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MEA (microwave endometrial ablation) is a treatment that can control hypermenorrhea. With the increase in the number of caesarean sections and myomectomies, an increasing number of patients with MEA have undergone previous incision of the uterine myometrium. Uterine perforation is major complication. Here we compared the incidence of complications and recurrence between groups with or without previous uterine surgery. 35 patients who underwent MEA were enrolled in the study. We assessed the thickness of uterine myometrium by MRI and transvaginal ultrasonography (TV-US). 12 patients (34%) had previous uterine surgery; Among 12 patients with previous uterine surgery, 6 (50%) showed thinning of the myometrium. No patient showed any complications. There was no difference in recurrence rate between two groups (1/12 = 8% and 2/23 = 8%, respectively). MEA can be performed safely and effectively even for patients with previous uterine surgery. What is already known on this subject? MEA (microwave endometrial ablation) is a treatment that can control hypermenorrhea.A few serious complications have been reported, including uterine perforation and intestinal injury. There have been no collective reports on women with a history of uterine surgery, and the decision to perform MEA and the detailed procedures have not been clarified. What do the results of this study add? No patient who received MEA showed any complication regardless of previous uterine surgery. There was no difference in recurrence rate of hypermenorrhea between groups with and without previous uterine surgery. MEA could be performed safely and effectively in patients with previous uterine surgery preoperative imaging and intraoperative ultrasounds What are the implications of these findings for clinical practice and/or further research? Curently, with the increase in the number of caesarean sections and myomectomies, the increasing number of patients with MEA have undergone previous incision of the uterine myometrium and this causes thinning of the myometrium. MEA can be safely performed without losing any therapeutic effect, even in patients with a history of uterine surgery, by using MRI and TV-US as preoperative evaluations. [ABSTRACT FROM AUTHOR]

Purpose: Vascular-rich myomas are resistant to treatment involving transcervical microwave myolysis. To overcome cooling by blood perfusion, we injected dilute vasopressin solution into the space between the myometrium and the surface of the vascular-rich myomas. Material and Methods: Seven outpatients [age (mean ± SD age), 44.9 ± 3.9 years] with a single symptomatic vascular-rich submucosal myoma measuring 4.2–9.2 cm (6.5 ± 2.5 cm) underwent transcervical microwave myolysis and microwave endometrial ablation. Before microwave irradiation, dilute vasopressin solution was injected into the space between the myometrium and the surface of the vascular-rich myoma. We assessed the changes in the volumes of the vascular-rich myomas and blood hemoglobin levels before and 3 and 6 months after treatment. In addition, improvements in menorrhagia and satisfaction after the operation were assessed using visual analog scales. Results: Submyometrial injection of dilute vasopressin effectively reduced the abundant blood flow. The vascular-rich myomas were necrotized and shrank significantly by 69.0% at 3 months and 72.4% at 6 months after the operation (p

Aim: We investigated the effects of uterine cavity lavage using hypochlorous acid water (HClO) on preventing postoperative intrauterine infection after microwave endometrial ablation (MEA). Methods: Four hundred and eleven consecutive patients were enrolled in this study. The patients were divided into two groups: 214 cases in 2014–2016 with disinfection using povidone‐iodine antiseptic solution alone (group A) and 197 cases in 2017–2019 with additional intrauterine douche using HClO (group B). HClO was used at a concentration of 200 ppm of residual chlorine. One gram of Ceftriaxone Sodium Hydrate was administered by drip infusion during MEA in both groups. Oral antibiotics were administered after MEA only in group A but not in group B. Results: Mean patient age (mean ± SD; years old) was 44.5 ± 4.6 in group A and 44.8 ± 5.4 in group B, and mean operation time (min) was 30.4 ± 19.1 in group A and 34.4 ± 22.6 in group B, respectively. Neither were significantly different between groups. The combined ablation techniques i.e. transcervical microwave myolysis and transcervical microwave adenomyolysis did not increase frequency of infection. Postoperative intrauterine infection cases in group B (8 cases) were significantly lower than those in group A (28 cases) (Chi‐square test, P = 0.001). Hysterectomy was performed in three severe intrauterine infection cases in group A, but no cases of severe intrauterine infection was found in group B. No adverse effect of HClO was seen. Conclusion: Intrauterine douche using HClO decreases postoperative intrauterine infection after MEA. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Menorrhagia and dysmenorrhea are common symptoms. Uterine adenomyosis is one of the causes of menorrhagia and dysmenorrhea. These symptoms often decrease the quality of life in women. Microwave endometrial ablation (MEA) is a recently developed procedure that enables endometrial ablation. Dienogest has long been used to suppress endometrium development and reduce adenomyosis‐related dysmenorrhea. However, some cases could be resistant to dienogest. In this study, we evaluated the efficacy of a combination of MEA and postoperative dienogest in reducing adenomyosis‐related dysmenorrhea and menorrhagia. Methods: Ten patients with hormone treatment‐resistant symptomatic adenomyosis underwent MEA and were administered oral dienogest after the procedure. The primary endpoints were reduction in pain recurrence and anemia. The secondary endpoint was a change in the adenomyosis lesion and its symptomatic recurrence. Results: Statistically significant improvements were seen in the visual analog scale score and hemoglobin levels in women post‐treatment. The difference in myometrial thickness pre‐ and post‐MEA was statistically significant. There were no cases of symptomatic recurrence. Conclusion: The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea. [ABSTRACT FROM AUTHOR]

This study aimed to describe the long‑term outcomes of patients with menorrhagia treated with microwave endometrial ablation (frequency, 2.45 GHz), as well as to identify factors associated with recurrence or re‑surgery. This retrospective cohort study was conducted from 2007 to 2015 at Shimane University Hospital in Japan. Patients with severe menorrhagia and a desire to preserve their uterus were included in the study. Clinical factors associated with recurrence of menorrhagia or re‑surgery were analyzed with a multivariable logistic regression model. Of 160 microwave endometrial ablation candidates, 100 had uterine myomas, 20 adenomyosis, 26 functional excessive menstruation, and 12 endometrial polyps. In the full cohort, age (<40) and uterine cavity length (≥10) were associated with recurrence of menorrhagia and re‑surgery. Among patients with myomas, age (<48) and number of myomas (≥4) were associated with recurrence, and largest myoma size (≥5) and preoperative hemoglobin level (<9 mg/dl) were associated with re‑surgery. Among subjects with adenomyosis, uterine cavity length (≥10) was associated with recurrence. Microwave endometrial ablation is thought to be a highly efficacious method to control menorrhagia caused by functional bleeding and endometrial polyps. However, microwave endometrial ablation may be less effective for patients younger than 48 years with myomas, especially those with 4 or more myomas, or with a myoma 5 cm or larger in size, and for patients with adenomyosis who have a thickened myometrium. These clinical factors may be useful predictors of success in selecting candidates for microwave endometrial ablation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of a microwave endometrial ablation (MEA) procedure to treat patients with menorrhagia after endometrial curettage but without medical pretreatment. Materials and Methods: From February to September 2001, 19 eligible and consenting premenopausal women with menorrhagia underwent endometrial curettage, immediately followed by MEA. No medical pretreatment with gonadotropin-releasing hormone (GnRH) analogues or danazol was given for endometrial preparation. The severity of menorrhagia was assessed using the menstrual score. The patients were followed up for at least 3 years. Results: Of the 19 women, 17 had completed at least 3 years' follow-up. Fourteen patients (82%) were satisfied with the posttreatment menstrual status, comparable with those patients receiving medical pretreatment of other studies (78–94%). The mean menstrual score was 11.8 before treatment and 1.95, 2.25, 2.2, 2.1 and 2.1 at 3, 6, 12, 24 and 36 months posttreatment, respectively. Of the 12 patients who complained of dysmenorrhea before surgery, six (50%) showed improvement. Three patients had hysterectomy; they all had adenomyosis and dysmenorrhea which did not respond to medical analgesics. Conclusion: MEA preceded by endometrial curettage instead of hormonal pretreatment had results comparable to those of other studies in which the patients received hormones for 4–6 weeks before MEA. Endometrial curettage is an alternative to drug pretreatment.

Endometrial ablation can be described as one of the great gynecological success stories. It has changed the management of heavy menstrual bleeding dramatically. The development of newer (second generation) endometrial ablative techniques has enabled clinicians to set up comprehensive 'one stop clinics' based on an outpatient service to treat heavy menstrual bleeding effectively without the need for general anesthetic or conscious sedation. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to outpatient endometrial ablation along with discussion on risks, complications and contraindications of the procedure. [ABSTRACT FROM AUTHOR]

We evaluated the efficacy of gonadotropin-releasing hormone agonist (GnRHa) therapy for improving the myometrial thickness in women with thin (less than 1 cm) uterine walls, a contraindication for microwave endometrial ablation (MEA). The normal myometrium thickness was 0.5 cm, 0.7 cm and 0.9 cm. After the third GnRHa dose, the myometrial thickness increased to over 1 cm in all the three patients, and all were able to undergo MEA. The VAS score for menorrhagia improved in all the cases. The patient satisfaction levels were 10 in 2 of the 3 patients, and 5 in the other. There was no symptom recurrence, and no adjuvant therapy was administered. GnRHa therapy in women with submucous leiomyomata and a myometrial thickness of less than 1 cm could effectively thicken the myometrium, allowing for the use of MEA. [ABSTRACT FROM AUTHOR]

Aim Conventional microwave endometrial ablation (MEA) can be insufficient to control menorrhagia resulting from adenomyosis. We compared the standard single ablation technique with multiple MEA - repeating ablation three times in the same region - in patients with adenomyosis and menorrhagia. Material and Methods We performed single MEA in 18 patients and multiple MEA in seven patients between 2007 and 2013. We compared the efficacy of single and multiple MEA using a visual analog scale (VAS) for menorrhagia, dysmenorrhea, and patient satisfaction. We also evaluated the incidence of menorrhagia recurrence, amenorrhea, and procedure complications in relation to patients' clinical factors. Results VAS scores for improved menorrhagia and patient satisfaction were significantly higher in the multiple MEA group than in the single MEA group; however, the operative time was longer in the multiple-treatment group. There were no statistical differences between groups in hemoglobin levels, VAS improvement for dysmenorrhea, menorrhagia recurrence, frequency of complications, or amenorrhea rate. Conclusion Multiple MEA successfully controls menorrhagia from adenomyosis and achieves a higher satisfaction rate than single MEA. [ABSTRACT FROM AUTHOR]

Aim The purpose of the current study was to determine the effectiveness of microwave endometrial ablation ( MEA) in inhibiting the proliferative response of the endometrium in women with breast cancer who are treated with tamoxifen. Material and Methods In the before-after study, we treated 31 postmenopausal patients who had received adjuvant tamoxifen for 1 year or more with MEA, the endometrial changes were compared before and after MEA. Results After MEA, the thickness of the uterine lining was decreased significantly. No patient had recurrent endometrial polyps or abnormal vaginal bleeding during the follow-up period. Conclusion MEA had a protective action against the uterine effects of tamoxifen for postmenopausal patients. MEA is a safe and effective minimally invasive treatment method for breast cancer patients treated with tamoxifen. [ABSTRACT FROM AUTHOR]

Objective: To asses the effectiveness of microwave endometrial ablation (MEA) using a new curved applicator for the emergent control of uterine hemorrhage. Study design: Seven patients received emergency MEA. Three out of seven patients were treated with MEA as their primary procedure, and four out of seven patients were treated for an intraoperative hemorrhage. Results: In all three patients treated preoperatively, MEA was highly effective and successfully controlled acute uterine hemorrhage. Four out of seven patients were treated with MEA for a hemorrhage following resection of a submucosal myoma or polyp. MEA successfully controlled bleeding in all four patients, thereby preventing them from undergoing hysterectomy. Conclusion: Our results suggest that emergency MEA is a promising way to control a life-threatening uterine hemorrhage. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Sambrook A, Jack S, Cooper K. Outpatient microwave endometrial ablation: 5-year follow-up of a randomised controlled trial without endometrial preparation versus standard day surgery with endometrial preparation. BJOG 2010;117:493–496. The objective was to compare long-term outcomes following outpatient microwave endometrial ablation in the postmenstrual phase with those following day surgery microwave endometrial ablation after standard drug-based endometrial preparation. Of the women originally recruited, 154/197 (78%) returned questionnaires. The primary outcome of satisfaction was high in both groups (71% postmenses versus 65% preparation) as were the amenorrhoea rates (84% versus 87%). There was no significant difference in the hysterectomy rates between the two arms. It can be concluded that microwave endometrial ablation outcomes are not affected in the long term by undertaking the procedure in the postmenstrual phase in an outpatient setting. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To assess the appearance of the endometrial cavity after microwave endometrial ablation. Design: Prospective observational study. Setting: GuangDong Women''s and Children''s Hospital, GuangDong, China. Patients: A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33–53] years) were recruited into the study at the time of endometrial ablation. Intervention: Outpatient hysteroscopy. Main Results: Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea. Conclusion: The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance. [Copyright &y& Elsevier]

Microwave endometrial ablation (MEA) is effective for the emergency control of uterine hemorrhage. However, to the best of our knowledge, there has been only a single report of life-threatening hemorrhage induced by endometrial carcinoma that was treated with MEA. The present report evaluates the efficacy of MEA as an emergency therapeutic option for the control of bleeding due to advanced endometrial carcinoma and minimally-invasive, early-stage endometrial carcinoma in 3 patients. MEA was able to effectively control massive uterine bleeding due to endometrial carcinoma in 2 patients with advanced disease and was curative in a patient with minimally-invasive endometrial carcinoma. Given its safety, simplicity and effectiveness, MEA may be utilized for the emergency treatment of uterine bleeding in advanced endometrial carcinoma, and may be used as a curative treatment in early-stage endometrial carcinoma. [ABSTRACT FROM AUTHOR]

To audit the practice and effectiveness of second generation endometrial ablation techniques (microwave and thermal balloon ablation). An audit of microwave and balloon endometrial ablation procedures was completed and performed during a 2-year period, in two district hospitals of Calderdale and Huddersfield NHS Trust, UK. Patients were followed up with for a maximum of 1 year postoperatively, or were referred again from their GPs, with symptoms. A questionnaire was also completed to evaluate patient satisfaction. About 136 and 59 women underwent balloon and microwave endometrial ablation, respectively (Total = 195), for heavy periods. By the end of year 1, 16% of patients were amenorrhoeic and 60% had lighter periods. About 15% of women did not have any relief of symptoms and needed a hysterectomy by 3 years. There were no statistically significant differences in the endometrial ablation techniques. There was no significant effect of age, body mass index, utero-cervical length, or the ablation technique on the results or the hysterectomy rates. A satisfaction survey showed that 75% of women felt better after the procedure and would recommend it to a close friend. Second generation ablation techniques are safe and effective methods of treating dysfunctional uterine bleeding, and are easy to use. They have reduced the incidence of hysterectomies and also have financial implications for healthcare providers. [ABSTRACT FROM AUTHOR]

Aim: To explore parameters relating to shrinkage of submucosal myomas after microwave endometrial ablation. Methods: Fourteen patients underwent microwave endometrial ablation at 2.45 GHz using a curved microwave applicator to treat menorrhagia caused by a submucosal myoma. The size of myomas was measured on magnetic resonance images before, one month after, and six months after the operation. The average radius r was defined as half of the size of the myoma measured in three dimensions. The protrusion ratio α was defined as the ratio of the thickness of the protruding part of a myoma in the uterine cavity to the size of the myoma before the operation. The ratio of the directly necrotized volume by microwave irradiation to the total volume ( RODNeV) of preoperative myomas was calculated using the following formula: where d is the depth of myoma tissue directly necrotized by microwave irradiation. The relationships of preoperative α, r and RODNeV to postoperative shrinkage were then examined. Results: Two-dimensional plots showing shrinkage of submucosal myomas versus the RODNeV indicated that shrinkage at six months after microwave endometrial ablation depends on the RODNeV. Myomas with a RODNeV greater than 0.17 had shrunk more than 50% at six months after the operation. Conclusions: RODNeV is closely related to postoperative necrosis and shrinkage of the submucosal myoma after microwave endometrial ablation. Prediction of the shrinkage rate of submucous myomas appears to be possible by calculating the RODNeV preoperatively. [ABSTRACT FROM AUTHOR]

Objective To compare outcomes and further operations at a minimum of 10 years following microwave endometrial ablation (MEATM) or transcervical resection of the endometrium (TCRE). Design Follow up of a randomised controlled trial using postal questionnaires and operative databank review. Setting Gynaecology department of a large UK teaching hospital. Main outcome measures Women’s satisfaction with treatment, menstrual symptoms, changes in health-related quality of life, and additional treatments received. Results One-hundred and eighty-nine of the original 263 women returned questionnaires (72%) after a minimum of 10 years post-treatment. Those totally or generally satisfied with treatment numbered 77/129 (60%) in the microwave arm and 70/134 (52%) in the resection arm, the difference is not statistically significant. Bleeding and pain scores were highly significantly reduced and similar following both MEATM and TCRE, achieving amenorrhoea rates of 83 and 88% respectively. The hysterectomy rate after 10 years was significantly different with 22 (17%) in the MEATM and 38 (28%) in the TCRE arm (95% CI: −0.21, −0.13). Conclusions Both techniques achieve significant and comparable improvements in menstrual symptoms, health-related quality of life and high rates of satisfaction. With the known operative advantages, lower costs and fewer hysterectomies, it is clear that MEA™ is a more effective and efficient treatment for heavy menstrual loss than TCRE. [ABSTRACT FROM AUTHOR]

A proportion of patients present with chronic pelvic pain following microwave endometrial ablation, presumed to be due to the development of a haematometra. This retrospective observational study of 20 patients was performed to determine if hysteroscopy and adhesiolysis is beneficial in this group of patients. Seventeen patients were found to have intrauterine adhesions at hysteroscopy that were divided. At follow-up, nine patients were cured of pain and discharged. Of the remaining 11 patients, one patient with endometriosis underwent laparoscopic bilateral salpingo-oophorectomy. Nine patients underwent hysterectomy and one patient was put on mefenamic acid. In conclusion, some patients were still symptomatic following hysteroscopy and needed further intervention in the form of major gynaecological surgery. However, 45% of patients improved following only the minor day case procedure, without needing to resort to a hysterectomy with its inherent risks and costs. [ABSTRACT FROM AUTHOR]

Aim: The effects of transcervical microwave myolysis at 2.45 GHz after microwave endometrial ablation for menorrhagia were examined in patients with myomas. Methods: A transcervical microwave irradiation system assisted by transvaginal ultrasonic guidance was developed. Ten patients waiting for microwave endometrial ablation for menorrhagia caused by myomas entered the study after complete informed consent was obtained. Their outcomes were examined at least 6 months after transcervical microwave myolysis using the system. After completion of microwave endometrial ablation, interstitial microwave irradiation was performed using a guiding needle set in a puncture adaptor attached to a transvaginal ultrasonic probe and a microwave applicator of 1.6 mm in diameter. Shrinkage of the myoma was measured at 3 months and ≥6 months after the operation. Results: In nine patients with typical myomas, the major part consisting of a submucous or an intramural node 4.0–7.5 cm in size was necrotized. The typical myomas had shrunk by 41–68% at 3 months and 37–69% at ≥6 months after the operation. In one patient with a 6.8-cm cellular leiomyoma, necrosis was limited to the neighborhood of the applicator tip. Shrinkage was 17% at both 3 and 6 months. This patient required a second microwave endometrial ablation at 6 months to treat recurrent menorrhagia. None of the patients underwent hysterectomy after the treatment. No remarkable complications were encountered. Conclusions: Typical myomas shrink after microwave myolysis following microwave endometrial ablation. Transcervical microwave myolysis seems to be applicable as a low-invasive treatment for a typical myoma. [ABSTRACT FROM AUTHOR]

To explore and analyse patients’ views and comments on microwave endometrial ablation (MEA), we designed a simple and concise questionnaire of 10 items that the participants answered by ticking boxes. They were invited to add their own comments and opinions if they wished. The questionnaire survey was posted to 470 patients who were treated with MEA at Derriford Hospital between 1997 and 2003. We received replies from 343 patients (73%), of whom 165 included handwritten comments (48%). These were reviewed using content thematic analysis. This paper describes the findings of this analysis. Of the 343 respondents, 127 expressed their satisfaction, 32 would recommend MEA to others, and 17 claimed that MEA had transformed their lives. They used words such as “delighted,” “grateful,” “fantastic,” “I cannot tell you how wonderful it has been,” “freedom at last,” “I feel so much better within myself,” “I cannot begin to describe the feelings of well-being and relief I have experienced since I had this treatment,” and “it has changed my life from being housebound to never giving my periods a thought.” Thirty-eight patients were not satisfied; of these, 14 were experiencing moderate to severe pain, and six claimed to have developed severe pain de novo. Their comments included “I was disappointed MEA did not work for me” and “I get heavy bleeding and pain each month, [whereas] before I had no period pains at all.” In conclusion, MEA has been a “miracle cure” for many women who responded, with around 77% being satisfied with this treatment. For a small number, MEA was not successful. For some women, pain was a problem that either developed de novo or was preexisting in the form of dysmenorrhoea. In this paper we also mention success rates and figures from quantitative studies, and we recommend including quotes from satisfied patients in patient information leaflets to further help women and their physicians make informed choices about managing heavy menstrual blood loss, particularly when medical treatment is known to be less successful and with some women being concerned about its side effects. [ABSTRACT FROM AUTHOR]

Aim: To examine the feasibility of microwave endometrial ablation (MEA), using a curved microwave applicator, in patients with menorrhagia caused by a submucous myoma greater than 3 cm in diameter, which is among the contraindications for conventional endometrial ablation. Methods: Patients included were refractory to medication, more than 45 years of age, and due to undergo hysterectomy to treat menorrhagia as a result of submucous myomas, although they hoped to avoid hysterectomy. Three patients underwent MEA at 2.45 GHz using a curved microwave applicator and microwave tissue coagulator to treat menorrhagia. Patients 1, 2 and 3 had submucous myoma nodes 4.5, 5.0 and 13 cm in diameter respectively. The applicator was guided under transabdominal ultrasonography to microwave irradiation sites arranged to cover the entire uterine lining based on preoperative magnetic resonance images. MEA was performed under general anesthesia or spinal anesthesia. Microwaves were irradiated at 40 W for 50 s for single irradiation sites. Results: Patient 1 became amenorrheic after the second MEA, which was performed 2 months after the first operation. Patients 2 and 3 became amenorrheic after the first MEA. Postoperative abdominal pain was controllable by a suppository of non-steroidal anti-inflammatory drugs. The patients were discharged the day after the operation. No remarkable complications were encountered during or after surgery. Conclusion: Microwave endometrial ablation improves menorrhagia caused by large submucous myomas when the microwave applicator reaches all parts of the uterine cavity. [ABSTRACT FROM AUTHOR]

Aim: We investigated microwave power and duration of use, which does not affect extrauterine organs, in order to treat organic menorrhagia caused by myomas or adenomyosis. Methods: Electric fields around a microwave applicator at a frequency of 2.45 GHz were calculated using the finite element method with commercially available software for analysis of electromagnetic fields. Transient temperature distributions around the applicator were obtained by numerically solving the bioheat transfer equation during microwave irradiation for 120 s in the human uterus and swine liver. We compared areas enclosed by the 60°C isotherm obtained using numerical simulations and necrosis areas after microwave irradiation. Postoperative avascular areas in a Gd-enhanced MRI of a uterus enlarged by adenomyosis after clinical microwave endomyometrial ablation were compared with numerical simulations. Results: There was good agreement between the calculated results and the experiments. At 40 W of output power for 50 s of duration and 64.5 W for 100 s, the depth of the necrotized uterine wall did not increase beyond 7 mm and 11 mm, respectively, either in the calculations or the experiments. Generally, the 50°C isotherm was located approximately 2 mm external to the 60°C isotherm in temperature distributions. The Gd-enhanced MRI after the operation depicted avascular areas, which agreed with the results of numerical simulations. Conclusions: The myometrial portion of a uterine wall ≥13 mm throughout the uterus irradiated for ≤64.5 W for 100 s is sufficient to avoid thermal damage of the extrauterine organs during microwave endomyometrial ablation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of microwave endometrial ablation (MEA) in the treatment of menorrhagia in patients with severe systemic disease or medical conditions.Methods: Forty-two menorrhagic women undergoing systemic disorders with failure of medical management were treated with MEA under local or general anesthesia, and were followed-up for 1 year.Results: The women had a mean age of 39.4 years (range, 17-49). The procedure was successfully completed in all patients, and no intraoperative complications occurred. Two cases died of their primary severe medical diseases within 2 months of treatment but these cases were not associated with MEA. Among the remaining 40 patients, 24 (60.0%) had amenorrhea within 12 months. The duration of hospitalization and the amount of blood transfusion were significantly reduced after treatment, and the quality of life of these patients was improved significantly.Conclusions: MEA is a safe and effective treatment for the management of severe menorrhagia in patients undergoing systemic illness or severe medical conditions. [ABSTRACT FROM AUTHOR]

Abstract: Microwave endometrial ablation (MEA™) has evolved from a theoretical technology, through rigorous laboratory and clinical testing to become an effective treatment for heavy menstrual loss, with a sound evidence base. The purpose of this article is to review the scientific basis, clinical research, safety and clinical applications of this endometrial ablative technique. [Copyright &y& Elsevier]

To ascertain whether microwave endometrial ablation under local anaesthesia is feasible in unselected women. A partially randomized patient preference pilot study. A large teaching hospital in North-east Scotland. 98 women who were referred and suitable for endometrial ablation and who agreed to participate after informed consent had been given. Women were randomly allocated to receive general or local anaesthesia for microwave endometrial ablation, or if they had a strong preference they were allocated to their chosen anaesthesia. All procedures were performed in the theatre setting and on a day case basis. Acceptability and satisfaction were primarily assessed in each group using validated tools. Operating times, failure under local anaesthesia, postoperative analgesia and postoperative discharge times were also recorded. Microwave endometrial ablation under local anaesthesia was feasible in 75% of unselected women. Acceptability was higher in those who chose local anaesthesia. Local anaesthesia should be offered to women undergoing microwave endometrial ablation and a randomized controlled trial is a feasible option for assessing prognostic factors and satisfaction. [ABSTRACT FROM AUTHOR]

Abstract: Heavy menstrual bleeding, or menorrhagia, is a primary cause of morbidity in women. Herein, we present the case of a 41-year-old woman who underwent day-surgery endometrial microwave ablation because of dysfunctional uterine bleeding. She had undergone previous laparoscopic sterilization, and had no other risk factors except for a retroverted uterus. The procedure was performed without any documented difficulties. The patient was readmitted the following day with clinical signs of acute abdomen. Emergency laparotomy revealed a large perforation on the anterior uterine wall, full-thickness burns in the distal ileum, and multiple ischemic areas in the ileum, cecum, and ascending colon secondary to microwave burns. A right hemicolectomy was required, with extended ileal resection and subtotal hysterectomy with ovarian conservation. Although microwave endometrial therapy seems to offer many advantages, in particular in terms of efficiency and technique, complications occur, and extensive safety measures must be implemented to prevent adverse effects such as occurred in this patient. [ABSTRACT FROM AUTHOR]

A 45-year-old lady with previous history of laporoscopic sterilization developed bilateral haematosalpinges 3 months post-microwave endometrial ablation (MEA). She subsequently underwent bilateral salpingectomy. This presentation, described as post-ablative tubal sterilization syndrome, has been reported in the literature with different endometrial ablation methods. However, according to our literature search, no case has been reported to date with MEA. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the incidence of occlusion of the upper genital tract following microwave endometrial ablation (MEA™) in women treated for therapy-resistant menorrhagia. A total of 35 women were recruited between January 1997 and January 2005, Royal United Hospital Bath, to have interval hysterosalpingogram (HSG) post-MEA. After a successful MEA, either with general or local anaesthesia, 35 HSGs were performed 3 or more months later. Complete occlusion of the upper genital tract was found in 30 women (85.7%) and incomplete occlusion with tubal patency persisted in 5 (14.3%). [ABSTRACT FROM AUTHOR]

Microwave endometrial ablation (MEA) is regarded as an effective nonsurgical option for managing dysfunctional uterine bleeding (DUB). It is believed to be safe, quick, and easy to perform. To our knowledge, there has been only one reported case of a serious complication of a bowel injury during MEA. We report another similar case of accidental uterine perforation and bowel injury. [ABSTRACT FROM AUTHOR]

Introduction. An enlarged uterus of more than 12 cm in cavum length with a distorted cavity is a contra-indication for conventional ablative techniques. It is difficult to perform satisfactory endometrial ablation in a large uterus with submucosal myomas using straight instruments. A new curved microwave applicator 4 mm in diameter was developed for microwave endometrial ablation (MEA) for uteri with an enlarged distorted uterine cavity. Method. For three patients of menorrhagia due to submucosal myomas with cavum lengths 13 to 15 cm, MEA was performed using the curved applicator. Results. Menorrhagia was improved in each case. No complications were encountered. Conclusion. A large number of hysterectomies could be avoided using the new curved microwave applicator. [ABSTRACT FROM AUTHOR]

Endometrial ablation techniques continue to play an important role in the management of heavy menstrual bleeding. The techniques for endometrial ablation have evolved from the first-generation to the newer, second- and thirdgeneration methods. The first-generation techniques are represented by endometrial laser ablation, transcervical resection of the endometrium, and rollerball endometrial ablation. The newer generation methods are: thermal balloon ablation, microwave endometrial ablation, hydrothermal ablation, bipolar radio-frequency endometrial ablation, and endometrial cryotherapy. The aim of this review is to compare the effectiveness, the safety, the acceptability, and the complication rates of first-, second-, and third-generation methods available for endometrial ablation. Conclusions. All the techniques are effective and safe. Newer generation techniques are blind methods and can be performed rather under local anesthesia than general anesthesia. Secondgeneration techniques are associated with shorter operating times, and can be performed under local rather general anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: Vascular-rich myomas are resistant to treatment involving transcervical microwave myolysis. To overcome cooling by blood perfusion, we injected dilute vasopressin solution into the space between the myometrium and the surface of the vascular-rich myomas. Material and Methods: Seven outpatients [age (mean ± SD age), 44.9 ± 3.9 years] with a single symptomatic vascular-rich submucosal myoma measuring 4.2-9.2 cm (6.5 ± 2.5 cm) underwent transcervical microwave myolysis and microwave endometrial ablation. Before microwave irradiation, dilute vasopressin solution was injected into the space between the myometrium and the surface of the vascular-rich myoma. We assessed the changes in the volumes of the vascular-rich myomas and blood hemoglobin levels before and 3 and 6 months after treatment. In addition, improvements in menorrhagia and satisfaction after the operation were assessed using visual analog scales. Results: Submyometrial injection of dilute vasopressin effectively reduced the abundant blood flow. The vascular-rich myomas were necrotized and shrank significantly by 69.0% at 3 months and 72.4% at 6 months after the operation (p < .05). Blood hemoglobin levels significantly increased at 3 months (p < .01). In addition, the visual analog scale results indicated that menorrhagia improved subjectively and the patients were satisfied with the results of the operation. Conclusions: Vasopressin injection before transcervical microwave myolysis leads to extended necrosis of vascular-rich submucosal myomas.

The article reports on the case of a 44-year-old nulliparous woman presented with a history of menorrhagia and dysmenorrhoea for two years. It says that the patient was administered with Microwave endometrial ablation and surface serosal temperature was performed. Moreover, the patient recovered and was discharged as well as did not required further treatment since the procedure was made.

We present details of a 39-year-old para 3 woman, who was treated with microwave endometrial ablation (MEA) for menorrhagia after previous failed medical treatments. She then presented at 8 weeks after the procedure and was confirmed to have an 8-week viable intrauterine pregnancy. She was counselled, but, based on the fact that there was no published literature about the effects of MEA on pregnancy, she decided to have a medical termination and she subsequently got pregnant again and had a healthy baby girl. There was no complication in pregnancy and delivery. [ABSTRACT FROM AUTHOR]

This study aimed to describe the long-term outcomes of patients with menorrhagia treated with microwave endometrial ablation (frequency, 2.45 GHz), as well as to identify factors associated with recurrence or re-surgery. This retrospective cohort study was conducted from 2007 to 2015 at Shimane University Hospital in Japan. Patients with severe menorrhagia and a desire to preserve their uterus were included in the study. Clinical factors associated with recurrence of menorrhagia or re-surgery were analyzed with a multivariable logistic regression model. Of 160 microwave endometrial ablation candidates, 100 had uterine myomas, 20 adenomyosis, 26 functional excessive menstruation, and 12 endometrial polyps. In the full cohort, age (<40) and uterine cavity length (≥10) were associated with recurrence of menorrhagia and re-surgery. Among patients with myomas, age (<48) and number of myomas (≥4) were associated with recurrence, and largest myoma size (≥5) and preoperative hemoglobin level (<9 mg/dl) were associated with re-surgery. Among subjects with adenomyosis, uterine cavity length (≥10) was associated with recurrence. Microwave endometrial ablation is thought to be a highly efficacious method to control menorrhagia caused by functional bleeding and endometrial polyps. However, microwave endometrial ablation may be less effective for patients younger than 48 years with myomas, especially those with 4 or more myomas, or with a myoma 5 cm or larger in size, and for patients with adenomyosis who have a thickened myometrium. These clinical factors may be useful predictors of success in selecting candidates for microwave endometrial ablation.

Microwave endometrial ablation (MEA) is effective for the emergency control of uterine hemorrhage. However, to the best of our knowledge, there has been only a single report of life-threatening hemorrhage induced by endometrial carcinoma that was treated with MEA. The present report evaluates the efficacy of MEA as an emergency therapeutic option for the control of bleeding due to advanced endometrial carcinoma and minimally-invasive, early-stage endometrial carcinoma in 3 patients. MEA was able to effectively control massive uterine bleeding due to endometrial carcinoma in 2 patients with advanced disease and was curative in a patient with minimally-invasive endometrial carcinoma. Given its safety, simplicity and effectiveness, MEA may be utilized for the emergency treatment of uterine bleeding in advanced endometrial carcinoma, and may be used as a curative treatment in early-stage endometrial carcinoma.