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Citation: Kakinuma, T.; Ohkusa, T.;
Shinohara, T.; Shimizu, A.; Okamoto,
R.; Kagimoto, M.; Kaneko, A.;
Kakinuma, K.; Yanagida, K.;
Takeshima, N.; et al. Myoma with
Hypermenorrhea Treated with
Ultrasound-Guided Microwave
Ablation of the Inflowing Blood
Vessels to the Uterine Myoma: A
Case. Endocrines 2022,3, 633–640.
https://doi.org/10.3390/
endocrines3040054
Academic Editor: Osamu Hiraike
Received: 5 August 2022
Accepted: 7 October 2022
Published: 13 October 2022
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Case Report
Myoma with Hypermenorrhea Treated with Ultrasound-Guided
Microwave Ablation of the Inflowing Blood Vessels to the Uterine
Myoma: A Case
Toshiyuki Kakinuma *, Takahumi Ohkusa, Takumi Shinohara, Ayano Shimizu, Rora Okamoto,
Masataka Kagimoto, Ayaka Kaneko, Kaoru Kakinuma, Kaoru Yanagida, Nobuhiro Takeshima
and Michitaka Ohwada
Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital,
Nasushiobara 329-2763, Japan
*Correspondence: tokakinuma@gmail.com; Tel.: +81-287-39-3060
Abstract:
Microwave endometrial ablation (MEA) is a minimally invasive treatment for uterine my-
oma with hypermenorrhea, which can replace conventional hysterectomy. However, cases requiring
additional treatment because of postoperative recurrence are often encountered. MEA cauterizes the
endometrium and is not recommended for patients who wish to preserve fertility. We present the
cases of a patient with myoma-related hypermenorrhea who underwent microwave ablation of the
inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance. A
43-year-old
woman was diagnosed with chronic myeloid leukemia and treated with dasatinib
2 years
ago. Wors-
ening hypermenorrhea was observed after treatment initiation. Ultrasound and pelvic magnetic
resonance imaging revealed a uterine myoma. Therefore, she underwent MEA under transvaginal
ultrasound guidance. Visual analog scale evaluation demonstrated considerable improvement in hy-
permenorrhea and dysmenorrhea; the myoma size showed reduction. The postoperative course was
uneventful, and the patient was discharged on the day after surgery. No postoperative complications
were observed. This patient is currently undergoing infertility treatment. The microwave ablation of
myoma under transvaginal ultrasound guidance can effectively and safely reduce the myoma size.
These findings suggest that this method is a novel treatment option for patients with myoma-related
hypermenorrhea who wish to preserve their fertility and have children.
Keywords: uterine myoma; microwave; endometrial ablation; hypermenorrhea; dysmenorrhea
1. Introduction
Uterine myomas are benign gynecologic tumors that are often encountered in clinical
practice. Uterine myomas lead to conditions, such as hypermenorrhea and algomenorrhea,
resulting in severe anemia and hindering daily activities. These result in reduced quality
of life for women and limit their social activities. Microwave endometrial ablation (MEA)
aims to reduce the volume of menstruation or promote amenorrhea by the destruction of
the endometrial basal layer, reducing the function through protein coagulation based on
dielectric tissue heating due to microwave irradiation. MEA is a treatment for functional
hypermenorrhea refractory to conservative treatment, hypermenorrhea associated with
systemic diseases or therapeutic agents, and organic hypermenorrhea caused by uterine
myoma and adenomyosis. MEA is a minimally invasive treatment that can be used as a
substitute for conventional hysterectomy. MEA has also become popular in Japan because
it has been covered by insurance since April 2012 as a minimally invasive treatment for
hypermenorrhea. Since our hospital introduced MEA in January 2016, we have reported the
efficacy of this treatment [
1
]. Although MEA can be expected to have a therapeutic effect on
uterine fibroids, there are some cases wherein additional treatment is required because of
postoperative recurrence [
2
,
3
], as it is often difficult to manage. Additionally, this treatment
Endocrines 2022,3, 633–640. https://doi.org/10.3390/endocrines3040054 https://www.mdpi.com/journal/endocrines
Endocrines 2022,3634
method cauterizes the endometrium and is not recommended for patients who wish to
preserve fertility. Uterine artery embolization (UAE) and magnetic resonance imaging
(MRI)-guided focused ultrasound (MRgFUS) have recently been somewhat effective as
conservative treatments. However, the treatment outcomes and complications are not
always satisfactory compared with those associated with surgical treatment [4,5].
We herein introduce microwave ablation of the inflowing blood vessels to the uterine
myoma under transvaginal ultrasound guidance as a new treatment method for patients
with uterine myoma with menorrhagia who wish to preserve fertility.
2. Case Presentation
Case: A 43-year-old woman
History of pregnancy and delivery: One pregnancy and one delivery
Chief complaint: Massive genital bleeding
Medical history: Chronic myelogenous leukemia (41 years of age)
Family history: None
Menstrual history: First menstruation at the age of 13 years. She had hypermenorrhea,
menstrual blood clots, and severe dysmenorrhea.
Present illness: She developed hypermenorrhea five years ago. At the age of
41 years
,
she was diagnosed with chronic myelogenous leukemia. Therefore, dasatinib (a tyrosine ki-
nase inhibitor) was initiated. Consequently, the platelet count reduced, showing worsening
hypermenorrhea. During menstruation, she visited our department for massive genital
bleeding. This patient had a desire of having children.
Physical examination findings: There were no notable findings.
Blood test findings: blood test findings are shown in Table 1. Severe anemia and
decreased platelet count were observed (hemoglobin, 2.7 g/dL; platelet, 1.6 million/µL).
Table 1. Blood test findings.
White Blood Cell (WBC) 1270/µL Total Protein (TP) 4.8 g/dL
Red blood cell (RBC) 131 million/µL Albumin (Alb) 3.1 g/dL
Hemoglobin (Hb) 2.7 g/dL Total bilirubin (T.bil) 0.5 mg/dL
Hematocrit (Ht) 8.00% Aspartate aminotransferase (AST) 20 U/L
Platelet (Plt) 1.6 million/µL Alanine aminotransferase (ALT) 15 IU/L
Blood urea nitrogen (BUN) 12.2 mg/dL
Prothrombin time and
international normalized ratio
(PT/INR)
1.09 Creatinine (Cre) 0.5 mg/dL
Activated partial thromboplastin
time (aPTT) 26.6 s Lactate dehydrogenase (LDH) 83 IU/L
Alkaline phosphatase (ALP) 35 IU/L
Creatine kinase (CK) 79 IU/L
Sodium (Na) 138 mEq/L
Potassium (K) 3.6 mEq/L
Chloride (Cl) 108 mEq/L
Severe anemia and decreased platelet count were observed.
Transvaginal ultrasound findings: A 65-mm mass was detected on the anterior uterine
wall. No notable findings were observed in the bilateral uterine appendages.
Pelvic MRI findings: The sagittal plane of the T2-weighted images showed a 65-mm
low-signal-intensity mass in the anterior uterine wall (shown in Figure 1a).
Cervical cytology: There were no special findings in the preoperative cervical and
endometrial cytology results.
Treatment course: Based on the aforementioned findings, she was diagnosed with
hypermenorrhea due to myoma or drugs. Dasatinib was discontinued, and she received
a transfusion of RBCs and Plts. To control hypermenorrhea, microwave ablation of the
inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance was
planned after obtaining written informed consent from the patient.
Endocrines 2022,3635
Endocrines 2022, 3, FOR PEER REVIEW 3
Potassium (K) 3.6
mEq/L
Chloride (Cl) 108
mEq/L
Severe anemia and decreased platelet count were observed.
Transvaginal ultrasound findings: A 65-mm mass was detected on the anterior
uterine wall. No notable findings were observed in the bilateral uterine appendages.
Pelvic MRI findings: The sagittal plane of the T2-weighted images showed a 65-mm
low-signal-intensity mass in the anterior uterine wall (shown in Figure 1a).
Figure 1. T2-weighted images of pelvic MRI (sagittal plane): (a) before surgery; (b) 3 months after
surgery. The myoma volume was reduced from 65 mm (before surgery) to 27 mm (3 months after
surgery).
Cervical cytology: There were no special findings in the preoperative cervical and
endometrial cytology results.
Treatment course: Based on the aforementioned findings, she was diagnosed with
hypermenorrhea due to myoma or drugs. Dasatinib was discontinued, and she received
a transfusion of RBCs and Plts. To control hypermenorrhea, microwave ablation of the
inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance
was planned after obtaining written informed consent from the patient.
Surgical findings: The patient underwent surgery in the lithotomy position with
intravenous anesthesia. Microwave ablation of the inflowing blood vessels to the uterine
myoma under transvaginal ultrasound guidance was performed using a Microtaze AFM-
712 (Alfresa Pharma Co., Osaka, Japan) and a coagulation needle electrode (CB-type,
CMD-16CBL-10/350) with a diameter of 1.6 mm and a length of 350 mm (Alfresa Pharma
Co., Osaka, Japan) (shown in Figure 2). The schema of the procedure is shown in Figure
Figure 1.
T2-weighted images of pelvic MRI (sagittal plane): (
a
) before surgery; (
b
) 3 months af-
ter surgery. The myoma volume was reduced from 65 mm (before surgery) to 27 mm (3 months
after surgery).
Surgical findings: The patient underwent surgery in the lithotomy position with
intravenous anesthesia. Microwave ablation of the inflowing blood vessels to the uterine
myoma under transvaginal ultrasound guidance was performed using a Microtaze AFM-
712 (Alfresa Pharma Co., Osaka, Japan) and a coagulation needle electrode (CB-type,
CMD-16CBL-10/350) with a diameter of 1.6 mm and a length of 350 mm (Alfresa Pharma
Co., Osaka, Japan) (shown in Figure 2). The schema of the procedure is shown in Figure 3.
After locating the inflowing vessels of the myoma under transvaginal ultrasound using a
color Doppler method (shown Figure 4a), direct ablation of these vessels was performed
using 2.45 GHz microwave with a needle electrode (shown in Figure 4b). Ablation per
lesion was performed using the following condition: power output of the Microtaze of
30 W
and ablation duration of 10 s
×
five sets. Ablation was applied to five lesions in the
feeding vessels around the myoma in the patient. The surgical time was 45 min. There
was a small amount of bleeding. The postoperative course was good. Therefore, she was
discharged at 4 h after surgery and followed up in an outpatient clinic.
Endocrines 2022,3636
Endocrines 2022, 3, FOR PEER REVIEW 4
3. After locating the inflowing vessels of the myoma under transvaginal ultrasound using
a color Doppler method (shown Figure 4a), direct ablation of these vessels was performed
using 2.45 GHz microwave with a needle electrode (shown in Figure 4b). Ablation per
lesion was performed using the following condition: power output of the Microtaze of 30
W and ablation duration of 10 s × five sets. Ablation was applied to five lesions in the
feeding vessels around the myoma in the patient. The surgical time was 45 min. There
was a small amount of bleeding. The postoperative course was good. Therefore, she was
discharged at 4 h after surgery and followed up in an outpatient clinic.
Figure 2. Microtaze AFM-712 generator and a coagulation needle electrode (Alfresa Pharma Co.,
Osaka, Japan).
Microwave ablation of the inflowing blood vessels to the uterine myoma under trans-
vaginal ultrasound guidance was performed using a Microtaze AFM-712 and a coagula-
tion needle electrode with a diameter of 1.6 mm and a length of 350 mm.
Figure 3. Schema of the procedure. After locating the inflowing vessels of the myoma under
transvaginal ultrasound using a color Doppler method, direct ablation of the feeding vessels of the
myoma was performed using 2.45 GHz microwave with a needle electrode.
Figure 2.
Microtaze AFM-712 generator and a coagulation needle electrode (Alfresa Pharma Co.,
Osaka, Japan).
Endocrines 2022, 3, FOR PEER REVIEW 4
3. After locating the inflowing vessels of the myoma under transvaginal ultrasound using
a color Doppler method (shown Figure 4a), direct ablation of these vessels was performed
using 2.45 GHz microwave with a needle electrode (shown in Figure 4b). Ablation per
lesion was performed using the following condition: power output of the Microtaze of 30
W and ablation duration of 10 s × five sets. Ablation was applied to five lesions in the
feeding vessels around the myoma in the patient. The surgical time was 45 min. There
was a small amount of bleeding. The postoperative course was good. Therefore, she was
discharged at 4 h after surgery and followed up in an outpatient clinic.
Figure 2. Microtaze AFM-712 generator and a coagulation needle electrode (Alfresa Pharma Co.,
Osaka, Japan).
Microwave ablation of the inflowing blood vessels to the uterine myoma under trans-
vaginal ultrasound guidance was performed using a Microtaze AFM-712 and a coagula-
tion needle electrode with a diameter of 1.6 mm and a length of 350 mm.
Figure 3. Schema of the procedure. After locating the inflowing vessels of the myoma under
transvaginal ultrasound using a color Doppler method, direct ablation of the feeding vessels of the
myoma was performed using 2.45 GHz microwave with a needle electrode.
Figure 3.
Schema of the procedure. After locating the inflowing vessels of the myoma under
transvaginal ultrasound using a color Doppler method, direct ablation of the feeding vessels of the
myoma was performed using 2.45 GHz microwave with a needle electrode.
Endocrines 2022, 3, FOR PEER REVIEW 5
Figure 4. Intraoperative transvaginal ultrasound: (a) After locating the inflowing vessels of the
myoma under transvaginal ultrasound using a color Doppler method (⇒); (b) microwave ablation
of the inflowing feeding vessels of uterine fibroids using a needle-shaped deep coagulation
electrode under transvaginal ultrasound guidance can be confirmed as a hyperechoic area. (⇒⇒).
Subjective assessment using the visual analog scale showed a considerable improve-
ment in clinical symptoms.
HB level increased significantly from 2.7 g/dL before surgery to 13.2 g/dL after sur-
gery.
Postoperative course: Menstruation resumed at 45 days after surgery. Subjective
assessment using the visual analog scale showed a considerable improvement in clinical
symptoms (the score for hypermenorrhea improved from 10 [before surgery] to 1 [after
surgery]; that for algomenorrhea improved from 10 [before surgery] to 2 [after surgery])
(shown in Figure 5). The Hb value considerably increased to 12.3 g/dL (shown in Figure
6). In addition, the myoma size reduced from 65 mm [before surgery] to 27 mm [3 months
after surgery] (shown in Figure 1b). No complications were noted during the course. No
hypermenorrhea recurrence was observed at 18 months after surgery. This patient is cur-
rently undergoing infertility treatment.
Figure 4.
Intraoperative transvaginal ultrasound: (
a
) After locating the inflowing vessels of the
myoma under transvaginal ultrasound using a color Doppler method (
⇒
); (
b
) microwave ablation of
the inflowing feeding vessels of uterine fibroids using a needle-shaped deep coagulation electrode
under transvaginal ultrasound guidance can be confirmed as a hyperechoic area. (⇒⇒).
Endocrines 2022,3637
Microwave ablation of the inflowing blood vessels to the uterine myoma under
transvaginal ultrasound guidance was performed using a Microtaze AFM-712 and a coagu-
lation needle electrode with a diameter of 1.6 mm and a length of 350 mm.
Subjective assessment using the visual analog scale showed a considerable improve-
ment in clinical symptoms.
HB level increased significantly from 2.7 g/dL before surgery to 13.2 g/dL after surgery.
Postoperative course: Menstruation resumed at 45 days after surgery. Subjective
assessment using the visual analog scale showed a considerable improvement in clinical
symptoms (the score for hypermenorrhea improved from 10 [before surgery] to 1 [after
surgery]; that for algomenorrhea improved from 10 [before surgery] to 2 [after surgery])
(shown in Figure 5). The Hb value considerably increased to 12.3 g/dL (shown in Figure 6).
In addition, the myoma size reduced from 65 mm [before surgery] to 27 mm [3 months
after surgery] (shown in Figure 1b). No complications were noted during the course.
No hypermenorrhea recurrence was observed at 18 months after surgery. This patient is
currently undergoing infertility treatment.
Endocrines 2022, 3, FOR PEER REVIEW 6
Hypermenorrhea Dysmenorrhea
Figure 5. Evaluation of menorrhagia and dysmenorrhea before and after surgery using a visual
analog scale.
Figure 6. Changes in hemoglobin (Hb) levels.
3. Discussion
MEA, which includes 2.45 GHz microwave irradiation and ablation of the
endometrial basal layer, reportedly has clinical benefits as a substitution therapy so that
total hysterectomy for hypermenorrhea can be avoided [1,6,7]. MEA may have therapeutic
effects on uterine myoma. Although MEA can be expected to have a therapeutic effect on
uterine fibroids, there are some cases in which additional treatment is required due to
postoperative recurrence [4,5] This may be caused by a dilated uterine cavity due to
enlarged myomas after MEA, resulting in endometrial regeneration over time. UAE, F
MRgFUS, and transcervical microwave myolysis (TCMM) are available as uterine-sparing
treatments for uterine fibroids associated with menorrhagia that can be performed in Ja-
pan.
UAE is an interventional radiology approach for transcatheter embolization of the
uterine artery. Since Ravina in France reported about UAE being used as a treatment for
uterine myoma in 1995 [8], it has drawn attention as a minimally invasive alternative
treatment for total hysterectomy. UAE has been widely used worldwide, mainly as a
treatment for symptomatic uterine myoma. UAE has been reported to be equally effective
in improving clinical symptoms, such as hypermenorrhea, and patient satisfaction
compared with operative management, which includes total hysterectomy and
myomectomies [9,10]. In contrast, the most common complication of UAE is postoperative
fever, followed by pain, endometritis, uterine adhesions, and uterine necrosis [10,11]. In
addition, regarding reproductive function following the UAE [12], ovarian dysfunction
has been reported to not be observed, and it is also used for women who wish to become
pregnant. However, other complications of UAE that may affect fertility include ovarian
failure and secondary amenorrhea caused by endometrium atrophy and uterine cavity
adhesions [9,13]. The possible effects of UAE on the uterine adnexa may include ovarian
failure caused by reduced blood flow to the ovaries, infection-related damage to the
fallopian tubes, and infertility due to these factors. There are some studies on pregnancy
Figure 5.
Evaluation of menorrhagia and dysmenorrhea before and after surgery using a visual
analog scale.
Endocrines 2022, 3, FOR PEER REVIEW 6
Hypermenorrhea Dysmenorrhea
Figure 5. Evaluation of menorrhagia and dysmenorrhea before and after surgery using a visual
analog scale.
Figure 6. Changes in hemoglobin (Hb) levels.
3. Discussion
MEA, which includes 2.45 GHz microwave irradiation and ablation of the
endometrial basal layer, reportedly has clinical benefits as a substitution therapy so that
total hysterectomy for hypermenorrhea can be avoided [1,6,7]. MEA may have therapeutic
effects on uterine myoma. Although MEA can be expected to have a therapeutic effect on
uterine fibroids, there are some cases in which additional treatment is required due to
postoperative recurrence [4,5] This may be caused by a dilated uterine cavity due to
enlarged myomas after MEA, resulting in endometrial regeneration over time. UAE, F
MRgFUS, and transcervical microwave myolysis (TCMM) are available as uterine-sparing
treatments for uterine fibroids associated with menorrhagia that can be performed in Ja-
pan.
UAE is an interventional radiology approach for transcatheter embolization of the
uterine artery. Since Ravina in France reported about UAE being used as a treatment for
uterine myoma in 1995 [8], it has drawn attention as a minimally invasive alternative
treatment for total hysterectomy. UAE has been widely used worldwide, mainly as a
treatment for symptomatic uterine myoma. UAE has been reported to be equally effective
in improving clinical symptoms, such as hypermenorrhea, and patient satisfaction
compared with operative management, which includes total hysterectomy and
myomectomies [9,10]. In contrast, the most common complication of UAE is postoperative
fever, followed by pain, endometritis, uterine adhesions, and uterine necrosis [10,11]. In
addition, regarding reproductive function following the UAE [12], ovarian dysfunction
has been reported to not be observed, and it is also used for women who wish to become
pregnant. However, other complications of UAE that may affect fertility include ovarian
failure and secondary amenorrhea caused by endometrium atrophy and uterine cavity
adhesions [9,13]. The possible effects of UAE on the uterine adnexa may include ovarian
failure caused by reduced blood flow to the ovaries, infection-related damage to the
fallopian tubes, and infertility due to these factors. There are some studies on pregnancy
Figure 6. Changes in hemoglobin (Hb) levels.
3. Discussion
MEA, which includes 2.45 GHz microwave irradiation and ablation of the endometrial
basal layer, reportedly has clinical benefits as a substitution therapy so that total hysterec-
tomy for hypermenorrhea can be avoided [
1
,
6
,
7
]. MEA may have therapeutic effects on
uterine myoma. Although MEA can be expected to have a therapeutic effect on uterine
fibroids, there are some cases in which additional treatment is required due to postop-
erative recurrence [
4
,
5
] This may be caused by a dilated uterine cavity due to enlarged
myomas after MEA, resulting in endometrial regeneration over time. UAE, F MRgFUS,
and transcervical microwave myolysis (TCMM) are available as uterine-sparing treatments
for uterine fibroids associated with menorrhagia that can be performed in Japan.
Endocrines 2022,3638
UAE is an interventional radiology approach for transcatheter embolization of the
uterine artery. Since Ravina in France reported about UAE being used as a treatment for
uterine myoma in 1995 [
8
], it has drawn attention as a minimally invasive alternative
treatment for total hysterectomy. UAE has been widely used worldwide, mainly as a
treatment for symptomatic uterine myoma. UAE has been reported to be equally effective in
improving clinical symptoms, such as hypermenorrhea, and patient satisfaction compared
with operative management, which includes total hysterectomy and myomectomies [
9
,
10
].
In contrast, the most common complication of UAE is postoperative fever, followed by
pain, endometritis, uterine adhesions, and uterine necrosis [
10
,
11
]. In addition, regarding
reproductive function following the UAE [
12
], ovarian dysfunction has been reported to
not be observed, and it is also used for women who wish to become pregnant. However,
other complications of UAE that may affect fertility include ovarian failure and secondary
amenorrhea caused by endometrium atrophy and uterine cavity adhesions [
9
,
13
]. The
possible effects of UAE on the uterine adnexa may include ovarian failure caused by
reduced blood flow to the ovaries, infection-related damage to the fallopian tubes, and
infertility due to these factors. There are some studies on pregnancy and birth after
UAE [
14
,
15
]. However, some studies on UAE reported a higher incidence of miscarriage [
14
]
and placental abnormalities, such as placenta accreta [15], after UAE. Therefore, pregnant
women after UAE require strict perinatal management.
MRgFUS is a conservative treatment for uterine myoma. In this method, high-power
ultrasound, also referred to as high-intensity focused ultrasound, is converted into thermal
energy, leading to coagulation necrosis in the focal area. MRgFUS in combination with
real-time MRI is a noninvasive extracorporeal thermal ablation method for the treatment of
myoma. Reduced myoma volume and improved clinical symptoms, such as hypermenor-
rhea, have been reported [
16
]. However, irradiation of a large myoma is time-consuming.
Additionally, reduced effects of ablation in patients with obesity and degenerated myoma
may lead to an increase in the size of myoma and relapse of clinical symptoms [
16
]. In
Japan, this therapy is not indicated for patients who wish to have children.
Similar to the development of our treatment, using microwaves, TCMM can be used
for ablation of the uterine myoma. TCMM, including MEA for uterine myoma itself,
uses a needle-type electrode compatible with a sounding applicator for MEA, which was
developed based on conventional electrodes for endometrial ablation. The clinical effects of
TCMM, including improved hypermenorrhea and anemia and a reduction in myoma size,
have been reported [
17
–
19
]. However, the ablation of a large myoma is time-consuming
because the range of ablation is approximately 6 mm from the surface of the sounding
applicator. In addition, owing to the large diameter (4 mm) of a sounding applicator
used for ablation, TCMM may cause surgical stress. Furthermore, because no study has
examined the therapeutic effects of TCMM alone, the method that contributed to the success
of this intervention is unknown.
Thus, in this study, we performed a treatment involving microwave ablation of the
inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance.
In this method, the location of the inflowing blood vessels of the myoma was identified
prior to ablation using the color Doppler method. Then, microwave ablation of the selected
inflowing blood vessels was performed under ultrasound guidance. This treatment may
have contributed to the reduction in surgical time. Microwave ablation of the the inflowing
blood vessels vessels of the myoma not only reduced blood flow but also improved clin-
ical symptoms, such as hypermenorrhea and anemia, thereby resulting in a reduction in
myoma size. In addition, the narrow coagulation needle electrode (1.6 mm diameter) used
for the ablation of the inflowing blood vessels of the myoma may be useful for minimally
invasive surgery.
Conventional MEA, which includes ablation of the endometrium (including basal
layer) to reduce the amount of menstruation by preventing cyclic endometrial regeneration,
is not indicated for the treatment of women wishing to conceive. MRgFUS and TCMM,
which are conservative treatments for uterine myoma, are also not indicated for the treat-
Endocrines 2022,3639
ment of women wishing to conceive. Furthermore, UAE reduces blood flow in some cases,
which may have a negative effect on the uterus and ovaries. Therefore, caution should be
exercised when considering ablation in women wishing to conceive. The method used in
this study included direct microwave ablation of the inflowing blood vessels of the myoma
without ablation of the endometrium. Thus, this method may minimize the reduction in
blood flow to the uterus and ovaries. Improved clinical symptoms in the present study
suggest the clinical utility of our method as a conservative treatment for women with uter-
ine myoma who prefer fertility preservation. Recent lifestyle changes among women have
resulted in a significant trend of late marriages and pregnancies. Therefore, in several cases,
symptomatic uterine myoma in women of reproductive age requires not only minimally
invasive treatment but also management focusing on fertility preservation.
Further studies with a larger sample size and long-term follow-up of cases with
uterine myoma with hypermenorrhea who underwent the procedure should examine the
effects of such treatments from various perspectives, such as clinical efficacy, safety, and
postoperative changes in hormone dynamics.
Microwave ablation of the inflowing blood vessels to the uterine myoma under
transvaginal ultrasound guidance showed efficacy and safety, which was comparable to
those exhibited by conventional MEA. Furthermore, this method also reduced the myoma
size. These findings suggest that this method is a novel treatment option for patients with
myoma-related hypermenorrhea who wish to preserve their fertility and have children.
Author Contributions:
Conceptualization, T.K.; data curation, T.K., T.O., T.S., A.S., R.O., M.K., A.K.,
K.K., K.Y., N.T. and M.O.; methodology, T.K.; investigation, T.K., T.O., T.S., A.S., R.O., M.K., A.K., K.K.,
K.Y., N.T. and M.O.; formal analysis, T.K.; writing—original draft preparation, T.K.; writing—review
and editing, T.K. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement:
Study approval statement: this study is approved by the
ethics committee of the International University of Health and Welfare Hospital Approval Number:
referral number: 20-B-399.
Informed Consent Statement:
Informed and written consent was obtained from all subjects involved
in the study.
Data Availability Statement:
The datasets generated during and/or analyzed during the current
study are available from the corresponding author on reasonable request.
Conflicts of Interest: The authors declare no conflict of interest.
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