2 The condition, current treatments and procedure

2 The condition, current treatments and procedure

The condition

2.1 Uterine fibroids are benign tumours of the uterine wall. They can be asymptomatic or cause symptoms including menorrhagia, intermenstrual bleeding, pelvic pressure or pain, and urinary incontinence. They can be associated with fertility problems and miscarriage.

Current treatments

2.2 Treatment depends on whether the fibroids cause symptoms, and if the person would like to have children in the future. For symptomatic fibroids, treatment options include medications, interventional radiology and surgery. Interventional radiology treatments include uterine artery embolisation and MRI-guided focused ultrasound. Surgery includes hysterectomy, myomectomy, endometrial ablation techniques and myolysis.

The procedure

2.3 Ultrasound-guided high-intensity transcutaneous focused ultrasound (HIFU) for symptomatic uterine fibroids is done with the patient lying face down, with the abdominal wall immersed in degassed water. Intravenous sedation may be used to help minimise body movement. A urinary catheter is inserted to keep the bladder empty during the procedure. Continuous sonographic imaging is used to identify the fibroid(s) with a real-time diagnostic ultrasound scanner integrated into the centre of a therapeutic ultrasound transducer. After the target fibroid has been confirmed, it is ablated by high-intensity ultrasound energy. The patient may have to lie still for up to 3 hours.

2.4 Ultrasound-guided HIFU uses grayscale or echogenicity changes to determine the adequacy of ablation. After treatment, imaging (by ultrasound or MRI scan) is used to evaluate the volume of the fibroid ablated.

  • National Institute for Health and Care Excellence (NICE)