Background: Fibroids (leiomyomas or myomas), the most common female pelvic tumour, are benign tumours that arise from individual smooth muscle cells. Fibroids are clinically found in up to a quarter of all women (Buttram 1981), however the true incidence is thought to be as high as 20-40% in women of reproductive age. Although fibroids are asymptomatic in most women, symptoms that have been attributed to uterine fibroids include heavy menstrual bleeding, pain, pressure type symptoms (i.e. on the bladder) and infertility. A number of treatment options are available including both medical and surgical modalities. Given the young female population affected by fibroids the need for fertility preserving treatment options is becoming increasingly more important and MRgFUS provides one such treatment alternative.

Aim: To review all cases of uterine fibroids treated by MRgFUS at the Royal Women's Hospital Melbourne between 2009-2013 specifically comparing outcomes of submucosal fibroids with all other fibroid types. Outcomes included treatment success, which was defined by a greater than ten percent reduction in symptom severity score measured at four and 12 months post-treatment and fibroid volume shrinkage greater than or equal to ten percent.

Methods: A retrospective clinical audit was undertaken of 204 women who underwent treatment with MRgFUS over the initial 52 months of MRgFUS use at the Royal Women's Hospital Melbourne. Patients were identified through a database maintained by the Radiology department and data regarding demographics, clinical characteristics and treatment outcomes were obtained through the clinical results database and individual patient hospital records. 

Results: Of the 204 patients identified, 113 (55.4%) patients were successfully treated by MRgFUS with a decrease in symptom severity score at 4 months (24 patients were lost to follow up or had incomplete data, 11 patients did not tolerate treatment), whilst at 12 months 95 (46.6%) patients were considered to have been successfully treated (49 patients were lost to follow up or had incomplete data). Nine patients (4.4%) required further intervention despite treatment with MRgFUS including either hysterectomy or open, laparoscopic or hysteroscopic myomectomy.

When looking at only the 131 people that completed treatment and had complete follow-up, submucosal fibroids (LSM1/LSM2) were identified and treated in 57 (43.5%) patients.  Treatment was successful in 43 (75.4%) and 44 (77.2%) patients at 4 and 12 months respectively.  The remaining 74 patients had non-submucosal fibroids and in this population treatment was successful in 50  (67.6%) and 43 (58.1%) at 4 and 12 months respectively.

Conclusion:  Although non-submucosal fibroids initially showed a greater response rate to MRgFUS at 4 months, the 12 months success rate was significantly lower in this group. MRgFUS provides a safe and fertility preserving treatment alternative in selected cases of non-submucosal fibroids. Further studies are required to more fully determine long-term outcomes and optimal patient characteristics for MRgFUS.