Long‑term outcomes of microwave endometrial ablation for treatment of patients with menorrhagia: A retrospective cohort study

Nakamura,Kohei; Nakayama,Kentaro; Sanuki,Kaori; Minamoto,Toshiko; Ishibashi,Tomoka; Sato,Emi; Yamashita,Hitomi; Ishikawa,Masako; Kyo,Satoru

doi:10.3892/ol.2017.7208

Long‑term outcomes of microwave endometrial ablation for treatment of patients with menorrhagia: A retrospective cohort study

Authors:
- Kohei Nakamura
- Kentaro Nakayama
- Kaori Sanuki
- Toshiko Minamoto
- Tomoka Ishibashi
- Emi Sato
- Hitomi Yamashita
- Masako Ishikawa
- Satoru Kyo
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Affiliations: Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan
Published online on: October 18, 2017 https://doi.org/10.3892/ol.2017.7208
Pages: 7783-7790
Copyright: © Nakamura et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

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.

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1	Kanaoka Y, Hirai K and Ishiko O: Microwave endometrial ablation for an enlarged uterus. Arch Gynecol Obstet. 269:30–32. 2003. View Article : Google Scholar : PubMed/NCBI
2	Nakayama K, Ishibashi K, Ishikawa M, Katagiri A, Katagiri H, Iida K, Nakayama N and Miyazaki K: Microwave endometrial ablation at a frequency of 2.45 GHz for menorrhagia: Analysis of treatment results at a single facility. J Obstet Gynaecol Res. 40:224–229. 2014. View Article : Google Scholar : PubMed/NCBI
3	Overton C, Hargreaves J and Maresh M: A national survey of the complications of endometrial destruction for menstrual disorders: The MISTLETOE study. Minimally Invasive surgical techniques-laser, EndoThermal or Endoresection. Br J Obstet Gynaecol. 104:1351–1359. 1997. View Article : Google Scholar : PubMed/NCBI
4	Nakayama K, Rahman MT, Rahman M, Ishikawa M, Yeasmin S, Katagiri A, Iida K, Nakayama N, Aoki S and Miyazaki K: Microwave endometrial ablation is a highly efficacious way to emergently control life-threatening uterine hemorrhage. Arch Gynecol Obstet. 283:1065–1068. 2011. View Article : Google Scholar : PubMed/NCBI
5	Nakayama K, Yeasmin S, Katagiri A, Rahman MT, Rahman M, Ishikawa M, Iida K, Nakayama N, Aoki S and Miyazaki K: A comparative study between microwave endometrial ablation and conventional surgical procedures for treatment of menorrhagia. Clin Exp Obstet Gynecol. 38:33–37. 2011.PubMed/NCBI
6	Kanaoka Y, Ishikawa N, Asakawa Y and Nakayama K: Practice guideline of MEA. http://www.alfresa-pharma.co.jp/microtaze/MEAApril 1–2012
7	Akashi Y, Shimizu A and Mizuuchi M: A survey of outcomes of microwave endometrial ablation for menorrhagia in our hospital. J Obstet Gynecol (Tokyo). 76:229–233. 2009.(In Japanese).
8	Milligan MP and Etokowo GA: Microwave endometrial ablation for menorrhagia. J Obstet Gynaecol. 19:496–499. 1999. View Article : Google Scholar : PubMed/NCBI
9	Downes E and O'Donovan P: Microwave endometrial ablation in the management of menorrhagia: Current status. Curr Opin Obstet Gynecol. 12:293–296. 2000. View Article : Google Scholar : PubMed/NCBI
10	Cooper KG, Bain C, Lawrie L and Parkin DE: A randomized comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of five years. BJOG. 112:470–475. 2005. View Article : Google Scholar : PubMed/NCBI
11	Flake GP, Anderson J and Dixon D: Etiology and pathogenesis of uterine leiomyomas: A review. Environ Health Perspect. 111:1037–1054. 2003. View Article : Google Scholar : PubMed/NCBI
12	Sato F, Mori M, Nishi M, Kudo R and Miyake H: Familial aggregation of uterine myomas in Japanese women. J Epidemiol. 12:249–253. 2002. View Article : Google Scholar : PubMed/NCBI
13	Faerstein E, Szklo M and Rosenshein N: Risk factors for uterine leiomyoma: A practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 153:1–10. 2001. View Article : Google Scholar : PubMed/NCBI
14	Shifren JL and Schiff I: MenopauseBerek & Novak's gynecology. Berek JS, Rinehart RD and Hengst TC: 14th edition. Lippincott Williams & Wilkins; Philadelphia, PA: c2007
15	Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, Semelka RC, Kowalik A, Armao D, Davis B and Baird DD: Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci USA. 105:pp. 19887–19892. 2008, View Article : Google Scholar : PubMed/NCBI
16	Fedele L, Parazzini F, Luchini L, Mezzopane R, Tozzi L and Villa L: Recurrence of fibroids after myomectomy: A transvaginal ultrasonographic study. Hum Reprod. 10:1795–1796. 1995. View Article : Google Scholar : PubMed/NCBI
17	Hanafi M: Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol. 105:877–881. 2005. View Article : Google Scholar : PubMed/NCBI
18	Jacobson GF, Shaber RE, Armstrong MA and Hung YY: Changes in rates of hysterectomy and uterine conserving procedures for treatment of uterine leiomyoma. Am J Obstet Gynecol. 196:601.e1–6. 2007. View Article : Google Scholar
19	Nishiyama S, Saito M, Sato K, Kurishita M, Itasaka T and Shioda K: High recurrence rate of uterine fibroids on transvaginal ultrasound after abdominal myomectomy in Japanese women. Gynecol Obstet Invest. 61:155–159. 2006. View Article : Google Scholar : PubMed/NCBI
20	Yoo EH, Lee PI, Huh CY, Kim DH, Lee BS, Lee JK and Kim D: Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol. 14:690–697. 2007. View Article : Google Scholar : PubMed/NCBI
21	Nakamura K, Nakayama K, Ishikawa M, Katagiri H, Katagiri A, Ishibashi T, Sato E, Asakawa Y and Kyo S: Efficacy of multiple microwave endometrial ablation technique for menorrhagia resulting from adenomyosis. J Obstet Gynaecol Res. 41:1769–1172. 2015. View Article : Google Scholar : PubMed/NCBI