Uterine artery embolization for symptomatic fibroids in postmenopausal women

Shin Jae Lee, Lee SJ, Kim MD, Man Deuk Kim, Kim GM, Gyoung Min Kim, Jong Yoon Won, Jong Yun Won, Sung Il Park, Park SI, Lee DY, Do Yun Lee
Clinical imaging · 2016 · doi:10.1016/j.clinimag.2015.08.010 · PMID:26372352
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Uterine artery embolization effectively resolved symptoms and reduced fibroid/uterine volume in postmenopausal women, suggesting it as an alternative to hysterectomy.

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This retrospective clinical imaging study evaluated uterine artery embolization (UAE) for symptomatic uterine fibroids in nine postmenopausal women (2007–2013), including three patients with fibroids plus adenomyosis, using pre- and 3-month postprocedure MRI to measure fibroid and uterine volumes. Symptoms were assessed, and contrast-enhanced MRI showed complete necrosis of the predominant fibroid in all patients, with overall symptom resolution in 8 of 9 participants and mean volume reduction of 39.7% (fibroid) and 36.9% (uterus). The study reports no comparison group and is limited by its very small sample size, and it uses adjunct analyses of uterine artery size on MR angiography. Relevance to endometriosis: it explicitly includes cases of adenomyosis (fibroid with adenomyosis) as part of the studied population, though the main focus is UAE treatment outcomes for fibroids in postmenopausal women rather than endometriosis.

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Abstract

PURPOSE: The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) for symptomatic fibroids in postmenopausal women. MATERIALS AND METHODS: Among 900 cases who underwent UAE between 2007 and 2013, a total of 9 postmenopausal women with symptomatic fibroids (n=6) and fibroid with adenomyosis (n=3) were included in this retrospective study. Ages ranged from 49 to 55years (median of 52). The embolic agent was nonspherical polyvinyl alcohol particles. We evaluated 18 uterine arteries in nine patients and compared the size of the uterine artery relative to inferior mesenteric artery (IMA) in preprocedural magnetic resonance (MR) angiography. Magnetic resonance imaging (MRI) was performed before and 3months after UAE. Predominant fibroid and uterine volumes were calculated from MR images. RESULTS: Urinary frequency was the most common symptom, observed in seven patients (77.8%). Of two patients (22.2%) with vaginal bleeding from submucosal myomas, one patient had been on hormone replacement therapy (HRT). One patient underwent UAE due to growing leiomyoma after HRT. All of the 18 uterine arteries were bigger than the corresponding IMAs in MR angiography. Contrast-enhanced MRI revealed complete necrosis of the predominant fibroid in all patients. Eight (88.9%) of the nine participants demonstrated resolution of symptoms. The mean predominant fibroid and uterine volume reduction rates were 39.7% and 36.9%, respectively. CONCLUSIONS: In postmenopausal women, UAE was effective to treat symptomatic fibroids, and it could be considered as an alternative treatment to hysterectomy.
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Materials and methods

Among 900 cases who underwent UAE between 2007 and 2013, a total of 9 postmenopausal women with symptomatic fibroids (n=6) and fibroid with adenomyosis (n=3) were included in this retrospective study. Ages ranged from 49 to 55years (median of 52). The embolic agent was nonspherical polyvinyl alcohol particles. We evaluated 18 uterine arteries in nine patients and compared the size of the uterine artery relative to inferior mesenteric artery (IMA) in preprocedural magnetic resonance (MR) angiography. Magnetic resonance imaging (MRI) was performed before and 3months after UAE. Predominant fibroid and uterine volumes were calculated from MR images.

Results

Urinary frequency was the most common symptom, observed in seven patients (77.8%). Of two patients (22.2%) with vaginal bleeding from submucosal myomas, one patient had been on hormone replacement therapy (HRT). One patient underwent UAE due to growing leiomyoma after HRT. All of the 18 uterine arteries were bigger than the corresponding IMAs in MR angiography. Contrast-enhanced MRI revealed complete necrosis of the predominant fibroid in all patients. Eight (88.9%) of the nine participants demonstrated resolution of symptoms. The mean predominant fibroid and uterine volume reduction rates were 39.7% and 36.9%, respectively.

Conclusions

In postmenopausal women, UAE was effective to treat symptomatic fibroids, and it could be considered as an alternative treatment to hysterectomy. - Appears in Collections: - 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

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Condition tags

adenomyosis

MeSH descriptors

Leiomyoma Postmenopause Uterine Artery Embolization Uterine Neoplasms Female Humans Leiomyoma Leiomyoma Magnetic Resonance Imaging Middle Aged Retrospective Studies Treatment Outcome Uterine Artery Embolization Uterine Neoplasms Uterine Neoplasms

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