Does menstrual bleeding decrease after ablation of intramural myomas? A retrospective study.

STUDY OBJECTIVE

To evaluate the effect of radiofrequency volumetric thermal ablation (RFVTA) on menstrual bleeding in patients with intramural myomas.

DESIGN

Retrospective analysis of a recently completed prospective trial of laparoscopic ultrasound-guided RFVTA in which 135 subjects had objectively measured heavy menstrual bleeding (≥160 to ≤500 mL) and confirmed submucosal, intramural, and subserosal myomas. We analyzed the pretreatment monthly menstrual blood loss as well as the response to treatment based on the types of myomas, specifically those subjects with only intramural myomas versus those with only submucosal myomas or those with both (Canadian Task Force classification II-2).

SETTING

Outpatient hospital and private surgery centers.

PATIENTS

One hundred thirty-five premenopausal symptomatic women (mean age: 42.4 ± 4.5 years) with uterine myomas and heavy menstrual bleeding confirmed by alkaline hematin analysis.

INTERVENTIONS

Laparoscopic ultrasound-guided RFVTA.

MEASUREMENTS AND MAIN RESULTS

Menstrual blood loss (MBL) at baseline and at 12 months after the procedure was quantified in 122 subjects with intramural myomas (including those that abut the endometrium, those that are within the myometrium, and those that extend from the serosa into the myometrium) and/or submucous myomas. Although 91.8% (112/122) of these subjects had 1 or more intramural myomas, submucous myomas were present in fewer than half of the subjects ([48.4%]). We identified 10 subjects who had submucous but no intramural myomas. This group had a significant (-45.1%) posttreatment decrease in monthly bleeding (95% confidence interval [CI], -78.0% to -12.2%; p = .013). In this same study, there were 63 subjects with intramural myomas and no submucosal myomas, and their posttreatment decrease in MBL of -31.8% was also clinically and statistically significant (95% CI, -41.4% to -22.2%; p<.001). Of those 63 subjects was a subset with intramural myomas (n = 27) without myomas abutting the endometrium or submucous myomas; this third set also resulted in a clinically and statistically significant reduction in MBL (-25.0% and -65.22 mL; 95% CI, -38.8% to -11.2%; p = .001).

CONCLUSION

Although it has been known that the treatment of submucous myomas results in a reduction of MBL, this is the first study to show that radiofrequency ablative therapy for intramural myomas without a submucosal component will also result in a significant reduction in menstrual blood loss.