Healthcare Professionals
Women today are empowered to consider their options regarding careers, family status and health. As such, women are keen to consider alternatives when faced with making decisions regarding choice of medical treatment – especially for those decisions which impact on their bodies and their sense of self as a woman.
Surgical treatment of Heavy Menstrual Bleeding (HMB) often follows failed or ineffective medical therapy. However, in approximately half of all cases referred to a gynaecologist, there is no clear pathology for HMB. Hysterectomy is carried out on 60% of women referred to secondary care with HMB.
Hysterectomy is, however, associated with a high level of post-operative complications, occasional mortality and is believed to increase the risk of developing other diseases and conditions, including urinary incontinence. Women undergoing hysterectomy require a period of convalescence before resuming normal activities.
Concerns about the safety of hysterectomy, the increasing weight being given to patient preference and the high cost of hysterectomy mean that hysterectomy should no longer be considered to be the primary surgical option for women with HMB.
One study has shown that 36% of women referred to a gynaecologist had a treatment preference. Many experts have argued that patient preference should be an important guide to treatment choice, and may strongly influence outcome success.
Less invasive surgical techniques have been introduced with the purpose of removing the entire thickness of the endometrium while leaving the uterus intact and producing amenorrhoea or hypomenorrhoea. These techniques are generically called Endometrial Ablation (EA) techniques.
Microwave Endometrial Ablation: MEA – a third-generation EA treatment that has substantial benefits compared to alternative methods of EA. Treatment time for the actual procedure (i.e. excluding anaesthetic preparation etc.) is approximately three minutes, which is substantially less than other methods of EA (e.g. balloon ablation takes 8-20 minutes). Very few complications of surgery have been recorded and rates of further surgery are extremely low.
The MEA treatment has the following advantages over current surgical and ablative procedures on the market:
• Safe: No risk of fluid overload
• Office, day or outpatient procedure
• Minimally invasive procedure, no abdominal scars or cutting
• Short recovery period with minimal post-operative pain
• Improved or non-existent dysmenorrhoea (period pain)
• Option for general or local anaesthetic
• High patient satisfaction and amenorrhoea rate
• Ability to treat irregular cavities and those with fibroids.
Hysterectomy is not the only or the best option for treating HMB
Patients should be advised
of all treatment options and
their associated risks and
benefits so that she can
work with her doctor to
choose the treatment that is
best for her.
MEA is being used by gynaecologists across Europe, the US and Canada and in Australia. Here are some of their comments:
Mr David Parkin
Consultant Obstetrician and Gynaecologist
Aberdeen Royal Infirmary, U.K.
'It’s difficult to estimate really how many women suffer from menorrhagia, but at least 1 in 10 women will see their GP complaining of heavy periods at some stage.
You can do MEA under both local and general anaesthetic. Approximately 90 per cent of MEA patients are satisfied with the result when followed up to one year.
The advantage of MEA over TCRE is it requires less training and less hand/eye co-ordination. MEA is both effective and simple. MEA will be safer than TCRE when performed by the majority of gynaecologists.
I think that, as MEA is as effective as TCRE and easy to learn it will undoubtedly have a major role to play in the future.'
Mike Milligan
Consultant Obstetrician and Gynaecologist
Kent and Canterbury Hospital, U.K.
'The gynaecologist spends a considerable amount of time dealing with menorrhagia. I would estimate in my practice that at least 20-30 percent of time I spend is dealing with menorrhagia.
Microwave Endometrial Ablation is a very safe technique. It is a technique, which can be easily learnt, and it is also a technique, which is suitable for use in a day surgical unit.
From the results so far the success of MEA can match any other form on endometrial ablation. What is very striking is the lack of problems you have and the lack of complications.
MEA provides an effective form of treatment for menorrhagia without tying up a huge amount of resources in our main theatres, which are extremely expensive to run.
I think we have finally found a safe, simple and effective surgical treatment for menorrhagia, which is going to relieve the distress of this condition which occurs in so many of our patients.'
Mr Ellis Downes
Consultant Obstetrician & Gynaecologist
Chase Farm Hospital, Enfield, UK.
'We've been delighted with MEA. It’s been straightforward to learn and there have been no serious complications. More importantly our patients have also been delighted'.
Professor Peter O'Donovan
Consultant Obstetrician & Gynaecologist,
Bradford Royal Infirmary, UK.
'It’s a good day case procedure and our patients have been very satisfied with it. I am using it more and more to treat menorrhagia instead of hysterectomy'.
