High-intensity focused ultrasound a promising treatment modality for uterine fibroids: SG data

The minimally invasive high-intensity focused ultrasound (HIFU) appears to be beneficial in the treatment of women with uterine fibroids, significantly reducing fibroid volume and improving symptoms without increasing the frequency of postoperative complications.

A retrospective study from Singapore showed that fibroid volume shrunk by 68 percent at 6 months (from 95 cm³ at baseline to 22 cm³; p<0.001) and by 75 percent at 12 months (from 95 cm³ to 14 cm³; p<0.001) after HIFU treatment. [Gynecol Minim Invasive Ther 2023;12:15-25]

Accompanying improvements in symptoms and quality of life (QOL) were also observed at the 6-month follow-up. Symptom severity scores (SSS) dropped from 46.9 at baseline to 15.6 (p<0.001), while health-related QOL scores increased from 58 to 86 (p<0.001).

Thirteen women (7.7 percent) required further intervention after HIFU treatment, with three undergoing retreatment with HIFU, three undergoing hysterectomy, one undergoing myomectomy, and three undergoing hysteroscopic endometrial ablation for symptomatic relief.

Successful pregnancy occurred for six women a median of 5 months (range, 3–15 months) after HIFU treatment. All of them delivered by caesarean section. No cases of any uterine complications, such as uterine rupture, were reported.

“One of the purported benefits of HIFU lies in its ability for fertility preservation,” the investigators said.

In comparison, myomectomy can affect the chances or outcome of pregnancy due to the risk of uterine rupture, miscarriage, preterm birth, and intrauterine adhesions. As such, patients are often advised to wait 6–12 months before attempting to conceive to allow myometrium healing. [N Engl J Med 2015;372:1646-1655]

“[The wait time] could prove significant in the fertility-desiring population, particularly those with advanced maternal age. HIFU, which has a shorter downtime, thus maximizes the window for conception in this population,” the investigators pointed out.

“More importantly, the avoidance of a myometrial scar, which is inevitable in a myomectomy, obliterates the risk of a uterine rupture. This risk is estimated to be approximately 0.5 percent to 0.75 percent, which is associated with significant maternal-foetal morbidity and mortality,” they added. [Acta Obstet Gynecol Scand 2016;95:724-734; Gynecol Surg 2014;11:197-206]

The study included 167 women (mean age 41.9 years, median BMI 22.0 kg/m²) with single or multiple fibroids or adenomyosis/adenomyomas treated with HIFU. The most common presenting complaint was menorrhagia, followed by pain.

As for safety, all patients were discharged home after 24 hours of observation in the hospital. One patient who presented with left lower limb weakness and foot drop after HIFIU was diagnosed with L4 nerve radiculopathy. She received a prescription for pregabalin and achieved full recovery in 3 months, without long-term sequelae.

“Other than [those mentioned], there were no other serious adverse events during the treatment period. There were minor complaints like mild lower abdominal pain or discomfort, which all resolved spontaneously. Except for the patient with L4 nerve radiculopathy, all the other patients returned to their normal activities within a few days after the procedure,” the investigators said.

Overall, the findings demonstrate that HIFU is a safe and effective treatment modality for uterine fibroids with promising initial results, according to the investigators. This noninvasive approach may offer benefits to certain patient groups, such as those desiring fertility.

“Further studies encompassing elements of economic analysis would be invaluable to guide treatment decisions. However, considering these results from our study and various other studies, it is imperative to include HIFU in the arsenal of treatment for fibroids and adenomyosis,” they added.