Radiofrequency ablation for uterine fibroids

A guide to radiofrequency ablation for uterine fibroids

Radiofrequency ablation is one of the treatment options available for certain symptomatic uterine fibroids. Its aim is not to remove the fibroid during the procedure, but to apply controlled thermal energy within it to produce a gradual reduction in its volume and associated symptoms.

Not all fibroids require treatment, and not all are suitable for radiofrequency ablation. The decision depends on the patient’s symptoms, the number of fibroids, their size and location, her medical history and reproductive plans.

When might a fibroid need treatment?

Many uterine fibroids cause no symptoms and require only monitoring. Treatment may be considered when they cause problems such as heavy menstrual bleeding, anaemia, pelvic pain or pressure, a sensation of heaviness or certain fertility-related difficulties.

The decision does not depend solely on the size of the fibroid. Its location, number, progression and impact on quality of life are also important when selecting treatment.

Which fibroids can be treated using radiofrequency ablation?

The indication must be established following a gynaecological assessment and ultrasound examination. The number, size and location of the fibroids, together with their relationship to the uterine cavity and other structures, help determine whether radiofrequency ablation is an appropriate option.

There is no single technique suitable for every type of fibroid. Fibroids that grow into the uterine cavity may be better suited to hysteroscopic treatment, while other fibroids may require radiofrequency ablation, laparoscopy or alternative approaches.

For this reason, the choice of procedure should be made after assessing the specific characteristics of the uterus and fibroids.

How is transvaginal radiofrequency ablation performed?

The procedure is performed under ultrasound guidance. A specialised needle or electrode is introduced transvaginally into the fibroid, where radiofrequency energy is applied in a controlled manner.

The heat generated produces an area of coagulation within the treated tissue. The body subsequently reabsorbs this tissue gradually, so the fibroid decreases in volume over time.

Ultrasound allows the specialist to locate the fibroid and monitor the position of the device during energy delivery.

Fibroid reduction is gradual

Radiofrequency ablation does not remove the fibroid immediately. Following treatment, a gradual reduction process begins and continues over the following months.

Available studies have shown reductions in fibroid volume and improvements in symptoms such as heavy menstrual bleeding. The extent of the response may vary between patients and different types of fibroids.

Follow-up ultrasound examinations therefore allow changes in fibroid size to be monitored and assessed alongside improvements in clinical symptoms.

Radiofrequency ablation, hysteroscopy or surgery: how is the choice made?

Treatment of uterine fibroids must be tailored to their characteristics and to each patient’s needs.

Operative hysteroscopy may be particularly useful for certain submucosal fibroids that protrude into the uterine cavity. Other fibroids may be treated using radiofrequency ablation, while some cases require laparoscopic myomectomy, mini-laparotomy or other techniques.

The aim of the initial assessment is to select the most appropriate option, taking into account the patient’s symptoms, anatomy, medical history and reproductive plans.

“The Gynaecology Unit manages conditions related to clinical and aesthetic gynaecology, reproductive health and gynaecological surgery, among other areas.”

Radiofrequency ablation, fertility and pregnancy

Radiofrequency ablation allows fibroids to be treated while preserving the uterus. However, preserving the uterus and improving fertility are not the same thing.

Pregnancies following transvaginal radiofrequency ablation have been reported, and the available findings are encouraging. Nevertheless, studies on reproductive outcomes remain more limited than those assessing reductions in fibroid volume and improvements in symptoms.

Therefore, when a patient wishes to become pregnant, either now or in the future, the indication must be assessed particularly carefully, considering the type of fibroid, its relationship to the uterine cavity, the patient’s reproductive history and the different treatment alternatives.

What is recovery like?

Transvaginal radiofrequency ablation is usually performed as an outpatient procedure, and recovery is generally shorter than after surgical procedures requiring abdominal incisions.

During the first few days, patients may experience pelvic discomfort, pain of varying intensity, light bleeding or other symptoms associated with the treatment process.

The time needed to resume normal activities fully depends on each patient’s recovery and the instructions provided after the procedure.

Possible risks and complications

Transvaginal radiofrequency ablation is a minimally invasive technique, but it is not entirely risk-free.

Published studies report a low frequency of serious complications and indicate that most recorded adverse events are mild. Possible complications include pain, fever, bleeding, infection and the expulsion of fibroid tissue, as well as other less frequent complications.

Appropriate patient selection, ultrasound guidance and postoperative follow-up are among the measures used to minimise these risks.

Could further treatment be needed in the future?

The response to radiofrequency ablation may vary according to the characteristics of the fibroids and the individual patient.

Although treatment may achieve a substantial reduction in fibroid volume and associated symptoms, the treated fibroid does not always disappear completely, and other fibroids may be present that did not initially require treatment.

In some cases, continued monitoring, a further procedure or another treatment option may be necessary if symptoms persist or recur.

Further information

Below are the authorship details and references for the information provided on this page.