Uterine artery embolization for symptomatic fibroids in postmenopausal women

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.

Keywords: Magnetic resonance imaging; Menopause; Uterine artery embolization; Uterine fibroid.