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Assessment of New Technology in the Treatment of Idiopathic Menorrhagia and Uterine Leiomyomata

From the University of Utah Health Sciences Center, Salt Lake City, Utah.

New technologies available for the treatment of idiopathic menorrhagia include five global endometrial ablation devices that use differing ablative methods, including thermal balloon, circulated hot fluid, cryotherapy, radiofrequency electrosurgery, and microwave energy. All have been compared with rollerball endometrial ablation by way of randomized clinical trials and are associated with high patient satisfaction rates, regardless of method, but a wide range of amenorrhea rates (13.9–55.3%). They are associated with low complication rates when performed by well-trained physicians following protocols in Food and Drug Administration trials. Some serious complications have been reported subsequently. Strict adherence to patient selection criteria and manufacturer protocols is strongly recommended.

New technologies for the treatment of uterine leiomyomata include uterine artery embolization, magnetic resonance–guided focused ultrasonography, laparoscopic uterine artery occlusion, and cryomyolysis. There is sound evidence for shorter hospital stay, quicker return to work, and a similar major complication rate compared with hysterectomy. Uterine artery embolization appears to be effective for up to 5 years in reducing bulk symptoms and menorrhagia associated with leiomyomata. The chance of reoperation for leiomyoma-related symptoms within 5 years is 20–29%. Women who wish to become pregnant should be cautioned about potential complications during pregnancy. There is insufficient evidence to recommend uterine artery embolization in postmenopausal women. With regard to magnetic resonance–guided focused ultrasonography, cryomyolysis, and laparoscopic uterine artery occlusion, although the initial symptom reduction outcomes have been reported as favorable, more data are needed to better understand the durability of these results.