Radiofrequency Ablation for Treatment of Adenomyosis: A Systematic Review

• Published in: Journal of minimally invasive gynecology Vol. 29; no. 11; p. S29
• Main Authors: Lin, E., Wang, E.B., Adam, G.P., Porter, A.E., Kho, K.A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2022
• ISSN: 1553-4650; 1553-4669
• DOI: 10.1016/j.jmig.2022.09.098

To review and synthesize the existing literature regarding short- and long-term outcomes following radiofrequency ablation (RFA) for the treatment of diffuse and focal adenomyosis. We also evaluated post-RFA treatment complications and reproductive outcomes.
Systematic review.
Not applicable.
All studies examining RFA treatment for symptomatic, imaging-diagnosed adenomyosis in adult women with ≥10 participants per group, both comparative and non-comparative, were included. Studies in any country/setting and in English were also included.
We conducted a systematic review of all studies examining the use of RFA for treatment of adenomyosis which reported clinical, patient-reported, or reproductive outcomes, and complications. A literature search was performed using the Medline, EMBASE, and Cochrane databases from inception to July 20, 2021.
2948 abstracts were doubly reviewed, followed by review of 279 full-text articles. 7 studies met inclusion criteria. The majority were single-arm studies examining RFA, while two studies were comparative. 4 studies examined transcervical RFA, 2 studies examined transabdominal RFA and 1 study examined percutaneous adenomyolysis. Post-RFA treatment, significant decreases were seen in global uterine volume and focal adenomyosis volume at 6- and 12-months. Significant decreases in reported pain scores (visual analogue scale) and symptom severity scores were also seen at 6- and 12-months post-procedure. The likelihood of a serious adverse event was low. The post-procedure reintervention rate ranged from 1.6% to 39.5%, with 1.6% to 9.9% of patients undergoing hysterectomy. Only 1 included study reported reproductive outcomes and noted a clinical pregnancy rate of 35.8% post-RFA treatment.
The currently available data suggest that RFA can be a safe and effective treatment for adenomyosis, causing volumetric reduction in the size of affected uteri and focal adenomyosis lesions, and improving pain and bleeding with a low rate of severe adverse events. Following RFA treatment, up to 9.9% of patients undergo hysterectomy. Reproductive outcome data post-RFA treatment are limited.