The effectiveness of microwave endometrial ablation combined with hysteroscopic transcervical resection in treating submucous uterine myomas: A retrospective study

Background Submucous uterine myomas can be effectively and safely treated using microwave endometrial ablation (MEA). However, recurrence is common and requires additional treatment. This study investigated the efficacy of MEA combined with transcervical resection (TCR). Methods This retrospective study included 32 women who underwent MEA in addition to TCR for submucous uterine myomas at the International University of Medicine and Welfare Hospital between January 2016 and June 2020. All patients were followed up for ≥ 6 months after the procedure. Results The 32 women had a mean age of 45.2 ± 4.3 years. The myomas had a mean major diameter of 26.3 ± 12.3 mm and a protrusion degree of 51.3 ± 11.3%. The patients reported very severe hypermenorrhea/dysmenorrhea (10/10 points on the visual analogue scale) before the procedure. After the procedure, the hypermenorrhea scores decreased to 1.2 ± 1.3 and 0.9 ± 1.3 after 3 and 6 months, respectively (both p < 0.001). The dysmenorrhea scores also decreased to 1.3 ± 1.8 and 1.3 ± 1.8 after 3 and 6 months, respectively (both p < 0.001). Circulating hemoglobin concentrations improved significantly from 8.7 ± 1.9 g/dL to 13.5 ± 1.1 g/dL (p < 0.001). The mean follow-up duration was 33.8 ± 16.8 months and 10 women (31.3%) developed amenorrhea during this period, although none experienced recurrence of hypermenorrhea. No surgical complications were observed. The patients reported being highly satisfied with the ability of the combined treatment to relieve hypermenorrhea (mean visual analogue scale score: 9.5 ± 0.8). Conclusion Reducing the size of uterine fibroids via a combination of MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas. Furthermore, the procedure’s effectiveness is complemented by the patients’ high satisfaction level.

A Patient With Organic Hypermenorrhea Who Developed Massive Genital Hemorrhage During Treatment Of Acute-Phase Cerebral Infarction And Responded To Microwave Endometrial Ablation

Microwave endometrial ablation (MEA) has been attracting attention as a low-invasive treatment alternative to conventional total hysterectomy for systemic disease-induced hypermenorrhea, such as functional hypermenorrhea and blood coagulation abnormality, and organic disease-induced hypermenorrhea such as myoma of the uterus and adenomyosis. We report a patient with hypermenorrhea causing massive genital hemorrhage during anticoagulant therapy who demonstrated a complete response to MEA. The patient was 41 years old, gravida 3 para 1. Aphasia and articulation disorder developed during work and she visited the emergency department. Cerebral infarction was noted on head MRI and anticoagulant therapy was initiated. Hypermenorrhea had been observed from approximately 4 years prior, but she had not visited a gynecology department. As massive genital hemorrhage and progression of anemia (Hb: 4.6 g/dL) were observed during the menstrual period, she was referred to our department. Multiple myomas of the uterus were observed on ultrasonography and pelvic MRI, and the patient was diagnosed with organic hypermenorrhea. As there was acute-phase cerebral infarction, MEA was performed as treatment for hypermenorrhea. The postoperative course was smooth and menstruation resumed on postoperative day 21. On subjective evaluation using the visual analogue scale (VAS), both hypermenorrhea and dysmenorrhea markedly improved from 10 to 1. The course was smooth without complications and the postoperative course was also favorable. MEA is a low-invasive treatment method safely applicable within a short time, and it may be an effective hypermenorrhea treatment method during oral anticoagulant administration or for those with perioperative risk due to complications.