ISP-26-5

The 75th Annual Congress of
the Japan Society of Obstetrics and Gynecology
Tokyo 12 May 2023

Clinical practice and short‐term efficacy ofmicrowave endometrial ablation
for treating menorrhagia in an outpatient clinic
Naoki Matsumoto
Matsumoto Women's Health Clinic

Background
MEA, 2.45-GHz microwave endometrial ablation with hysteroscopy
AFM-712Microtaze® (Alfresa Pharma, Japan)

Sounding Applicator® (intrauterine ablation device)

Flexible Hysteroscope (Pentax Medical, Japan)

Method

MEA procedures and patients

Indication

Organic/functional menorrhagia
No need of spearing fertility

MEA

Performed as a 1-day surgery

Anesthesia

Thiamylal sedation and paracervical block.

Study period

2016–2021 (6 years)

Patients

31 patients treated with MEA(A patient who was diagnosed with atypical polypoid adenomyoma was excluded from this study)

Method

Study design

Data collection

Patients' medical records
Pre-/postoperative VAS questionnaire for each symptom

MEA outcome
Effective

Evaluated in 6 and 12 months after treatment.
Patients with reduced menorrhagia and no anemia
without hysterectomy
Hysterectomy or other surgical therapy after MEA

MEA Failure

The control group for comparison
82 patients with menorrhagia who were treated with LNGIUS insertion
during the same period.
VAS: Visualized analog scale scoring 0–100
LNGIUS: Levonorgestrel-containing intrauterine system

Results
Characteristics
of 31 MEA and82 LNGIUS
cases for thetreatment ofmenorrhagia*Significantly
differentResults
MedianMEA procedures summary
7Ablation number

12 minVAS 28Operative time†

VAS score of perioperative pain

†From starting the first ablation to ascertaining sufficient ablation by hysteroscopy

Results

Survival graphs without
treatment failure†ns†Treatment failure:
Hysterectomy in the MEA group(2 cases in 24 months)

MEA

100% 96%89%

LNGIUS

95% 92%86%Months

Device expulsion or discontinuationin the LNGIUS group(8 cases in 24 months)

ns: not significant

Results
AgeDiagnosis
Exam/lab findings

Number of ablation
Period at hysterectomy
Reason of hysterectomy

Hysterectomy after MEA
Case 1Case 2
41 y, Para 1, Schizophrenia
47 y, Para 1, Smoker
Adenomyosis, Menorrhagia,
Adenomyosis, Menorrhagia, Anemia,
Dysmenorrhea, Anemia
History of LNGIUS expulsion
Hemoglobin 9.2 g/dL
Hemoglobin 11.3 g/dL
Uterus 10 × 6 cm, LNGIUS-ineffective Uterus 12 × 8 cm

66 months after MEA
Severe dysmenorrhea

1017 months after MEA
Recurrence of menorrhagia

Results

LNGIUS

The effective group:
patients with reduced
menorrhagia and noanemia

Effective95%

Effective
96%

nsns

MEA

Efficacy outcome

Effective
90%

Effective91%

in 6 months

in 12 months

Results

Changes in theMEALNGIUS

10.6* 13.8 13.8

12.4* 13.7 13.9

PrePre(g/dL)

medianHemoglobin concentration

6M

12M

6M

12M

*significantly different from another groupResults

Changes in the VAS scores:

LNGIUS

100* 11*

25

77*

24*

20Pre

12M

Pre

6M

12M

VAS score

medianMEA

Menstrual bleeding

6M*significantly different from another groupResults

27*

MEA

Menstrual pain

0*

075*

6M

12M

Pre

LNGIUS
12*

13

6M

12M

VAS score

medianChanges in the VAS scores:Pre*significantly different from another groupResults
50

MEA

Fatigue

725

48

6M

12M

Pre

LNGIUS
2019

6M

12M

VAS score

medianChanges in the VAS scores:Pre*significantly different from another groupResults

MEA

100*90

6M

12M

Satisfaction
LNGIUS

90*90

VAS score

medianChanges in the VAS scores:

6M

12M

*significantly different from another groupResults
GradeMildModerate

Adverse events after MEA
Adverse events
Endometritis
Hematometra

Number (%) (excluding slight events)
2 (6%)
1 (3%)

Ultrasound imagesof the right casePost-MEA Hematometra (Fig. B)
AgeDiagnosis
Pre-MEA exam/lab finding

Number of ablation
Period at the adverse event
Treatment

37 y, Para 3
Multiple fibroids, Menorrhagia,
Dysmenorrhea, Anemia
Hemoglobin 10 g/dL
Uterus 10 × 6 cm
Submucosal fibroid 3 cm (Fig A)
1018 months
Drainage, successful

FigureA

A. Pre-MEA image.
Submucosal fibroid
3 cm

B

B. Hematometra
4 cm

Discussion

Summary MEA was safely performed in the outpatient clinic.
 Fibroma and anemia were more frequently observed in the MEA groupthan in the LNGIUS group.
 However, equally effectively treated in the MEA groupat 6 months (96% vs. 90%) and at 12 months (95% vs. 91%).
 MEA had high short-term efficacy in alleviating menorrhagia symptoms.
 Patients with uterine fibroids who seem unsuitable for the LNGIUS
treatment can be treated with MEA.

Discussion
Short-term
MEA efficacy
reported on
the recentliteraturesin Japan

Conclusion

MEA performed as a 1-day surgery
is an effective therapeutic option
in outpatient clinics.