Abstract

Microwave endometrial ablation (MEA) has been attracting attention as a low-invasive treatment alternative to conventional total hysterectomy for systemic disease-induced hypermenorrhea, such as functional hypermenorrhea and blood coagulation abnormality, and organic disease-induced hypermenorrhea such as myoma of the uterus and adenomyosis. We report a patient with hypermenorrhea causing massive genital hemorrhage during anticoagulant therapy who demonstrated a complete response to MEA.

The patient was 41 years old, gravida 3 para 1. Aphasia and articulation disorder developed during work and she visited the emergency department. Cerebral infarction was noted on head MRI and anticoagulant therapy was initiated. Hypermenorrhea had been observed from approximately 4 years prior, but she had not visited a gynecology department. As massive genital hemorrhage and progression of anemia (Hb: 4.6 g/dL) were observed during the menstrual period, she was referred to our department. Multiple myomas of the uterus were observed on ultrasonography and pelvic MRI, and the patient was diagnosed with organic hypermenorrhea. As there was acute-phase cerebral infarction, MEA was performed as treatment for hypermenorrhea. The postoperative course was smooth and menstruation resumed on postoperative day 21. On subjective evaluation using the visual analogue scale (VAS), both hypermenorrhea and dysmenorrhea markedly improved from 10 to 1. The course was smooth without complications and the postoperative course was also favorable.

MEA is a low-invasive treatment method safely applicable within a short time, and it may be an effective hypermenorrhea treatment method during oral anticoagulant administration or for those with perioperative risk due to complications.