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Focused Ultrasound and Myolysis FAQ

 

What is MR-Guided Ultrasound?

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.

 

What is myolysis?

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.

 

How many are performed?

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.

 

What happens?

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.

Myolysis

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.

 

How long would I stay in hospital?

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.

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How long does it take to recover?

Again, this will depend on the procedure used. With Focused Ultrasound normal activity can be resumed in 3-4 days.

 

Side effects and safety

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.

 

Effect on fertility

Although fertility is maintained this is not a treatment option for women with pregnancy wishes.

 

Questions to ask your doctor

  • How long will I be in hospital?
  • How will I feel immediately after the procedure?
  • How much pain will I suffer?
  • How much support will I need at home?
  • What will I be able to do after the procedure?
  • When can I return to work?
  • What are the short-term side effects?
  • What are the long-term side effects?
  • What could go wrong?
  • Will it have any effect on my sex life?
  • Will I be able to become pregnant/?
  • How will it affect my periods and menopause?
  • Will I need HRT?

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