Sonata® fibroid ablation - All you need to know

Traditionally, treatments for fibroids have involved surgical options such as hysterectomy or myomectomy. However, advances in medical technology have now made it possible to treat fibroids with less invasive methods. One such option is Sonata® (sonography-guided transcervical fibroid ablation).

Miss Natalie Nunes, leading consultant gynaecologist, provides a comprehensive overview of the treatment.

Is Sonata® suitable for all types of fibroids?

While Sonata® is a versatile and effective treatment, it’s primarily used to treat intramural, submucosal, and transmural fibroids. These fibroids form within the muscular wall of the uterus or protrude into the uterine cavity.

How does the Sonata® treatment work?

Sonata® is a minimally invasive treatment that combines radiofrequency ablation with an advanced intrauterine ultrasound to precisely locate and target uterine fibroids. Unlike traditional surgery, Sonata® is a uterus-sparing procedure.

The procedure is carried out through the natural opening of the vagina. On the day of the procedure, you will be given local and inhalational analgesia or placed under sedation or light anaesthesia to ensure your comfort. A speculum will be inserted to allow access to your cervix.

Your gynaecologist will then insert a slender device called the Sonata® handpiece through the cervix and into your uterus. This handpiece contains an integrated ultrasound probe that will allow your gynaecologist to visualise the fibroids in real-time from inside the uterus, creating a clear image of their size and location.

Once the fibroids have been identified, your gynaecologist will insert a small needle-like device into each fibroid. This device will deliver focused radiofrequency energy to the tissue, which will heat and destroy the fibroid tissue in a process called ablation. This will result in the fibroids gradually shrinking over time.

Multiple fibroids can be treated during the same session. Once all fibroids have been treated, your gynaecologist will remove the devices, and the procedure will be complete.

Are there any risks or side effects associated with Sonata®?

The Sonata® procedure is generally well-tolerated, with few associated side effects. These may include mild cramping or abdominal discomfort, light vaginal bleeding or spotting, and vaginal discharge.

More serious complications are rare, but as with any medical procedure, there is a small risk of infection, injury to nearby organs, or complications related to anaesthesia. Very rarely, your uterus may push out the treated fibroid which you pass with your period. Your gynaecologist will take measures to carefully control the ablation process to minimise any damage to the surrounding healthy tissue.

What is the recovery time after Sonata® treatment ablation?

The Sonata® procedure typically takes about 45 minutes to 2 hours, depending on the number and size of the fibroids being treated. You can go home on the same day of the procedure, as it’s an outpatient procedure.

Since there are no incisions involved, most patients are able to resume normal activities within 1 to 2 days following the procedure. However, it’s recommended to avoid heavy lifting and strenuous exercise for at least a week to prevent any discomfort.

How soon will I see results with Sonata®?

The results of Sonata® fibroid ablation aren’t immediate, as it takes time for the treated fibroids to shrink and for symptoms to improve. Most patients start to notice symptom relief within a few weeks to a few months after the procedure, with significant improvements often occurring by the 3-month mark. This includes a reduction in heavy menstrual bleeding, as well as relief from pelvic pain and pressure.

Can I get pregnant after having Sonata® treatment?

Yes, you can. A recent publication (2024) suggests it to be a feasible safe treatment option for women wishing future pregnancy. There was no increase in miscarriage rates and no cases of uterine rupture, placenta accreta spectrum, or stillbirth.