Microwave endometrial ablation for menorrhagia: outcome at 2 years--experience of a district general hospital

Abstract

One hundred and twenty-three women underwent microwave endometrial ablation (MEA) for the treatment of dysfunctional uterine bleeding (DUB). The mean age at treatment was 40.2 years and the average treatment time was 2 minutes 50 seconds. All patients stayed as day cases, except for two who stayed overnight, one due to pain and the other due to urinary retention. The follow-up was carried out at 6 months, 1 and 2 years, respectively. The success rate was 80%, 76% and 70% at 6 months and 1-year and 2-year follow-up. The patient satisfaction rate was 80%, 75% and 68% at 6 months, 1 year and 2 years, respectively. However, in women 45 years old and over the success rate was more than 90%, suggesting that MEA could be a preferred procedure for treatment of DUB in this age group compared to younger women, especially in those who do not benefit from the mirena intrauterine system or decline it. Approximately 70% of patients, who underwent hysterectomy due to the failure of treatment, had uterine/pelvic pathology in the form of adenomyosis, fibroid uterus or endometriosis; therefore prior to MEA, proper patient selection is vital. There were a few minor complications but no uterine perforation or emergency hysterectomies in the group studied.

Adenomyosis: Still largely under-diagnosed

“…She would return in several months or years time because of treatment failure. Such women ultimately would have a hysterectomy after prolonged periods of dissatisfaction (Sharma et al 2004;Kuzel et al 1999;McCausland and McCausland 1998). Timely confident diagnosis of adenomyosis can avoid unnecessary interventions and procrastination.…”

“…Clinical diagnosis of adenomyosis is important for patient counselling as regards provision of management options. For example, endometrial ablation is not very effective in the management of menorrhagia secondary to deep-seated adenomyosis (Reinhold et al 1999;Sharma et al 2004;Kuzel et al 1999). …”

Pelvic pain following microwave endometrial ablation—is hysteroscopic adhesiolysis worthwhile?

“…This is supported by the fact that for five patients with pain pre-MEA who were not cured by hysteroscopic adhesiolysis, pathological study revealed two had endometriosis and three had adenomyosis, for which hysteroscopic adhesiolysis would not be the treatment of choice. Other similar studies confirm that the majority of patients undergoing hysterectomy, for continued bleeding or pain, following endometrial ablation have other pathology present such as adenomyosis or endometriosis [2,11].…”

“…It has been granted National Institute of Clinical Excellence approval and has been shown to be effective in 70-80% of women [1]. The overall risk of complications associated with MEA is small [1,2], although long term data on complications and success rates is lacking. One complication that has been associated with first generation endometrial ablative techniques is postoperative pelvic pain.…”

Impact of microwave endometrial ablation in the management of subsequent unplanned pregnancy

“…4 The incidence of pregnancy after ablative techniques is as low as 0.7%. 2 In 2006, 74 pregnancies were reported after endometrial ablative methods.…”