Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13200
Peer-review started: August 3, 2022
First decision: October 12, 2022
Revised: October 29, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life. This condition can restrict women’s social activities and decrease their quality of life. Microwave endometrial ablation (MEA) using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment, triggered by systemic disease or medications, or caused by uterine myomas and fibrosis. The popularity of MEA has increased worldwide. Although MEA can safely and effectively treat submucous myomas, some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment.
Although MEA can safely and effectively treat submucous myomas, some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment. This study evaluated whether a combination of MEA and transcervical resection (TCR) was effective in treating submucous uterine myomas by reducing the size of uterine myomas in patients with hypermenorrhea, thereby decreasing the possibility of recurrence and additional treatment.
To investigate the efficacy of MEA combined with TCR.
Participants underwent cervical and endometrial evaluations. Magnetic resonance imaging and hysteroscopy were performed to evaluate the size and location of the myomas. TCR was performed before MEA using a hystero-resectoscope. MEA was performed using transabdominal ultrasound. The variables included operation time, number of ablation cycles, length of hospital stay, and visual analog scale cores for hypermenorrhea, dysmenorrhea, and treatment satisfaction at 3 and 6 mo postoperatively. The postoperative incidence of amenorrhea, changes in hemoglobin concentrations, and MEA-related complications were evaluated.
A total of 34 women underwent a combination of MEA and TCR during the study period. Two patients were excluded from the study as their histopathological tests identified uterine malignancies (uterine sarcoma and endometrial cancer). The 32 eligible women (6 nulliparous, 26 multiparous) had a mean age of 45.2 ± 4.3 years (range: 36–52 years). Patients reported very severe hypermenorrhea (10/10 points on the visual analog scale) before the procedure. However, after the procedure, the hypermenorrhea scores decreased to 1.2 ± 1.3 and 0.9 ± 1.3 at 3 and 6 mo, respectively (P < 0.001). The mean follow-up duration was 33.8 ± 16.8 mo. Although 10 women (31.3%) developed amenorrhea during this period, none experienced a recurrence of hypermenorrhea. No surgical complications were observed.
Reducing the size of uterine myomas by combining MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas.
MEA may be ineffective in menorrhagia with uterine myomas. Combining TCR and endometrial ablation can help reduce the tumor volume, and cauterization can ensure the effectiveness of this procedure. This can facilitate the pathological evaluation of the excised specimen. The therapeutic effect of this method is considered to be a reduction in the number of uterine myomas. Furthermore, patient satisfaction with this surgical procedure is high.