However women need to be made aware about the high rates of further intervention required following the procedure .
MRgFUS MRgFUS scanning to locate the fibroid and focus high intensity ultrasound beams on to a point within the fibroid results in tissue heating and subsequent necrosis . Its advantages are that it is low cost , non-invasive and requires no general anaesthesia or hospitalisation . Because it is an ambulatory procedure , recovery time is approximately one to two days . Large or multiple fibroids and pedunculated fibroids are considered relative contraindications to this treatment . The presence of bowel loops or abdominal wall scars in the projected pathway of the ultrasound beam may preclude use of the technique . Common symptoms during the procedure are lower abdominal pain , leg pain and buttock pain . The main drawback of the technique is high rates of further surgical or radiological interventions required .
There have been a number of reports of pregnancies following MRgFUS with reassuring pregnancy outcomes ; however , further evidence is needed before recommending the procedure to women planning to conceive .
Evidence A pilot , randomised , placebo-controlled trial evaluated the feasibility of a full-scale placebocontrolled trial of magnetic resonance-guided focused ultrasound for fibroids in premenopausal women with symptomatic uterine fibroids . 7 Twenty women with a mean age of 44 years (± standard deviation 5.4 years ) were enrolled , and 13 were randomly assigned to MRgFUS and seven to placebo . Four weeks after treatment , all participants reported improvement in the uterine fibroid symptoms and health-related quality of life score ( UFS-QOL ): a mean of 10 points in the MRgFUS group and 9 points in the placebo group ( for difference in change between groups ). By 12 weeks , the MRgFUS group had improved more than the placebo group ( mean 31 points and 13 points , respectively ). The mean fibroid volume decreased 18 % in the MRgFUS group with no decrease in the placebo group at 12 weeks . Two years after MRgFUS , 4 of 12 women who had a follow-up evaluation ( 30 %) had undergone another fibroid surgery or procedure . 7
A study compared the long-term outcomes after UAE versus MRgFUS for symptomatic uterine fibroids . 8 Seventy-seven women ( median age , 39.3 years ; range , 29.2 – 52.2 years ) with symptomatic uterine fibroids , equally eligible for UAE and MR-g high-intensity focused ultrasound underwent treatment ( UAE , n = 41 ; MRgFUS , n = 36 ) from 2002 to 2009 . Re-intervention was significantly lower after UAE ( 12.2 %) than after MRgFUS ( 66.7 %) at long-term follow-up ( p < 0.001 ). Improvements in symptom severity and quality of life scores was significantly better after UAE resulting in a significant lower re-intervention rate compared to MRgFUS . 8
Another study of 119 women comparing outcomes of treatment between volumetric MRgFUS and UAE for uterine fibroids . 9 Both procedures resulted in significant symptom relief and quality of life improvement . UAE had a stronger positive effect on the clinical outcomes . Re-intervention rate after MRgFUS was significantly higher than after UAE . 9
Other minimally invasive techniques Ultrasound-guided high-intensity focused ultrasound ablation is a new non-invasive treatment of uterine fibroids . The technique allows a check on the immediate efficacy of the procedure and if viable residual tissue is detected , there is the option to repeat the ablation immediately . 3 Transcervical intrauterine sonography with radiofrequency ablation of the fibroids is yet another novel approach being investigated . A graphical interface delineates the boundaries of ablation and thermal spread so that thermal injury to the serosa as well as adhesions and injury to bowel or bladder can be minimised . A recent study looked into the effectiveness in day clinics of microwave endometrial ablation ( MEA ) on transcervical microwave myolysis for patients with menorrhagia caused by submucosal fibroids . 10 Thirty-five outpatients ( average age 44.8 ± 5.2 years ( mean ± SD ), range 34 – 58 ) with a single submucosal fibroid that was 4 – 7cm ( 5.5 ± 2.1cm ) in size underwent MEA with transcervical microwave myolysis using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture . The mean operation time was 27.9 ± 13.6 min . The fibroids had shrunk by 56.2 % at three months and 73.8 % at ≥six months after the operation . Blood haemoglobin levels had increased significantly at three months ( 10.2 ± 2.0 vs . 12.7 ± 1.2 ; p < 0.001 ). 10 Further clinical trials are needed to better define the role and limitations of these techniques for treatment of symptomatic uterine fibroids .
Conclusions Many uterine fibroids are asymptomatic and require no intervention . While myomectomy and hysterectomy have been the traditional definitive treatments for symptomatic uterine fibroids , not all women wish to have a surgery and many would like to retain their uterus . Non-surgical treatment options for symptomatic fibroids include pharmacologic as well as radiologically guided interventions . Radiologically guided procedures such as UAE and ablation by highintensity focused ultrasound are newer treatment modalities that should be tailored to women ’ s age , general health , fibroid size / symptoms , fertility and their individual wishes .
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