Preparing Your Patient for Treatment With Cerene Cryotherapy

Promoting positive outcomes for medical treatment requires clear communication between the patient and doctor. This is especially true for surgical procedures, as patients may need additional information and resources to feel ready for their procedures. If your patient is preparing for endometrial cryoablation with the Cerene® Cryotherapy Device, follow this step-by-step guide to set the right expectations for a positive treatment experience.

Setting Your Patient Up for Success: Key Points to Cover

To help prepare your patient as well as possible for her procedure, discuss each key point in-depth to ensure she has a thorough understanding of what to expect before, during, and after her treatment with Cerene.

• Why endometrial ablation with Cerene is the right treatment option for her. The right candidate will have already attempted medical therapy and either saw little to no improvement,  struggled to tolerate the side effects of hormonal medication, or in specific patient populations, medical therapy was contraindicated due to comorbities. Another good candidate is a patient who has completed childbearing and shows no signs of a major uterine abnormality that could interfere with the cryotherapy. 

• What Cerene does and does not aim to achieve. Setting the right expectations is essential to promoting treatment satisfaction. Cerene is designed to reduce heavy bleeding and severe cramping associated with menorrhagia. Emphasize that amenorrhea is not the goal — that can only be guaranteed with a hysterectomy. The patient should expect a normalization of her period with a corresponding improvement in quality of life.

• What to do on the morning of the procedure. Instruct the patient to dress in comfortable clothes and eat a normal meal on the day of treatment. If treatment will take place in your office, the patient may or may not need someone to drive her home, depending on her pain management protocol. Discuss any preliminary anxiolytic medications to reduce anxiety before treatment.

• What to expect during the procedure. The patient should take any pre-procedure medication at the correct time before her treatment. Explain the preparation process, including dilating the cervix, measuring the length of the uterine cavity, and potentially administering a paracervical block. Next, explain that the Cerene device will be gently inserted into the uterus, the cavity-conforming liner will deploy, and the device will complete final safety checks. Treatment begins when you press a button to fill the liner with the cooling agent, nitrous oxide, to deliver the cryotherapy for 2.5 minutes. Once complete, the liner will deflate and you will remove the device. She should expect the whole procedure, from Cerene device insertion to removal, to last approximately 7 minutes.

• What type of pain management will be used. Cerene’s cryotherapy provides a natural analgesic effect during treatment, allowing patients to opt out of general anesthesia or IV sedation for a more efficient procedure and less time in the procedure room. Discuss other pain management methods that may be used, including paracervical block, NSAIDs, or prescription pain medications.

• What level of discomfort is to be expected. Emphasize that Cerene is generally a well-tolerated treatment that may cause some discomfort in the form of menstrual-like cramping when the device is first inserted into the uterus. Share real patient results, including that 92% of patients report their pain at or below the acceptable median pain score during treatment, with the median pain score remaining at 2 out of 10.

• What happens immediately after the procedure. If the patient has an office-based procedure, she can leave within a matter of minutes, as long as she is stable. For surgery centers or hospital-based procedures involving general anesthesia or IV sedation, she will need to stay longer. Explain that most patients feel ready to return to normal activities within 24 hours and that she should expect to see watery or bloody vaginal discharge for the 2 to 4 weeks after the treatment.

• What clinical outcomes and improvements she should expect. Within 3 to 6 months, she should start to see improvement in her heavy menstrual bleeding (HMB) symptoms. Cerene is clinically proven to reduce bleeding (90% of patients reported normal, light, or no periods^†) and dysmenorrhea (in 86% of patients^‡). 90% report little to no limitations in their activities^†, allowing patients to increase their productivity at work and school, and participate more with family, friends, and hobbies. There have been no reported cases of PATSS and 91% of patients had full visualization of the uterine cavity, which is helpful should she need later pathologic evaluation for abnormal uterine bleeding.^1,2 As a result, Cerene’s ability to promote both short- and long-term clinical outcomes achieves a 3% hysterectomy rate for patients with continued heavy menstrual bleeding.

• What side effects are abnormal and should be shared with you. Endometrial cryoablation side effects can vary for everyone, but certain symptoms and signs (especially those associated with infection) should not be ignored, including severe abdominal or pelvic pain, extremely heavy bleeding that lasts for several days, foul-smelling discharge, fever, chills, or other symptoms that are concerning or alarming to the patient.

Learn more about how Cerene can help your patients find relief with safe, well-tolerated, effective endometrial cryoablation at https://cerene.com/healthcare-professionals/. 

† Patient-reported data are 1 year after treatment with durable results at 3 years

‡  Improvement reported one year after treatment for patients reporting severe/very severe period pain

††† Patient-reported data include definitely and consider recommending Cerene and are 1 year after treatment with durable results at 3 years.

Key Takeaways:

• OBGYNs play a central role in helping their patients prepare for surgical treatment for HMB, providing necessary information and insights to set the right expectations for a positive treatment experience.
• Helping a patient best prepare for the Cerene treatment involves an in-depth discussion of what to do before treatment and what to expect before, during, and after the procedure, including normal and abnormal experiences and side effects.
• Patients should understand what Cerene does and does not aim to do with cryotherapy, especially in terms of achieving eumenorrhea — not amenorrhea — and what long-term outcomes Cerene is designed to achieve.

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Sources

1. Curlin, H., Cholkeri-Singh, A., Leal, J. G. G., & Anderson, T. (2022). Hysteroscopic Access and Uterine Cavity Evaluation 12 Months after Endometrial Ablation with the Cerene Cryotherapy Device. Journal of Minimally Invasive Gynecology 29(3), 440-447.
2. Curlin, H.L., Cintron, L.C., Anderson, T.L. (2021). A Prospective, Multicenter, Clinical Trial Evaluating the Safety and Effectiveness of the Cerene Device to Treat Heavy Menstrual Bleeding. Journal of Minimally Invasive Gynecology 28(4), 899-908.