Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2023; 11(24): 5653-5659
Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5653
Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Yoshio Matsuda, Kaoru Yanagida, Nobuhiro Takeshima, Michitaka Ohwada
Toshiyuki Kakinuma, Ayaka Kaneko, Kaoru Kakinuma, Yoshio Matsuda, Kaoru Yanagida, Nobuhiro Takeshima, Michitaka Ohwada, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
Author contributions: Kakinuma T contributed to conceptualization, methodology, software, validation, original draft preparation, manuscript review and editing, visualization, supervision, and project administration; all authors contributed to formal analysis, investigation, resources, and data curation; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the International University of Health and Welfare (approval number, 20-B-399; approval date, May 7, 2020).
Informed consent statement: All patients provided written and verbal informed consent for study participation.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com
Received: April 14, 2023
Peer-review started: April 14, 2023
First decision: July 7, 2023
Revised: July 17, 2023
Accepted: August 3, 2023
Article in press: August 3, 2023
Published online: August 26, 2023
Abstract
BACKGROUND

Microwave endometrial ablation (MEA) is a minimally invasive treatment for menorrhagia. It has been covered by the national insurance in Japan since April 2012, and its demand has been increasing as the importance of women’s health has advanced in society.

AIM

To examine the efficacy of MEA as a treatment option for menorrhagia.

METHODS

In this study, we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our department. MEA was performed in the lithotomy position, under general anesthesia, and with transabdominal ultrasound guidance, including the entire endometrial circumference while confirming endometrial coagulation. The Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA, and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per cycle. The visual analog scale (VAS) was used to evaluate menorrhagia, menstrual pain, and treatment satisfaction. Additionally, the hemoglobin (Hb) levels before and after MEA and associated complications were investigated.

RESULTS

The average age of the patients was 44.8 ± 4.0 years. While 14 patients had functional menorrhagia, 62 had organic menorrhagia, of whom 14 had endometrial polyps, 40 had uterine fibroids, and 8 had adenomyosis. The VAS score before MEA and 3 and 6 mo after the procedure were 10, 1.3 ± 1.3, and 1.3 ± 1.3, respectively, for menorrhagia and 10, 1.3 ± 1.8, and 1.3 ± 1.8, respectively, for menstrual pain, both showing improvements (P < 0.001). The MEA Hb level significantly improved from 9.2 ± 4.2 g/dL before MEA to 13.4 ± 1.2 g/dL after MEA (P = 0.003). Treatment satisfaction was high, with a VAS score of 9.6 ± 0.7. Endometritis was observed in one patient after surgery and was treated with antibiotics.

CONCLUSION

MEA is a safe and effective treatment for menorrhagia.

Keywords: Menorrhagia, Visual analog scale, Dysmenorrhea, Endometrial ablation techniques, Microwaves, Leiomyoma, Adenomyosis

Core Tip: In the short-term follow-up after microwave endometrial ablation (MEA), we were able to confirm the efficacy and safety of MEA not only in functional hypermenorrhea but also in hypermenorrhea with organic causes. MEA could be a useful option for the treatment of menorrhagia in patients who are at high risk for hysterectomy due to complications or comorbidities, or who desire minimally invasive surgery.