Successful microwave endometrial ablation in a uterus enlarged by adenomyosis.

Adenomyosis can cause severe menorrhagia, which is a common indicator of the need for hysterectomy. None of the ablative techniques developed over the last two decades are of use in treating menorrhagia in a uterus enlarged by deep adenomyosis. Using a curved microwave applicator specifically developed for enlarged uterine cavities, microwave endometrial ablation at a frequency of 2.45 GHz was successfully applied in the treatment of menorrhagia in a patient with adenomyosis and an enlarged uterine cavity 12 cm in length. Two weeks after the operation, the patient experienced a menstrual period of ten days with no flooding. Menstrual duration gradually decreased to six days over the following six months. The quality of life score recovered to within the normal range six months after the operation. The post-operative sub-endometrial low signal intensity zone on the T2-weighted magnetic resonance images, which corresponds to the region of necrotic tissue, vanished 12 months after the operation. Although microwave endometrial ablation using the curved applicator could not treat bleeding from deep adenomyosis lesions, it improved menorrhagia in the uterus, which would conventionally require a hysterectomy.