Menorrhagia and metrorrhagia are two of the most frequently reported gynecologic concerns. The search is ongoing for new treatments for abnormal uterine bleeding. Many of the current medical therapies have side effects that limit their duration of use. Although hysterectomy is curative for menorrhagia, there is significant morbidity and mortality associated with the operation. In an attempt to reduce hysterectomy rates and the rates of its associated complications, minimally invasive procedures including uterine artery embolization, hysteroscopic myomectomy, focused ultrasound, and cryomyolysis have been developed. Unfortunately, each of these alternatives has a risk of its own. These procedures may result in any of the following complications, such as: fluid overload, uterine perforation, infection, thermal injury, hemorrhage, deep venous thrombosis, etc. In addition, these procedures can be technically difficult for general practitioners to perform. Recently, efforts have been directed to develop new techniques for destroying the endometrium that are safer and simpler to perform. The new devices ablate the endometrium with lasers, radiofrequency waves, electrocautery, microwaves, heated saline, or a heated balloon. These procedures can be performed with minimal surgical skill in patients who would otherwise be poor surgical candidates. Blood loss is minimal and complications are few. The short-term curative rate of MEA is similar to that of a total hysterectomy. In terms of operative complications and post-operative recovery, MEA is obviously superior to total hysterectomy. It can also be used to treat larger or irregular cavities [
4], and has even been used successfully in a didelphic uterus [
5]. MEA is only contraindicated when the uterine bleeding arises from a malignancy. There is, however, one case report documenting successful MEA without recurrence for endometrial hyperplasia with atypia. An increasing number of reproductive-aged women are choosing endometrial ablation as a way to manage erratic perimenopausal bleeding. The fertility after endometrial destruction is low and is reported to be 0.7%, although there is a report of pregnancy after MEA [
6]. Thus women considering this procedure should be carefully counseled that though pregnancy following ablation is possible, desired fertility is a contraindication given that EA can significantly increase the risk of obstetric complications mainly due to the development of uterine synechiae.
Microwave ablation therapy has been extensively utilized in the liver and kidney. The use of microwaves at 9.2 GHz in gynecology was first reported in the form of MEA at the University of Bath [
7]. This particular device, however, was unsuitable for treating uterine cavities remarkably distorted or enlarged by uterine myomas. Recently, Kanaoka et al. [
4] developed a special instrument which delivers 2.45-GHz microwaves through a thin curved microwave applicator that conforms to the curvature of the uterine cavity. This applicator may be used in cavities up to 16 cm in length and can treat myomas bigger than 3 cm [
4].
MEA has been evaluated extensively in randomized trials against first- and second-generation endometrial ablative techniques and has been shown to have good outcomes with a high level of patient satisfaction [
1]. We used the device modified by Kanaoka et al. [
4]. In the case of our first patient, a poor surgical candidate, the size of her myoma exceeded that which could be treated with a conventional MEA device. In the case of the second patient, MEA was useful emergently to control a life-threatening hemorrhage. Neither of the patients experienced any significant intra- or post-operative complications related to the procedure. Moreover, menorrhagia was successfully controlled and subsequent cycles were normal. MEA therefore is a promising new method for controlling life-threatening uterine bleeding in patients who are poor surgical candidates.