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What is microwave ablation?

Microwave ablation (MWA) is an advanced, image-guided treatment that uses targeted microwave energy to destroy abnormal or diseased tissue while preserving surrounding healthy structures. In gynaecology, MWA is gaining recognition as an effective option for conditions that cause heavy menstrual bleeding, pelvic pain, and reduced quality of life, particularly adenomyosis.

Adenomyosis occurs when the tissue that normally lines the uterus grows into the uterine muscle, leading to chronic discomfort and, for many women, a significant impact on daily activities. Traditional treatments such as medication or hysterectomy may not be suitable for all patients, especially those wishing to avoid major surgery or preserve their uterus. Microwave ablation offers a middle ground, a targeted, uterus-preserving approach designed to relieve symptoms, shorten recovery time, and minimise hospital stays.

Adenomyosis is a condition where the tissue lining the uterus grows into the uterine muscle, causing heavy menstrual bleeding, pelvic pain, and an enlarged uterus.

How does microwave ablation work?

Microwave ablation (MWA) uses electromagnetic waves to create heat within targeted tissue. When these waves cause polar molecules in the tissue to oscillate, frictional heating occurs, leading to thermal destruction of abnormal cells. In adenomyosis, this heat induces coagulative necrosis, effectively breaking down the embedded endometrial tissue within the uterine muscle.

The heating process triggers several changes at a cellular level, including dehydration of cells, denaturation of proteins, and disruption of DNA and protein synthesis, which stop the growth and function of the abnormal tissue. It also damages the lesion’s blood supply, further contributing to cell death. Over time, the treated tissue is naturally broken down and absorbed by the body, without the need for surgical removal.

For gynaecological use, microwave ablation can be performed through abdominal, vaginal, or laparoscopic access, depending on the location and size of the lesion. Under continuous ultrasound guidance, a fine MWA antenna, typically around 1.6 mm in diameter, is precisely inserted into the target area. The generated microwave energy is delivered evenly, ensuring thorough treatment while protecting surrounding healthy tissue.

Microwave Ablation for Adenomyosis Singapore

Microwave ablation for adenomyosis involves using imaging guidance to insert a thin antenna into the affected uterine tissue, where controlled microwave energy is applied to heat and destroy the abnormal cells while preserving healthy structures.

This method treats adenomyosis and other benign uterine lesions without cutting or removing the uterus. The procedure leaves no open wounds, stitches, or scars, and maximises preservation of the uterus’s structure and function.

What are the benefits of microwave ablation?

Microwave ablation offers a uterus-preserving, targeted treatment approach that can significantly improve quality of life for women affected by adenomyosis.

Minimally invasive — performed through small skin punctures or minimally invasive access, which helps minimise surgical trauma and recovery time.
Uterus preservation — treats adenomyotic tissue without removing the uterus, an advantage for women who wish to retain their reproductive anatomy.
Targeted symptom relief — focuses on the affected area, helping reduce heavy menstrual bleeding, pelvic pain, and pressure.
Quick recovery — most patients can return to normal activities within days, compared to weeks after major surgery.
Lower complication risk — the targeted nature of the treatment reduces risks such as excessive bleeding, infection, or damage to surrounding tissues.
Repeatable procedure — can be performed again if needed, offering flexibility in long-term symptom management.

What are the possible risks and side effects of microwave ablation?

While microwave ablation is generally safe and well-tolerated, no medical procedure is entirely without risk. Understanding the potential side effects helps patients make an informed decision.

Mild discomfort — some women experience cramping, pelvic discomfort, or mild pain for a few days after the procedure.
Spotting or discharge — light vaginal bleeding or watery discharge may occur during the healing phase.
Infection — rarely, bacteria can enter the treated area, leading to pelvic infection that may require antibiotics.
Thermal injury — although uncommon, there is a small risk of heat affecting nearby healthy tissue if not precisely targeted.
Incomplete symptom relief — in some cases, symptoms may persist or recur, requiring further treatment.
Allergic reaction — rare sensitivity to local anaesthesia or medications used during the procedure.

Menstrual changes:

Who is a suitable candidate for microwave ablation?

Microwave ablation may be an option for women with adenomyosis or certain other gynaecological conditions who want targeted symptom relief without major surgery.

Confirmed diagnosis — suitable for women whose adenomyosis has been confirmed through ultrasound or MRI imaging.
Persistent symptoms — recommended for those with heavy menstrual bleeding, pelvic pain, or pressure that has not improved with medication.
Uterus preservation goals — appropriate for women who wish to avoid hysterectomy and retain their uterus.
General health suitability — candidates should be fit enough for a minimally invasive procedure and have no active pelvic infection or uncontrolled medical conditions.
Lesion accessibility — lesions must be reachable with the microwave probe under imaging guidance for effective treatment.

What happens during a microwave ablation procedure for adenomyosis

Microwave ablation is carried out in a clinical setting with advanced imaging to ensure the treatment is delivered precisely to the adenomyotic tissue. The aim is to reduce symptoms while preserving healthy uterine structure.

Pre-procedure preparation — before the procedure, your doctor will review your medical history and perform detailed imaging such as ultrasound or MRI to identify the size and location of the adenomyosis. Blood tests may be done to ensure you are fit for the procedure, and you might be advised to fast for a few hours and stop certain medications.
Anaesthesia — the procedure is usually done under local, regional, or light general anaesthesia, depending on the size and location of the lesion, as well as your comfort level. This ensures the treatment is pain-free and you remain relaxed throughout.
Imaging guidance — continuous ultrasound or MRI imaging is used to guide every step of the procedure. This allows the doctor to accurately position the microwave antenna in the exact centre of the adenomyotic tissue, which helps reduce the risk of affecting healthy areas.
Antenna insertion — a slim microwave antenna, about 1.6 mm in diameter, is inserted through the skin or via a minimally invasive route such as laparoscopic or vaginal access. It is carefully advanced under imaging guidance until it reaches the targeted tissue.
Energy delivery — the microwave generator sends electromagnetic energy through the antenna, causing the abnormal cells to heat up and undergo coagulative necrosis. This process destroys the adenomyotic tissue and cuts off its blood supply, allowing it to shrink over time.
Duration — the length of the procedure depends on the size and number of lesions, with most treatments taking between 30 and 60 minutes. Larger lesions may require slightly longer energy application to ensure complete coverage.
Post-procedure monitoring — once the ablation is complete, the antenna is removed and the tiny entry site is covered with a dressing. You will be monitored in a recovery area for a short period to ensure stability before being discharged home the same day.

What results can I expect from microwave ablation?

Microwave ablation aims to provide gradual, lasting relief from adenomyosis symptoms while preserving uterine function.

Symptom improvement — most women experience a noticeable reduction in heavy menstrual bleeding, pelvic pain, and a feeling of pelvic pressure within the first few menstrual cycles after treatment. For some, the relief is significant enough to allow them to carry out daily activities comfortably and sleep better during their periods without being disturbed by pain or excessive bleeding.
Progressive results — the treated adenomyotic tissue continues to shrink in the months following the procedure. This means that improvements often become more pronounced over time, with ongoing relief as the body naturally absorbs the damaged tissue..
Quality of life gains — many women report improved energy levels, the ability to participate in social and physical activities without discomfort, and a reduced need for pain medication. Daily routines, work commitments, and personal life are less frequently disrupted by symptoms.
Uterus preservation — unlike hysterectomy, microwave ablation treats the disease without removing the uterus. This is especially valuable for women who wish to retain their reproductive anatomy.
Long-term relief — clinical evidence suggests that many patients enjoy durable results that last for years. However, recurrence of symptoms is possible, and in such cases, repeat microwave ablation or other treatments may be considered.
Individual variation — the extent of improvement can vary depending on the size and number of lesions, the severity of adenomyosis, and overall health. Your doctor will discuss realistic expectations based on your specific condition.

Summary

Microwave ablation is a safe, uterus-preserving procedure that uses focused electromagnetic energy to treat adenomyosis by destroying abnormal tissue within the uterine muscle. Under ultrasound or MRI guidance, a fine applicator is positioned precisely in the affected area, where microwave energy generates controlled heat to induce cell death, disrupt protein and DNA synthesis, and cut off the lesion’s blood supply. The treated tissue then shrinks and is naturally absorbed by the body, without the need for surgical removal.

Suitable for women with confirmed adenomyosis whose symptoms such as heavy menstrual bleeding, pelvic pain, and pressure persist despite medical treatment, this minimally invasive approach offers quick recovery, low complication risk, and the option for repeat procedures if required. Most patients experience progressive improvement over the following months, with significant relief and better quality of life.

If you are experiencing symptoms of adenomyosis, schedule a consultation with Dr. Ma Li’s clinic to explore whether microwave ablation is the right treatment for you.

FAQs

Frequently asked questions

Is microwave ablation safe for treating adenomyosis?

Yes. When performed by a trained specialist under ultrasound or MRI guidance, microwave ablation is considered a safe and effective option for relieving adenomyosis symptoms.

How long does microwave ablation take?

Microwave ablation typically takes between 30 and 60 minutes, depending on the size and number of lesions being treated.

Do I need to stay in the hospital after microwave ablation?

Most women go home the same day, as microwave ablation is usually performed as a day procedure.

How soon will I see results after microwave ablation?

Many women notice symptom relief within the first few menstrual cycles, with further improvement over the following months as the treated tissue shrinks.

Does microwave ablation remove the uterus?

No. Microwave ablation preserves the uterus while targeting and destroying the abnormal tissue causing adenomyosis symptoms.

What side effects can occur after microwave ablation?

Mild cramping, spotting, or watery discharge may occur for a few days after microwave ablation, but serious complications are rare.

Can microwave ablation affect my ability to get pregnant?

The effect of microwave ablation on fertility is still being studied, so it is generally recommended for women not planning an immediate pregnancy.

Can adenomyosis return after microwave ablation?

Recurrence is possible, but microwave ablation can be repeated if symptoms come back.

Who is not suitable for microwave ablation?

Women with active pelvic infections, suspected cancer, or certain medical conditions may not be suitable for microwave ablation.

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