Focused ultrasound surgery is a noninvasive treatment option for uterine fibroids — noncancerous growths of the uterus. A pelvic magnetic resonance imaging (MRI) scan is typically performed before treatment to determine whether you're a good candidate for focused ultrasound surgery.
Focused ultrasound surgery — also called magnetic resonance-guided focused ultrasound surgery or focused ultrasound ablation — is performed while you're inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment.
The images give your doctor the precise location of the uterine fibroids and the locations of nearby structures to be avoided, such as the bowel and bladder. While the MRI monitors the targeted fibroid and surrounding structures, the ultrasound transducer focuses sound waves into the fibroid to heat and destroy small areas of fibroid tissue.
Not widely available, focused ultrasound surgery typically is done at specialized clinics.
Why it's done
Focused ultrasound surgery:
- Can ease bothersome symptoms associated with uterine fibroids, including heavy bleeding and pelvic pain and pressure
- Provides a noninvasive alternative to surgical treatment of fibroids
- Is done on an outpatient basis
- Typically allows a rapid return to normal activities after the procedure
Although focused ultrasound surgery offers many advantages over other fibroid treatment options, it's not the best option for everyone. It may not be a good choice for you if:
- You have multiple abdominal scars that make it difficult to find a safe path between the transducer and the fibroid
- You have many fibroids or very large fibroids
- You want to optimize your chance of a future pregnancy
A number of women have had successful pregnancies after treatment. However, long-term effects on a woman's ability to become pregnant and carry a baby to term have not been studied adequately yet.
Rarely, focused ultrasound surgery may result in:
- Burns to the skin on your abdomen
- Damage to tissues and structures near the fibroid targeted for treatment
- Nerve stimulation causing temporary back or leg pain after the procedure
- Blood clots in your legs (deep vein thrombosis)
Other drawbacks specific to focused ultrasound surgery include:
- Less long-term data on safety and effectiveness than most other fibroid treatments
- Less data on fertility and pregnancy than with other fibroid treatments
As with many other fibroid treatments, when you have focused ultrasound surgery:
- You may have some fibroids that may not be able to be treated
- You may require further treatment if your symptoms return
How you prepare
An MRI uses a magnetic field to create detailed pictures of the inside of your body. Metal objects on — or in — your body may interfere with the magnetic field used during the exam, affecting the quality of the MRI and possibly causing a safety problem. The magnetic field may also damage electronic items.
- If possible, leave jewelry or metal or electronic accessories at home, as you'll be asked to leave these items in the dressing room before the procedure.
- Tell the technologist if you have any metal or electronic devices inside your body, such as metallic joint prostheses, artificial heart valves, implanted electronic devices, cochlear implants, body piercings or dental implants.
Focused ultrasound surgery is performed as an outpatient procedure in an MRI scanning room. The day of treatment you'll need to shave your lower abdomen between your pubic bone and bellybutton.
Shortly before the procedure begins, you'll:
- Have an intravenous line placed in one of your veins to inject contrast material for MRI and to give you medication for relaxation and pain
- Be offered earplugs because the internal part of the magnet produces repetitive tapping, thumping sounds and other noises
- Have special stockings to prevent blood clots put on your legs
- Have a urinary catheter inserted into your bladder to keep the bladder stable during your treatment and improve visibility of the uterus
What you can expect
During your treatment, MRI allows doctors to evaluate the effects and define areas that need additional treatment.
During the procedure
Treatment time varies, depending on the size and number of fibroids you have. Here's the procedure.
- You lie on your stomach on a movable table that slides into the opening of the MRI scanner. A doctor monitors you from an adjoining room and can talk to you and hear you by microphone.
- Using focused ultrasound waves (sonications), each portion of the fibroid is heated. MRI is used to monitor tissue temperature and determine if the fibroid has been heated enough to achieve the desired results. The process is repeated until most of the fibroid has reached a temperature that should destroy the tissue.
- Each sonication lasts approximately 20 to 25 seconds. Typically it takes about 80 sonications during a treatment session to destroy a fibroid. However, depending on the size and number of fibroids you have, more sonications or a second treatment may be necessary.
- Throughout the treatment, you'll be asked about your level of discomfort so that your medication can be adjusted or other necessary changes can be made.
After the procedure
You'll need a friend or family member to be with you and drive you to and from your treatment due to the medications you receive during treatment.
When you get home, you can resume your normal daily activities. Usually you'll need only over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), for discomfort.
Your body gradually and naturally absorbs the treated tissue over months and even years. This means that an ultrasound may show the fibroid still there. However, an MRI shows that the fibroid has been treated, and your symptoms reflect that improvement.
The majority of women experience significant improvement in the severity of their fibroid-related symptoms within the first six months after focused ultrasound surgery. Most researchers report that women continue to have symptom relief after three years of follow-up.