title: Effect of undiagnosed deep adenomyosis after failed NovaSure endometrial ablation.
abstract: OBJECTIVE
  To determine the prevalence of adenomyosis and deep adenomyosis after NovaSure (Hologic Inc., Newark, DE) endometrial ablation in hysterectomy specimens after NovaSure endometrial ablation failure.
  
  
  METHODS
  Prospective observational study (Canadian Task Force classification II-2).
  
  
  METHODS
  The TweeSteden Hospital, a teaching hospital in the south of the Netherlands.
  
  
  METHODS
  All women who underwent hysterectomy for menorrhagia and/or dysmenorrhea after failure of NovaSure endometrial ablation between November 2007 and January 2011.
  
  
  METHODS
  All patients who underwent hysterectomy between January 2005 and April 2009 for the same indication but did not undergo prior endometrial ablation from choice or the lack of availability of the endometrial ablation procedure.
  
  
  RESULTS
  Of 213 patients who underwent NovaSure therapy, 22 (10.3%) underwent a hysterectomy because NovaSure failed. Of these, 10 (45.5%) exhibited adenomyosis in their hysterectomy specimens. The control group patients had a similar adenomyosis prevalence (74/173, 42.8%). However, the NovaSure failure group had a significantly higher prevalence of deep adenomyosis (>2.5 mm endometrial penetration) (9/22, 40.9%) than the control group (37/173, 21.4%, p < .05).
  
  
  CONCLUSIONS
  Deep adenomyosis after failed NovaSure endometrial ablation was present in a significant number of patients. It is not clear whether adenomyosis is induced by endometrial ablation or whether it causes endometrial ablation failure.
authors.affiliation: Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: BiancaMengerink@radboudumc.nl.
authors.forename: Bianca B
authors.initials: BB
authors.lastname: Mengerink
authors.affiliation: Department of Pathology, St Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Anneke A M
authors.initials: AA
authors.lastname: van der Wurff
authors.affiliation: Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Johanne F
authors.initials: JF
authors.lastname: ter Haar
authors.affiliation: Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Ilse A
authors.initials: IA
authors.lastname: van Rooij
authors.affiliation: Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Johanna M A
authors.initials: JM
authors.lastname: Pijnenborg
mesh_terms: D062788:Adenomyosis / Q000209:etiology; D000328:Adult; D004412:Dysmenorrhea / Q000601:surgery*; D055356:Endometrial Ablation Techniques / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D017211:Treatment Failure
keywords: Adenomyosis; Deep adenomyosis; Endometrial ablation; Hysterectomy; NovaSure