Intrauterine expulsion of a submucosal fibroid following transcervical radiofrequency fibroid ablation

A woman in her 40s presented with complaints of watery discharge (sloughing).

These symptoms developed three months after treatment of her Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) type 2 fibroid with the transcervical use of intrauterine ultrasound-guided radiofrequency ablation, the Sonata system (Gynesonics). Previous symptoms of heavy menstrual bleeding significantly decreased three months after transcervical ablation. In spite of this, the patient presented with complaints of sloughing. Examination by transvaginal ultrasound revealed an intracavitary fibroid. Additional hysteroscopy identified a FIGO type 0 fibroid with a necrotic aspect. Eventually, the intracavitary fibroid was removed by hysteroscopic myomectomy, and complaints of sloughing vanished completely. The necrotic fibroid tissue was confirmed by the pathologist.

Intrauterine expulsion of a (submucosal) fibroid after treatment with the Sonata system should be discussed with patients during pre-treatment counselling as a possible consequence of this treatment. Thus, patients can recognise symptoms of intrauterine expulsion of the ablated fibroid in a timely manner.