Vascular Intervention
The Impact of Uterine Fibroid Embolization on Resumption of Menses and Ovarian Function

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PURPOSE

To evaluate the effect of uterine fibroid embolization (UFE) on menstruation and ovarian function.

METHODS

The authors performed an observational study of UFE for the treatment of symptomatic fibroids. All patients had regular predictable menses before intervention and none had clinical or laboratory findings of menopause. UFE was performed with use of standard methods with 355–700-mm-diameter polyvinyl alcohol (PVA) foam particles. The incidence of ovarian failure was calculated for women younger than 45 years and for those 45 years or older, based on retrospective stratification by age. The authors assessed statistical differences in ovarian failure between the two age groups with use of the χ2test.

RESULTS

Sixty-six premenopausal women (age range, 30–55 years) underwent bilateral UFE and were followed for an average of 21 weeks (range, 12–77 weeks). In 56 of 66 (85%) patients, regular menses resumed after an average of 3.5 (range, 1–8) weeks. In 10 of 66 (15%) patients, regular menses did not resume. Clinical and biochemical findings consistent with ovarian failure and presumed menopause were seen in nine of 10 patients without resumption of menses (14% of total patients). Ovarian failure occurred in nine of 21 (43%) women older than 45 years and in none of the 45 women younger than 45 years (P < .05). There were no differences in presenting symptoms, amount of PVA used, or fibroid size between patients who did and did not resume menses.

CONCLUSION

The majority of patients undergoing UFE will have resumption of menses, but the incidence of postprocedure ovarian failure is considerably higher than reported to date. Loss of menses induced by UFE is significantly more likely to occur in women older than 45 years.

Section snippets

• Patient Selection

Sixty-six women with symptomatic fibroids were treated with UFE from April 1998 to September 1999 at two institutions. One institution was a major tertiary care university medical center and the other was a community hospital with an active interventional radiology section. Indications for UFE included menorrhagia unresponsive to hormonal therapy and/or progressive bulk/pelvic pain symptoms. All patients were believed to be premenopausal and had been evaluated by an attending gynecologist to

RESULTS

Sixty-six premenopausal women (age range, 30–55 years) underwent bilateral UFE and were followed for an average of 21 weeks (range, 12–77 weeks). All patients included in the study had technically successful bilateral embolizations and all were available for follow-up. Patients who underwent UFE either refused any surgical intervention, were considered poor myomectomy candidates by their gynecologist, or did not desire future fertility. For example, a 30-year-old patient in our study, as a

DISCUSSION

The primary purpose of this study was to document the effect of UFE on menses and to measure the incidence of ovarian failure. In a multiinstitutional retrospective and prospective review of 66 patients, we determined that UFE is associated with ovarian failure in 14% of all patients. However, when stratifying our data by age, 43% of women 45 years of age or older developed ovarian failure, whereas no women younger than 45 years of age developed ovarian failure. Determination of the incidence

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