Patients desire effective therapy for their symptomatic fibroids with the least amount of intervention and the shortest recovery possible. Within Australia, only two non-surgical techniques exist. Uterine artery emobolisation (UAE) has been used for more than 20 years with good success. Clinical trials demonstrate similar outcomes for quality of life (QOL) scores when compared to surgical approaches, but higher reoperation rates long term. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) involves focussed ultrasound beam on the fibroid which heats it to a temperature which results in tissue necrosis. It requires no surgical intervention, but has several exclusion criteria. Overall, it has lower QOL and higher re-oepration rates than UAE.
Laparoscopic and hysteroscopic radiofrequency ablation (RFA) devices are not available in Australia. RFA uses monopolar current at frequencies between 300 kHz and 500 kHz to heat tissue to 80C to 105C, which results in coagulation and necrosis of tissue. Laparoscopic RFA devices have shown a significant reduction in menstrual bleeding and fibroid volume and significant improvements in quality of life. RFA had similar outcomes when compared to laparoscopic myomectomy. Transcervical RFA has also shown significant reductions in fibroid volume, menstral blood loss and symptoms scores at 12 months follow up and further studies are currently being undertaken.
There is minimal evidence available for fertility after these procedures.