This article was adapted from "Building Interventional Gynecology," which appeared in START-UP, June 2010.

Once a sluggish category for clinical innovation, gynecology is drawing new venture-backed companies eager to build upon the lead created by first-generation companies operating in minimally-invasive endometrial ablation and female sterilization. First generation companies had the difficult task of creating paths to early adopters of minimally invasive procedures. These now exist, and the clinical specialty appears to be also evolving in ways that encourage the growth of in-office procedures.

Using an aggressive clinical trials strategy to overcome early setbacks, Novacept is proof a small company can succeed in a big company market, and that a patient exit strategy can pay off for device companies--evidenced by Cytyc's $325 million cash acquisition of Novacept.

Impres Medical Inc. aims to offer women an office-based non-surgical solution for menorrhagia. The start-up has developed an implantable device that replicates Asherman's syndrome, a disorder that forces a buildup of fibrous tissue in the uterus that replaces the endometrium and eventually deactivates the menstrual cycle.