Magnetic resonance imaging [MRI] is used to guide high powered focused ultrasound to target the fibroid. Pulses heat up part of fibroid and ablate it. This process needs to be done a number of times.
Myolysis is the coagulation of the blood supply to the fibroid using a laser. The fibroid then should shrink and die. Fibroid size can be reduced by 30-50%. It is not always successful.
These are new techniques and very few centres in the UK perform it. The number of procedures is unknown. It was first performed in the late '80s.
MR-Guided Focused Ultrasound
The woman lies on a specially adapted bed inside an MRI scanner. Pulses of high-powered focused ultrasound cause part of the fibroid to heat up and ablate. This is done a number of times on different parts of the fibroid to ensure that ablation is complete. There are cooling periods between each treatment. The procedure is carried out under conscious sedation and normally takes 2-3 hours.
A laser is inserted into the uterus via a laparoscope. It is then inserted into the fibroids and coagulates the blood supply. Two different types of laser can be used - a Nd:YAG laser and bipolar needles.
A fibroid of up to 10cm can be treated. Women are not usually treated by myolysis if there are more than 4 fibroids, each of 5cm or more. Each 8cm fibroid takes approximately 30 minutes to treat with a laser.
Normally drug treatment is given for 3 to 6 months before myolysis to reduce the size of the fibroid(s). If they do not shrink by at least 30%, myolysis is not attempted.
Myolysis can be performed by itself or in combination with other procedures such as myomectomy or endometrial ablation.
A general anaesthetic is required.
This depends on which treatment has been performed. Focused ultrasound is normally a day case and women can go home later that day. In some centres performing myolysis alone patients can go home the same day. If there is combination treatment with myomectomy hospital stay is much longer.
Again, this will depend on the procedure used. With Focused Ultrasound normal activity can be resumed in 3-4 days.
It is essential that women do not become pregnant after myolysis. There have been a number of cases of uterine rupture one ending in the death of the baby.
Myolysis is not always effective at reducing the size of the fibroid. Cryomyolysis only reduces fibroids by 10% with some increasing in size. Adhesions (tissues grow into one another after surgery causing severe pain and requiring surgical correction) can occur.
Although fertility is maintained this is not a treatment option for women with pregnancy wishes.
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Thanks to all who took part in our survey about the information and choices for their fibroid treatment. Please click here for the Patient Information and Choice Survey report and here for our report on access to UFE treatment with The Medical Technology Group and All Party Parliamentary Group on Improving Patient Access to Medical Technologies.
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