Our Summary

This research paper focuses on a treatment called microwave endometrial ablation (MEA), which is used to manage heavy menstrual bleeding. With the rise in the number of caesarean sections and myomectomies (surgical removal of fibroids from the uterus), more patients undergoing MEA have had prior surgery on their womb. This previous surgery can lead to a thinning of the muscle wall of the uterus, which could potentially increase the risk of complications.

The researchers studied 35 patients who had MEA, 12 of whom had previously had uterine surgery. They used MRI and ultrasound to assess the thickness of the uterine muscle wall. They found that half of the patients with previous uterine surgery showed thinning of this muscle wall. However, none of the patients experienced any complications from the MEA procedure, regardless of whether they’d had previous surgery or not.

The recurrence rate of heavy menstrual bleeding was the same in both groups (around 8%). This suggests that MEA can be performed safely and effectively even in patients who have previously had surgery on their uterus. The authors also note that preoperative evaluations using MRI and ultrasound can be beneficial in these cases.

In simple terms, this study shows that even if a woman has had previous surgery on her womb, a treatment called MEA can still be used safely and effectively to manage heavy periods.

FAQs

  1. What is microwave endometrial ablation (MEA) and what is it used for?
  2. Does having prior uterine surgery increase the risk of complications with MEA?
  3. Is the recurrence rate of heavy menstrual bleeding higher in patients who have had previous uterine surgery and undergo MEA?

Doctor’s Tip

One helpful tip a doctor might give a patient considering endometrial ablation is to ensure they disclose their full medical history, including any previous surgeries on the uterus, so that the doctor can assess the potential risks and benefits of the procedure. Additionally, it is important for patients to follow any preoperative evaluation recommendations, such as undergoing MRI and ultrasound scans, to ensure the safest and most effective outcome.

Suitable For

Typically, patients who are recommended endometrial ablation are those who suffer from heavy menstrual bleeding (menorrhagia) that has not responded to other treatments such as medications or hormonal therapy. Endometrial ablation is often considered for women who have completed childbearing or do not wish to have children in the future.

Women with conditions such as uterine fibroids, abnormal uterine bleeding, or endometrial hyperplasia may also be candidates for endometrial ablation. It is important for patients to have a thorough evaluation by their healthcare provider to determine if they are suitable candidates for the procedure.

It is worth noting that endometrial ablation is not recommended for women who have certain gynecological conditions such as uterine cancer, active pelvic inflammatory disease, or an active pelvic infection. Additionally, women who have a desire to have children in the future should not undergo endometrial ablation, as it can affect fertility.

Overall, patients who are recommended endometrial ablation are those who have persistent heavy menstrual bleeding and have not responded to other treatment options. It is important for patients to discuss their individual medical history and concerns with their healthcare provider to determine if endometrial ablation is the right treatment option for them.

Timeline

Before endometrial ablation:

  • Patient experiences heavy menstrual bleeding
  • Patient may have had previous surgeries on the uterus, such as caesarean sections or myomectomies
  • Patient undergoes preoperative evaluations using MRI and ultrasound to assess the thickness of the uterine muscle wall

After endometrial ablation:

  • Patient undergoes the MEA procedure
  • MRI and ultrasound are used postoperatively to assess the effectiveness of the procedure
  • Patient experiences a low recurrence rate of heavy menstrual bleeding, regardless of previous uterine surgery
  • Patient does not experience any complications from the MEA procedure

Overall, the study suggests that MEA can be a safe and effective treatment for managing heavy menstrual bleeding, even in patients who have had previous surgeries on their uterus.

What to Ask Your Doctor

Some questions a patient should ask their doctor about endometrial ablation include:

  1. What is endometrial ablation and how does it work?
  2. Am I a good candidate for endometrial ablation?
  3. What are the potential risks and complications associated with endometrial ablation?
  4. Will I need to have any preoperative evaluations, such as MRI or ultrasound, before the procedure?
  5. How effective is endometrial ablation in managing heavy menstrual bleeding?
  6. What is the recovery process like after endometrial ablation?
  7. Are there any long-term effects or considerations I should be aware of after the procedure?
  8. Will I still be able to have children after undergoing endometrial ablation?
  9. Are there any alternative treatments or procedures I should consider?
  10. How often will I need to follow up with you after the procedure?

Reference

Authors: Maebayashi A, Hayashi N, Kamata S, Sugi T, Nakajima T, Nagaishi M, Kawana K. Journal: J Obstet Gynaecol. 2022 Aug;42(6):2164-2169. doi: 10.1080/01443615.2022.2035330. Epub 2022 Feb 16. PMID: 35170390