 2018. Follow-up data were collected from 431 patients. Methods Retrospective analysis of clinical records and prospective standardized telephone interviews assessing satisfaction, bleeding status, and surgical outcomes. Primary Outcome Measures Patient satisfaction, rate of amenorrhea, and need for subsequent surgical intervention (e.g., hysterectomy). Results NovaSure® was the most commonly used method (63%). The median age was 46 years. Hysterectomy was necessary in 13%, with only 7.2% due to persistent AUB. Of the patients interviewed, 90% reported satisfaction (74.5% very satisfied, 15.5% satisfied), 64% achieved amenorrhea, and 83% required no further surgery. Most hysterectomies were related to fibroid-associated bleeding. Conclusions Radiofrequency endometrial ablation is an effective, minimally invasive option for AUB, offering sustained symptom relief and high satisfaction. Careful patient selection remains essential. Funding No external funding received. Keywords Endometrial ablation – Radiofrequency – Abnormal uterine bleeding – Patient satisfaction – Hysterectomy Abstract Objective: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint that significantly affects quality of life and healthcare resources. Radiofrequency ablation offers a minimally invasive alternative to hysterectomy for the management of AUB, but long-term outcome data remain limited. Methods: This single-center study combined retrospective and prospective components to assess the efficacy and patient satisfaction after endometrial ablation. We analyzed data from 1,757 patients treated for AUB at the Medical University of Innsbruck between 2004 and 2022, including 609 patients who underwent radiofrequency ablation (NovaSure) between 2014 and 2018. Patient-reported outcome was evaluated through standardized telephone interviews. Results: NovaSure was the most commonly used method (63%), followed by ThermaChoice balloon ablation (29%) and hydrothermoablation (1,6%), due to its reduced treatment times and minimal post-operative discomfort. The median patient age was recorded as 46 years. Hysterectomy was required in 13% of cases, but only 7.2% were due to persistent or recurrent AUB. Among 431 patients contacted for follow-up, 90% reported satisfaction (74.5% very satisfied, 15.5% satisfied), 64% experienced complete amenorrhea, and 83% required no further surgery. A hysterectomy post-ablation was mainly associated with fibroid-related bleeding. Long-term follow-up confirmed sustained bleeding reduction and high satisfaction levels, consistent with prior studies. Conclusion: Endometrial ablation is a highly effective and well-tolerated treatment for AUB, achieving high patient satisfaction and significant bleeding reduction over a long follow-up period. Careful patient selection and preoperative assessment are crucial to optimize outcomes and minimize the need for secondary interventions. Keywords: endometrial ablation, radiofrequency ablation, patient satisfaction, hysterectomy Funding No external funding was received to support the conduct of this study. Introduction Abnormal uterine bleeding (AUB) affects a substantial proportion of reproductive-aged women and is responsible for a significant number of gynecological consultations (1, 2, 3) . In addition to its economic burden, AUB—especially heavy menstrual bleeding—can lead to iron-deficiency anemia, which negatively impacts quality of life, daily functioning, sexual health, and work productivity (2, 4, 5) . Timely and effective management is therefore crucial. AUB has a wide range of generally benign causes (6, 7) . To standardize terminology and improve diagnostic clarity, the International Federation of Gynecology and Obstetrics (FIGO) developed a dual classification system. The first defines AUB as any deviation in menstrual cycle length, duration, regularity, or volume (2, 8-10) . The second, known as PALM-COEIN, distinguishes structural causes (Polyp, Adenomyosis, Leiomyoma, Malignancy) from non-structural ones (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified) (1, 9-11) . Chronic AUB is defined as abnormal bleeding lasting more than six months, whereas acute AUB requires urgent medical intervention (1) . First-line treatment typically involves medical therapy, both hormonal (e.g., progestogens, combined estrogen-progestogen regimens) and non-hormonal (e.g., prostaglandin synthetase inhibitors). The levonorgestrel-releasing intrauterine system (LNG-IUS) is considered the gold standard for managing chronic heavy menstrual bleeding (12) . However, up to 40% of patients discontinue use within two years due to inadequate bleeding control or side effects (13) . While hysterectomy provides definitive resolution, it is associated with higher complication rates, costs, and prolonged recovery (14) . As a uterus-sparing option, endometrial ablation, particularly radiofrequency ablation (RFA), has become increasingly popular (3) . Second- and third-generation techniques, unlike earlier methods, do not require hysteroscopy, thereby reducing procedural complexity and duration (15, 16) . RFA delivers bipolar energy to destroy the endometrial lining in a short procedure that can be performed under local anesthesia. It shows high amenorrhea rates, excellent patient satisfaction, and quick return to daily activities. A study by Reinders et al. reported that most patients resumed light household tasks within one day and returned to sports in under a week (17) . Long-term results are promising, but data beyond five years are still limited (18) . Rare complications include pelvic infections and, in very rare cases, delayed bowel perforation (19, 20) . Age, fertility plans, and underlying pathology are critical in determining appropriate candidates (21, 22) . Although RFA significantly reduces pregnancy likelihood, it is not a method of contraception or sterilization (23) . This study aims to assess long-term outcomes, satisfaction, and predictors of treatment failure to improve patient selection and contribute to more individualized AUB care. These insights may contribute to more personalized AUB management. Methods This single-center descriptive study combined retrospective and prospective components. Retrospectively, medical records of 1,757 patients treated for abnormal uterine bleeding (AUB) at the Medical University of Innsbruck between January 2004 and October 2022 were reviewed. Data collected included medical history, procedure dates, treatment indications, hospital stay duration (>3 vs. ≤3 days), histopathological findings (with emphasis on endometrial neoplasia), anemia status, hormonal therapy use, patient age, and body mass index (BMI). All patients underwent hysteroscopy and curettage before ablation. Treatment modalities included NovaSure, ThermaChoice® thermal balloon ablation, hysteroscopic endometrial resection, and hydrothermal ablation. Patients who later required hysterectomy were classified using FIGO’s PALM-COEIN system. Analyses followed an Intention-to-Treat (ITT) approach. The prospective part involved telephone interviews with 609 patients who underwent radiofrequency ablation between 2014 and 2018. The structured questionnaire (Murphy, Miles – SSQ8) included a four-point Likert scale: (1) How satisfied are you with the intervention? Very dissatisfied - dissatisfied - neutral – satisfied - very satisfied, (2) looking back, would you repeat this intervention? Rather not – unsure - rather yes - very satisfied, (3) since you have had surgery, how has your bleeding behaved? Increase in bleeding - no change - spotting (no tampons or pads needed - reduction in bleeding (tampons or pads needed) - no more bleeding, (4) have you had another operation (hysterectomy)? If yes, for what reason? And when (how much later after the first operation?)? The focus was on items 6–8, which best reflected overall treatment satisfaction, while questions on postoperative pain and return to daily activities were excluded from the primary analysis. Statistical analyses were conducted using SPSS Version 26.0 (IBM Corp., 2020). Results are reported as mean ± standard deviation (SD), median with interquartile range (IQR), or absolute and relative frequencies (%). A p-value < 0.05 was considered statistically significant. All participants provided written informed consent for the use of their clinical data. The study received ethical approval from the Medical University of Innsbruck (EK Nr: 1319/2023, Version 6). Results During the study period, 1,757 patients were treated for AUB. NovaSure was the predominant ablation method (63%), followed by ThermaChoice (29%). The median age at treatment was 46 years. Preoperatively, 18.5% of patients were anemic, defined by WHO as hemoglobin <120 g/L in non-pregnant women. (24) Post-ablation hysterectomy was performed in 229 patients (13%), but only 126 cases (7.2%) were due to persistent or recurrent AUB. The median interval between ablation and hysterectomy was 14 months. Endometrial carcinoma was diagnosed in 0.5% (n = 8), with no additional cases in the remaining cohort. Among the 229 hysterectomies, 103 (5.8%) were performed for unrelated indications, including uterine prolapse, adnexal cysts, or endometrial hyperplasia/neoplasia. In the AUB-related group (7.2%), the leading causes were menometrorrhagia (39.7%), hypermenorrhea (16.6%), hematometra with pain (15.8%), and fibroid-associated bleeding (17.5%). Of the 609 patients who underwent radiofrequency ablation between 2014 and 2018, 431 (70.8%) completed follow-up interviews assessing satisfaction. The follow-up ranged from 6 to 11 years (median: 123 months; mean: 109 months). Most respondents (74.5%) were very satisfied, 15.5% satisfied, 4.2% neutral, while 2.1% and 3.7% were dissatisfied or very dissatisfied, respectively. Regarding willingness to repeat the procedure, 59.9% responded affirmatively, 20.6% “rather yes,” 8.6% were unsure, and 10.9% would not repeat it. In terms of bleeding outcomes, 64% reported amenorrhea, 12.8% experienced minor spotting, and 10.2% noted reduced bleeding. Conversely, 9.3% saw no change, and 3.7% reported increased bleeding. Hysterectomy was ultimately required in 16.9%, primarily due to fibroids (19.2%) and hypermenorrhea (19.2%). The majority (83%) did not require further surgical intervention. Of the 178 non-respondents, 63.3% were unreachable, 22.7% had incorrect contact data, and 11.1% declined participation. Discussion Summary of Main Results This study assessed the clinical efficacy of endometrial ablation with a focus on patient satisfaction following radiofrequency ablation. Satisfaction was evaluated based on subjective responses, bleeding outcomes, and subsequent hysterectomy. The findings support radiofrequency ablation as an effective treatment for AUB, with a high satisfaction rate (90.0%) and amenorrhea reported in 64.0% of patients. Although hysterectomy was required in 13.0% of cases, only 7.2% were due to AUB, mainly persistent menometrorrhagia often linked to uterine fibroids (39.7%). Importantly, this is the first study on radiofrequency ablation combining a prospective design with extended follow-up, offering meaningful insight into its long-term outcomes. Results in the context of Published Literature This study confirms high patient satisfaction, with 80.5% willing to repeat or recommend the procedure and 90.0% satisfied in follow-ups via telephone. Prior research aligns with these findings: Baskett et al. followed up one to four years and reported 81.5% treatment success and 97.3% willingness to recommend (n = 200), Unger et al. found a 90.4% satisfaction rate (n = 114), and Lopez et al. observed 86% overall satisfaction (n = 333) (25-27) . The patient populations in these studies, including ours, are predominantly women with heavy menstrual bleeding (HMB) and associated quality of life impairments. Notably, the median age of participants in the study by Lopez et al. was 46 years, which is consistent with the median age of 46.7 years reported by Unger et al. and our findings with a median age of 46 years (26, 27) . While our study involved a larger sample size and extended follow-up duration, the consistent satisfaction rates across these studies underscore the procedure’s effectiveness and positive reception over time. Our findings indicate a significant bleeding reduction in 87.0% of cases, with amenorrhea in 64.0% of patients. These results align with prior research, including Galliant et al., who reported a 97.2% bleeding reduction and increasing amenorrhea rates over time (46.2% at six months, 58.6% at 12 months, and 75% at five years), likely due to aging and menopausal transition (18, 28) . A meta-analysis by Kroft et al. (2019) found significantly higher amenorrhea rates with radiofrequency ablation than other second-generation EA devices (29) . Similarly, Scordalakes et al. (2018) reported superior one-year amenorrhea rates with NovaSure compared to Minerva (30) . Additionally, residual bleeding was lower with NovaSure, requiring fewer menstrual products, further supporting its superior efficacy among second-generation EA treatments. In the present study, 229 patients (13.0%) underwent hysterectomy, with a mean interval of 14 months post-treatment. This is comparable to the 13.9% hysterectomy rate reported by Unger et al., but notably higher than the rates observed by other groups: for example, Lopez et al. reported a 5.9% post-ablation hysterectomy rate, Wei Li-Ying et al. 2.65%, Hui Xie et al. 1.91%, and Sun Xiaoli et al. 1.5% (after 12 months) (20, 26, 27, 31, 32) . Several factors could account for the higher hysterectomy rate in our cohort. One consideration is the patient population: our median patient age was 46 years, which lies in the perimenopausal range when AUB is frequently associated with structural abnormalities such as leiomyomas and adenomyosis. In our data, a significant proportion of hysterectomies (39.7%) were performed for persistent menometrorrhagia, often in the context of uterine fibroids (17.5%). The presence of fibroids has been identified in previous literature as a major predictor of endometrial ablation failure, leading to a higher likelihood of subsequent hysterectomy (33) . It should be noted that differences in follow-up duration may partly explain the discrepancy in reported hysterectomy rates. For instance, Hui Xie et al. followed patients for only one year post-ablation, whereas our prospective survey was conducted 4–8 years after the radiofrequency ablation procedures (20) . Since our median time to hysterectomy was 14 months, the longer observation period in our study could capture more late failures, contributing to a higher cumulative hysterectomy rate than in studies with shorter follow-ups. These discrepancies may be influenced by various risk factors affecting radiofrequency ablations efficacy. Hui Xie et al. found that coagulation disorders and a uterine cavity length >10 cm significantly predicted ablation failure, suggesting that patients with these factors have a higher likelihood of needing a subsequent hysterectomy (20) . Eisele et al. demonstrated that intramural lesions (such as fibroids or polyps) diminished the success of ablation - a limitation that might be mitigated by careful preoperative ultrasound screening and treatment of such lesions beforehand (34) . Emslie et al. reported an overall post-ablation hysterectomy rate of 22.6% but noted that this rate declined with increasing age and was highest in women under 40 (35) . Additionally, Shazly et al. identified a short ablation duration (<93 seconds) as a predictor of suboptimal long-term outcomes (36) . These findings underscore the importance of appropriate patient selection and preoperative assessment to optimize ablation success and minimize the risk of later hysterectomy, which may in turn translate into greater patient satisfaction. Strengths and Weakness The strengths of this study include the large sample size of 1,757 patients, as well as the extended follow-up period for assessing long-term patient outcomes, with a median duration of 8,4 years (range: 6 to 11 years). By combining a retrospective review with a prospective patient survey, we were able to corroborate medical record data with patient-reported outcomes, enhancing the reliability of our findings. However, a potential limitation is selection bias in the survey responses: patients who were lost to follow-up or declined participation may have been less satisfied with their outcomes, meaning our telephone survey could have underestimated the proportion of dissatisfied patients. This possibility should be kept in mind when generalizing the satisfaction results. Conclusion In conclusion, endometrial ablation is a safe and effective treatment option for abnormal uterine bleeding, offering the advantages of a low complication rate and a rapid recovery. In our experience, the procedure’s effectiveness is reflected in high patient satisfaction rates and significant improvements in bleeding and quality of life. Endometrial ablation represents a valuable alternative to prolonged medical therapy or more invasive surgical interventions such as hysterectomy for appropriately selected patients with AUB. Future research should focus on long-term outcomes and comparative effectiveness among different ablation techniques to further guide clinical decision-making. References [1] Tsolova AO, Aguilar RM, Maybin JA, Critchley HOD. Pre-clinical models to study abnormal uterine bleeding (AUB). EBioMedicine. 2022;84: 104238. doi: 10.1016/j.ebiom.2022.104238. [Epub 05.09.2022][2] Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019;99: 435-43.[3] Gimpelson RJ. Ten-year literature review of global endometrial ablation with the NovaSure® device. Int J Womens Health. 2014;6: 269-80.[4] Miller JD, Lenhart GM, Bonafede MM et al. Cost effectiveness of endometrial ablation with the NovaSure(®) system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives. Int J Womens Health. 2015;7: 59-73.[5] Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10: 183-94.[6] Chodankar RR, Munro MG, Critchley HOD. Historical Perspectives and Evolution of Menstrual Terminology. Front Reprod Health. 2022;4: 820029. doi: 10.3389/frph.2022.820029. [eCollection 2022][7] Woolcock JG, Critchley HO, Munro MG et al. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. Fertil Steril. 2008;90: 2269-80.[8] Munro MG, Critchley HO, Broder MS et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113: 3-13.[9] Munro MG, Critchley HOD, Fraser IS, Committee FMD. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143: 393-408.[10] Marnach ML, Laughlin-Tommaso SK. Evaluation and Management of Abnormal Uterine Bleeding. Mayo Clin Proc. 2019;94: 326-35.[11] Deneris A. PALM-COEIN Nomenclature for Abnormal Uterine Bleeding. J Midwifery Womens Health. 2016;61: 376-9.[12] Showstack J, Lin F, Learman LA et al. Randomized trial of medical treatment versus hysterectomy for abnormal uterine bleeding: resource use in the Medicine or Surgery (Ms) trial. Am J Obstet Gynecol. 2006;194: 332-8.[13] Beelen P, van den Brink MJ, Herman MC et al. Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding. Am J Obstet Gynecol. 2021;224: 187.e1-.e10. doi: 10.1016/j.ajog.2020.08.016. [Epub 12.08.2020][14] Bofill Rodriguez M, Lethaby A, Fergusson RJ. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2021;2: CD000329.[15] Bofill Rodriguez M, Lethaby A, Grigore M et al. Endometrial resection and ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;1: CD001501.[16] Biscette S, Shepherd J, Pasic RP. Global endometrial ablation. Surg Technol Int. 2010;20: 208-13.[17] Reinders IMA, van de Kar MRD, Geomini PMAJ et al. Short-term recovery after NovaSure® endometrial ablation: a prospective cohort study. Facts Views Vis Obgyn. 2022;14: 299-307.[18] Gallinat A. An impedance-controlled system for endometrial ablation: five-year follow-up of 107 patients. J Reprod Med. 2007;52: 467-72.[19] Laberge P, Leyland N, Murji A et al. Endometrial ablation in the management of abnormal uterine bleeding. J Obstet Gynaecol Can. 2015;37: 362-79.[20] Xie H, Wan Y, Yi S et al. Clinical analysis of 2152 cases of abnormal uterine bleeding treated by NovaSure endometrial ablation. Int J Gynaecol Obstet. 2022;158: 301-7.[21] Bergeron C, Laberge PY, Boutin A et al. Endometrial ablation or resection versus levonorgestrel intra-uterine system for the treatment of women with heavy menstrual bleeding and a normal uterine cavity: a systematic review with meta-analysis. Hum Reprod Update. 2020;26: 302-11.[22] Marret H, Fauconnier A, Chabbert-Buffet N et al. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol. 2010;152: 133-7.[23] Fernandez H, Toth D, Descamps P et al. Post procedural pregnancy occurrence risk after endometrial ablation. J Gynecol Obstet Hum Reprod. 2022;51: 102259. doi: 10.1016/j.jogoh.2021.102259. [Epub 29.10.2021][24] Organization. WH. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations [Online document]. Geneva: World Health Organization; 2024 zitiert am [18.05.2025]. Verfügbar unter: https://www.who.int/publications/i/item/9789240088542[25] Baskett TF, Clough H, Scott TA. NovaSure bipolar radiofrequency endometrial ablation: report of 200 cases. J Obstet Gynaecol Can. 2005;27: 473-6.[26] Unger HW, Megaly E, Dick A et al. Women’s satisfaction and symptoms following NovaSure endometrial ablation: a postal questionnaire survey in Lothian, Scotland. J Obstet Gynaecol. 2014;34: 350-1.[27] Alvarez López C, González Paredes A, Martínez Morales S et al. Retrospective study on the outcomes and satisfaction with endometrial ablation by bipolar energy (NovaSure. Arch Gynecol Obstet. 2025;311: 385-93.[28] Gallinat A. NovaSure impedance controlled system for endometrial ablation: three-year follow-up on 107 patients. Am J Obstet Gynecol. 2004;191: 1585-9.[29] Kroft J, Liu G. First- versus second-generation endometrial ablation devices for treatment of menorrhagia: a systematic review, meta-analysis and appraisal of economic evaluations. J Obstet Gynaecol Can. 2013;35: 1010-9.[30] Scordalakes C, delRosario R, Shimer A, Stankiewicz R. Efficacy and patient satisfaction after NovaSure and Minerva endometrial ablation for treating abnormal uterine bleeding: a retrospective comparative study. Int J Womens Health. 2018;10: 137-45.[31] Xiaoli S, Chunmei Z, Hongbo W, al e. Clinical study of NovaSure system endometrial ablation for menorrhagia: a report of 349 cases. In: 2016 CJMIS, 16(10):875‐878+883., eds.[32] Li‐ying W, Ren‐feng Z, Xue LI, al. e. Clinical analysis of Novasure system in 151 cases with menorrhagia. In: 2016 CJCOG, 17(02):132‐135., eds. 2016.[33] Lybol C, van der Coelen S, Hamelink A et al. Predictors of Long-Term NovaSure Endometrial Ablation Failure. J Minim Invasive Gynecol. 2018;25: 1255-9.[34] Eisele L, Köchli L, Städele P et al. Predictors of a Successful Bipolar Radiofrequency Endometrial Ablation. Geburtshilfe Frauenheilkd. 2019;79: 286-92.[35] Emslie E, Mui J, Sullivan MB et al. Evaluation of Radiofrequency Endometrial Ablation: A 17-year Canadian Experience. J Minim Invasive Gynecol. 2023;30: 905-11.[36] Shazly SA, Famuyide AO, El-Nashar SA et al. Intraoperative Predictors of Long-term Outcomes After Radiofrequency Endometrial Ablation. J Minim Invasive Gynecol. 2016;23: 582-9. Supplementary Material File (tables.docx) Download 20.49 KB Information & Authors Information Version history V1 Version 1 06 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords general gynaecology gynaecological surgery: endometrial ablation gynaecology: outpatient procedures qualitative research Authors Affiliations Laura Strobel Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Nina Gleirscher Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Felix Hofbauer Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Miriam Emmelheinz Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Christian Marth Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Andreas Widschwendter [email protected] Landeskrankenhaus Innsbruck Universitatsklinik fur Gynakologie und Geburtshilfe View all articles by this author Metrics & Citations Metrics Article Usage 469 views 190 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Laura Strobel, Nina Gleirscher, Felix Hofbauer, et al. 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