Microwave endometrial ablation after endometrial curettage for the management of heavy menstrual bleeding

M. Nikolaou, G. Androutsopoulos, G. Michail, V. Papadopoulos, G. Adonakis, G. Decavalas
2015 Clinical and experimental obstetrics & gynecology  
Heavy menstrual bleeding is a significant healthcare issue in premenopausal women and the main reason for referral to gynecologist [1, 2] . It is a common cause of iron deficiency anemia and may reduce their quality of life [2] . For most patients with heavy menstrual bleeding, medical management should be the initial approach [3] . Medical treatment options include: intravenous (conjugated equine estrogens), oral (progestins, combined oral contraceptives, non-steroidal anti-inflammatory drugs,
more » ... anti-fibrinolytic drugs) or intrauterine medication (levonorgestrel releasing devices) [2] [3] [4] [5] [6] [7] [8] . However the effectiveness, side effect profile, and acceptability to women show considerable variation [2] [3] [4] [5] [6] [7] [8] [9] [10] . The choice of surgical treatment option depends on clinical stability, suspected etiology, underlying medical problems, contraindications or lack of response to medical treatment, and desire for future fertility [3] . Surgical treatment options include: dilation and curettage, endometrial ablation, uterine artery embolization, and hysterectomy [3, 8] . Recent years, microwave endometrial ablation gained popularity. It is a minimally invasive surgical technique for patients with heavy menstrual bleeding [11] . It uses lowpower, high-frequency microwave energy to destroy the basal layer of the endometrium and the glands by heating them to 70-80°C [11] . The aim of this study was to evaluate the efficacy of microwave endometrial ablation after endometrial curettage, in selected patients with heavy menstrual bleeding. Materials and Methods Between January 2005 and December 2007, 32 premenopausal women with heavy menstrual bleeding underwent microwave endometrial ablation at the Department of Obstetrics and Gynecology of the University of Patras Medical School. All patients did not respond to previous medical treatment, had completed their childbearing, and they did not desire future fertility. Preoperatively the authors evaluated myometrial thickness, uterine cavity length, and configuration with vaginal ultrasound, in order to avoid thermal injury of adjacent organs. In this study, the authors chose endometrial curettage rather than hormonal pretreatment (GnRH analogs, danazol, progestogens) for endometrial preparation. Exclusion criteria from the study were: pregnancy, desire for future fertility, menopausal status, previous endometrial ablation, uterine cavity length < six cm or >14 cm, previous uterine surgery (cesarean section, myomectomy), previous uterine trauma (resulting myometrial thickness < ten mm), submucosal fibroids, intrauterine device, active genital or urinary tract infection, active pelvic inflammatory disease, atypical endometrial hyperplasia, endometrial cancer, cervical dysplasia, clotting defects or bleeding disorders. The procedure was performed under light general anesthesia and the patient placed in dorsal lithotomy position. The cervix dilated up to nine mm and the authors confirmed uterine cavity
doi:10.12891/ceog1870.2015 fatcat:bktgwhi5tfc5lgfjunip4bbmoa