Sonata Fibroid Ablation

Private Sonata® Fibroid Treatment

Transcervical ultrasound-guided radiofrequency ablation uterine fibroids (Sonata®)

What are fibroids?

Fibroids are non-cancerous growths that develop in or around the uterus. They are made of muscle and fibrous tissue and can vary in size from very small to large masses that can cause noticeable symptoms. While the exact cause of fibroids is not fully understood, factors like hormones (especially estrogen and progesterone) and genetics are believed to play a role in their development. Many women with fibroids experience no symptoms, but others may have heavy menstrual bleeding, pelvic pain, painful sex, abdominal bloating, frequent urination, difficulty conceiving or carrying a pregnancy or complications during pregnancy and childbirth. Fibroids typically grow over time before the menopause with small fibroids (< 20 mm) and large fibroids (> 50 mm) demonstrating the fastest growth in volume (median of 51.3% and 40.7% respectively) in 1 year. More information can be found on NHS website (https://www.nhs.uk/conditions/fibroids/)

How are fibroids treated?

The treatment for fibroids depends on their size, location, and the severity of symptoms. In mild cases (small fibroids and asymptomatic), the fibroids may be monitored without immediate treatment. For more significant symptoms, options include medications to manage pain and bleeding, minimally invasive procedures, or, in severe cases, surgery such as a myomectomy (removal of fibroids) or hysterectomy (removal of the uterus). If you have concerns about fibroids, it's important to consult a healthcare provider to discuss the best approach for your situation.

What is Sonata®?

Sonata® is a minimally invasive, incision-free uterus-preserving treatment designed to shrink fibroids and relieve symptoms such as heavy menstrual bleeding and pelvic discomfort. It works by using radiofrequency energy to target and shrink fibroids from inside the uterus, without the need for traditional surgery. This makes it a less invasive alternative to procedures like myomectomy or hysterectomy, with a faster recovery time and fewer complications.

Sonata® is a new treatment now available at Chelsea and Westminster NHS Trust (Chelsea and Westminster Hospital and West Middlesex Hospital). It has been used in the United States and some hospitals in Europe since 2015 and was approved for use in the UK by the National Institute for Health and Care Excellence (NICE) in 2021.

Sonata® has been offered since the start of 2023 at Chelsea and Westminster NHS Trust by our experienced lead consultant Miss Natalie Nunes who performed the greatest number of procedures in the UK in 2024.

The data on Sonata® outcomes suggests that it is an effective and well-received treatment for fibroids. Key findings include:

Symptom Improvement: Over 90% of patients reported overall improvement in their symptoms within 12 months, while only about 1% experienced worsened symptoms.
Menstrual Blood Loss Reduction: After three months, 90% of patients noticed reduced bleeding, and after one year, around 70% were bleeding less than half the amount they did before the procedure.
Patient Satisfaction: About 90% of patients were satisfied with their treatment after 12 months.
Recommendation Rate: Approximately 80% of patients would definitely recommend the procedure to others, while a small percentage (about 3%) would probably not.

Overall, the data indicates that Sonata® provides significant relief from fibroid-related symptoms, with high patient satisfaction and a strong recommendation rate.

What are the risks of Sonata® Treatment?

While Sonata® is considered a minimally invasive and generally safe treatment for fibroids, like any medical procedure, it carries some risks. These include:

Pain and Cramping: Some patients may experience pelvic pain or cramping after the procedure, which usually resolves within a few days.
Infection: Any procedure inside the uterus carries a small risk of infection requiring antibiotics.
Bleeding or Vaginal discharge: Although the procedure aims to reduce menstrual bleeding, some patients may experience temporary or unexpected bleeding changes briefly after the procedure or a clear heavier vaginal discharge for a few weeks.
Failure to Improve Symptoms: While most patients see improvement, a small percentage may not experience significant relief or may have worsening symptoms.
Damage to Nearby Organs: In rare cases, there is a risk of unintentional injury to surrounding structures, such as perforation of the uterus or damage to other areas like the bladder or bowel.
Fertility and Pregnancy Risks: In 2024, a case series was published which showed promising results with no increased risk of miscarriage. Your doctor can explain these to you.

How is the procedure done?

The Sonata® treatment is a gentle, non-surgical procedure used to treat fibroids. It involves a specially designed device with a tiny ultrasound tip, which allows the doctor to see the fibroids inside the uterus during the procedure. Once located, each fibroid is treated using a technique called ablation, which helps shrink the fibroid and reduce symptoms.

One of the key benefits of Sonata® is that it is completely incision-free. The device is carefully inserted through the cervix, meaning no cuts on the abdomen and no scars. The device has two parts: the first is an ultrasound probe that allows the doctor to see the fibroids in real time, and the second is a radiofrequency probe, which delivers a safe and controlled heat treatment to shrink the fibroids. Since this energy is very targeted, the surrounding uterus is not damaged, making it a potential option for women who may wish to have children in the future.

The procedure can be done under general anesthesia (where you are asleep) or local anesthesia (where you are awake but comfortable). The best option for you will depend on factors such as your medical history, number of fibroids, and symptoms, which your doctor will discuss with you in detail.

Sonata® is usually done as a day procedure, meaning you can go home the same day. It typically takes less than an hour, depending on the size and number of fibroids being treated. After the procedure, you may need pain relief such as paracetamol or ibuprofen for a few days. Most women recover quickly and are able to return to normal activities, including work, within a few days to one week.

The procedure is performed under light sedation or anesthesia. A small, specially designed device is inserted through the vagina and guided into the uterus. Using real-time ultrasound imaging, the doctor identifies and targets individual fibroids. The device then delivers controlled radiofrequency energy to heat and shrink the fibroid tissue while preserving healthy surrounding tissue. Since no incisions are made, there is minimal scarring, and the uterus remains intact.

Symptom relief typically begins within the first few months, with most patients experiencing reduced menstrual bleeding and improved overall comfort. Because Sonata® does not require major surgery, it may be a good option for women looking to manage fibroids while preserving their uterus. However, it’s important to discuss with a doctor whether this treatment is right for you, especially if you are considering future pregnancy.

Aftercare for the Sonata® Treatment

After the procedure, you will rest for a short time before being discharged. Most patients are able to go home within two to three hours after the treatment. There are usually no strict restrictions on physical activities, but we recommend gradually increasing your activity level at a pace that feels comfortable for you. Many patients are able to return to their normal routine by the next day.

It is important to avoid driving for at least 24 hours after the procedure. However, you can bathe or shower as advised by your doctor and resume your regular diet as soon as you feel ready. Your consultant will provide you with any specific aftercare instructions tailored to your needs.