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Objective To describe the introduction of microwave endometrial ablation to clinical practice, and to Design A clinical trial using prototype microwave endometrial ablation equipment.Setting District general hospital.Population Forty-three women with completed families and with failed medical management for menorrhagia were treated with microwave endometrial ablation between October 1994 and April 1995.Main outcome measures A statement of perceived menstrual loss and satisfaction supported by a menstrual symptom questionnaire score. Dysmenorrhoea was graded as a measure of described severity. Treatment time.Results Forty-three women had a total of 46 treatments. Mean treatment time: n = 43, was 141 seconds (50-310). Amenorrhoea: n = 16; 37.2%. Very light periods/discharge: n = 11; 25.6%. Improved periods and woman satisfied: n = 9; 20.9%. Improved periods and woman not satisfied: n = l; 2.3%. Overall satisfaction at three years is 83.7%. Moderate (55.8%) or severe (27.9%) dysmenorrhoea preoperatively had improved to 11.6% and 6.8% respectively at three years. Three re-treatments and four hysterectomies will be discussed. ConclusionsMicrowave endometrial ablation is a new treatment for dysfunctional uterine bleeding using the application of microwave energy to the endometrium. This results in a rapid but restricted depth of intrauterine heating avoiding hysteroscopic fluid, operative haemorrhage and earthing risks. The technique is simple to learn and perform. Women report a high level of satisfaction three years after microwave endometrial ablation.report the outcomes three years after endometrial ablation.

The objective was to assess the feasibility, acceptability, efficacy and safety of outpatient microwave endometrial ablation (MEA) under local anaesthesia in the treatment of therapy-resistant menorrhagia. This was carried out as a prospective observational study with a follow-up postal questionnaire at the Royal United Hospital Bath, NHS Trust, Bath, UK. For the study, 117 selected women fulfilled the selection criteria with a mean age of 42.4 years (range 29-53 years), referred because of uncontrolled menorrhagia. They were recruited between April 2000 and March 2003. Preoperative evaluation included history taking, physical examination and ultrasound scanning. Follow-up was by specially designed home postal questionnaire, which was mailed to all women 3 to 6 months after surgery. The acceptability of MEA under local anaesthesia, efficacy in changing the menstrual pattern and operative and postoperative complications were measured. For a total of 117 women, 116 procedures were successfully performed under local anaesthesia. One procedure was abandoned. There were no intraoperative or postoperative complications. The procedure was well tolerated. The menstrual satisfaction rate was 89.5%. The percentage of women reporting amenorrhoea was 41.2%. All other measures of pain were improved. Five women requested a repeat MEA, and 12 women underwent hysterectomy following MEA. In conclusion, MEA is a feasible, safe, easy and effective outpatient method of endometrial ablation in women suffering from therapy-resistant menorrhagia. Outpatient MEA is accepted and tolerated by patients. It has a place in current modern practice in treating menorrhagia.

References1 Milad MP, Sokol E. Laparoscopic morcellator-related injuries. J. Am. Assoc Gynecol. Laparosc 2003; 10: 383 -385. 2 Steiner RA, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol. 1993; 81: 471-474.Figure 1 Magnetic resonance imaging (MRI) brain showing hyperresonant area in the region of the pituitary (see arrows), in low and high power (a-b). MRI showing atrophy of the pituitary gland 3 months postpartum (c).

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