Finally free after a decade of discomfort and pain, Beth Fretz said she is glad the days of being miserable for three weeks each month are over.
"It was during the last 10 years that I was having problems," said Fretz, a mother of two young boys from Stafford.
Fretz was one of countless women who suffer from menorrhagia, a condition in which a woman's menstrual periods are heavier and last longer than usual, causing her painful cramping and making her easily irritable for the majority of the time.
"I had tried to take oral contraceptives to help ease the cramping, but it made my face blotchy and only relieved the pain a little," she said. "I just assumed this was how my life was going to be."
During a routine yearly checkup with her family doctor, Michael Ross of McLean, he asked her if she had been informed about a simple, 90-second procedure that could possibly eliminate her menstrual cycle altogether.
"I told him to put me on the list," she said. "I had to try it."
The procedure, called NovaSure, is essentially the cauterization of the uterine lining by the release of an electrical charge from inside the uterus.
"Typically, this is a problem that occurs in women who are 40 years of age or older," said Dr. Michael Ross. "In most cases, the woman does not have any fibroids or abnormalities in her uterus, she just bleeds in a way that she finds uncomfortable. There is no known cause of it," he said.
"Menorrhagia is actually a common problem," Ross said. "There are a lot of theories as to what causes it. It might be a result of the inconsistent function of the ovaries, we're not sure. The women who suffer from it are not always menopausal. Something's just not working right."
THE ONLY TREATMENT for menorrhagia used to be a hysterectomy, he said, involving the complete removal of the uterus and forcing the patient to spend as much as six weeks recovering.
"The benefit of NovaSure is that it uses radio frequency energy to cauterize the lining of the uterus, so it's an outpatient procedure with quick recovery and relatively few complications," Ross said. "Most women who have the procedure say that they're happy a year later, and half of them say they have no bleeding at all."
In patients who do not have any fibroids or any polyps, the success rate for the procedure is at about 80 to 85 percent, he said.
No hormone treatment or therapy is needed prior to the procedure, Ross said, and unlike a hysterectomy, none is needed after either.
"We will bring the woman in for an ultrasound about a week before the procedure to make sure there's nothing abnormal in her uterus causing the bleeding," he said.
A biopsy is performed and the size of the uterus is measured in order to set the scope of the NovaSure tool to the right size for the procedure "to make sure it goes safely," he said.
When the patient returns for the procedure, "the machine is inserted and spreads out like a mesh net inside the uterus," Ross said. "The machine automatically calibrates itself on how long it will take to cauterize the lining of the uterus and shuts off automatically when it has been completed, which can take between one and two minutes," he said.
The patient spends a total of 20 to 40 minutes in the doctor's office, Ross said, and is then released home to rest for a day.
"With most patients, there is no further pain other than some mild cramping, and most women are back to work the next day if they want," he said.
Fretz, an aerobics teacher who spends a lot of time at the gym, was back teaching classes the next day.
"I had the procedure on December 3 and probably would have been OK to go to the gym that night," she said. "I was given a prescription for a pain killer that I didn't even need to get filled. The next day I was a little tired but I took one class and taught another."
The procedure is relatively new, coming onto the market in some form in the 1980s, Ross said. "It used to be done with electrocurrents, but then we started using lasers. The problem with using the electrocurrent is that it was a skill-intense procedure and doctors didn't do it enough to have the right amount of practice," he said.
As science and technology have evolved, the procedure has become faster, easier and more accurate, he said.
There are similar procedures that produce the same results as NovaSure, he said, to complete the uterine ablation, another term for the procedure.
A balloon filled with hot water can be used to burn off the lining, but if the balloon is not the right size it will not be as effective, he said. "There are other techniques that freeze the lining, but the tool for that procedure was bulky and very uncomfortable for the patient. There's also hydrablation, which circulates hot water into the uterine cavity. If there's any punctures in the uterus, that hot water goes into it," he said.
"The best thing with NovaSure is that it doesn't take a lot of time out of your life," Dr. Ross said. "It doesn't affect ovarian function. It doesn't prohibit life from continuing if by some chance it doesn't work."
Of course, there are possible risks and side effects. The procedure might not work. The uterus might be perforated, Ross said, in which case "the patient would have to spend a day in the hospital to make sure the uterus is not bleeding out. There's always the risk of extra bleeding or infection," he said.
HOWEVER, DESPITE THE RISKS, the procedure has been able to help the vast majority of patients who have it, he said.
"The key is to prepare the patient and talk to people to understand their goals," he said. "If the patient has painful periods and lots of cramping, she might not be the best case because this will not alleviate the pain. If the patient has large fibroids, the pressure will still be there," he said.
The procedure, which could cost up to $1,500, is usually covered by health insurance, Ross said.
"This is not a procedure done for sterilization, although women who have it done cannot have more children," he said. "If a woman does get pregnant after this procedure, she could have some serious complications."
NovaSure is becoming a fairly common procedure, with Dr. Ross performing between one and five each month, he said.
"Condoleeza Rice had this done a little while ago," he said. "Patients are happy with the speed at which it's done. They're happy with the lack of hindrance, they're happy with the results."
For Young Lee, the best part about her job as product representative for Cytyc, the company that makes NovaSure, is hearing from patients whose lives have been improved after having the procedure.
"This procedure is so much less invasive than a hysterectomy," Lee said. "Most women in the past have either had that or taken oral contraceptives, but that just doesn't work for everyone."
Up to 74 percent of women who have the NovaSure procedure see their menstrual periods stop altogether, she said.
"The biggest benefit of this procedure is that it's safe, quick and painless," she said. "At Inova today, five procedures were completed, so the doctors can do them back to back. It's a quick recovery for the patient as well."
Lee said the procedure is available at all of the Inova branches in Fairfax County and "most gynecologists know it's available."
The subject of reproductive health is still something of a taboo for women to discuss, she said, which is why so many women didn't talk about their heavy bleeding in the past.
"It's embarrassing for women to have this problem, but it's a common thing," Lee said. "It truly affects their entire lifestyle and mood. It's great to know that there's this product out there that can give these women their lives back."