Microwave endometrial ablation: development and clinical application

Heavy menstrual bleeding is a common problem. Hysterectomy has been the standard treatment for women with heavy menstrual bleeding who have not responded to medical treatment. Minimally invasive procedures to destroy the lining of the uterus (the endometrium) are alternatives to hysterectomy. They involve destroying the endometrium using lasers, radiofrequency waves, electrocautery, microwaves, heated saline, or a heated balloon. Microwave endometrial ablation (MEA) is one of these minimally invasive procedures. In this Chapter, use of microwave MEA in the management of heavy menstrual bleeding is described. MEA was developed in Bath, UK in the mid 1990s. MEA is a second-generation method of EA, which involves the use of microwaves at a fixed frequency of 9.2 GHz to destroy the endometrial lining. Initial results for MEA were encouraging, with active treatment times of less than three minutes and high satisfaction rates. Recent studies also showed an equivalent outcome with regards to patients' satisfaction and health-related quality-of-life issues. The procedure, indications, contraindications, principles of operation, potential risks, results, and patient-satisfaction is described herein.