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

Chrisman, Howard B.; Saker, Mark B.; Ryu, Robert K.; Nemcek, Albert A.; Gerbie, Melvin V.; Milad, Magdy P.; Smith, Steven J.; Sewall, Luke E.; Omary, Reed A.; Vogelzang, Robert L.

doi:10.1016/s1051-0443(07)61627-3

Cited by 243 publications

(105 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mean radiation exposure in this series is approximately the quoted pelvic radiation dose of 6000 cGy cm 2 for a barium enema in the UK 27,28 . The exclusion of adenomyosis is important, some groups reporting poor response with one group reporting short [38] 67 (À89 to 100)* term efficacy 8,11,29,30 . The vascularity of fibroids is very different from that of adenomyosis with peripheral hypervascularity allowing infarction of the fibroid followed by hyalinisation, fibrosis and reduction in volume.…”

Section: Discussionmentioning

confidence: 99%

Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up

Walker¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

Objective To evaluate the mid-term efficacy and complications of uterine artery embolisation in women with symptomatic fibroids. To assess reduction in uterine and dominant fibroid volumes using ultrasound and magnetic resonance imaging. Design Prospective observational single-centre study.Setting A district general hospital in Surrey and a private hospital in London.Methods Four hundred consecutive women were treated between December 1996 and February 2001.Indications for treatment were menorrhagia, menstrual pain, abdominal swelling or bloating and other pressure effects. Uterine artery embolisation was performed using polyvinyl alcohol particles and platinum coils. Main outcome measures Imaging was performed before embolisation and at regular intervals thereafter.Clinical evaluation was made at regular intervals after embolisation to assess patient outcome. Results Bilateral uterine artery embolisation was achieved in 395 women, while 5 women had a unilateral procedure. With a mean clinical follow up of 16.7 months, menstrual bleeding was improved in 84% of women and menstrual pain was improved in 79%. Using ultrasound, the median uterine and dominant fibroid volumes before embolisation were 608 and 112 cc, respectively, and after embolisation 255 and 19 cc, respectively ( P ¼ .0001). Three (1%) infective complications requiring emergency hysterectomy occurred. Twenty-three (6%) patients had clinical failure or recurrence. Of these, nine (2%) had a hysterectomy. Twenty-six (7%) women had permanent amenorrhoea after embolisation including four patients under the age of 45 (2%). Of these, amenorrhea started between 4 and 18 months after embolisation, and only three had elevated follicle stimulating hormone levels when amenorrhea developed. Thirteen (4%) women had chronic vaginal discharge considered as a major irritant. Thirteen pregnancies occurred in 12 patients. Ninety-seven percent of women were pleased with the outcome and would recommend this treatment to others. Conclusions Uterine artery embolisation is associated with a high clinical success rate and good fibroid volume reduction. Infective complications requiring hysterectomy, amenorrhoea under the age of 45 and chronic vaginal discharge may complicate the procedure. INTRODUCTIONS

show abstract

Section: Discussionmentioning

confidence: 99%

Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up

Walker¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

show abstract

“…The specific distribution is related to the difference in vascular networks between fibroids (terminal artery) and normal myometrium (large capillary network). The changes in ovarian vascularization which were suspected on previous studies 21,24 were not assessed in this series.…”

Section: Figurementioning

confidence: 98%

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids

Tranquart

Brunereau

Cottier

et al. 2002

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Uterine artery embolization (UAE) is now a recognized alternative to hysterectomy [28]. UAE may be particularly advantageous in women within the climacteric as the risk of precipitating earlier onset of the menopause is higher and the risk of symptomatic recurrence of fibroids is lower [29]. Progestogens are once again cheaper and effective alternatives to GnRHa.…”

Section: There Is Conflicting Evidence For the Benefits Of Gnrha Usedmentioning

confidence: 99%

GnRH Agonists: Do They Have a Place in the Modern Management of Fibroid Disease?

Talaulikar

Belli

Manyonda

2012

J Obstet Gynecol India

View full text Add to dashboard Cite

In the management of women with fibroid disease, GnRH agonists (GnRHa) are frequently used to reduce volume and vascularity before myomectomy, apparently to render the operation easier and reduce operative blood loss, and to enable a transverse supra-pubic incision instead of a midline vertical one. They induce amenorrhoea and thus aid in the correction of pre-operative anaemia. Other gynaecologists use GnRHa to shrink sub mucous fibroids greater than 5 cm in diameter to facilitate access and reduce blood loss and operating time at transcervical resection. GnRHa are also occasionally used as a temporizing measure in women with symptomatic fibroids within the climacteric. We argue against the use of GnRHa in the management of fibroid disease because they are not cost effective, render myomectomy more difficult to apply because they destroy tissue planes, the more difficult enucleation in fact increasing rather than reducing perioperative blood loss and operating time. When used before myomectomy, they increase the risk of 'recurrence' because they obscure smaller fibroids that 'recur' when the effects of the GnRHa wear off, and are associated with side effects in situations where they confer no benefits, or where alternative cheaper drugs with fewer side effects are available.

show abstract

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

Cited by 243 publications

References 14 publications

Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up

Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids

GnRH Agonists: Do They Have a Place in the Modern Management of Fibroid Disease?

Contact Info

Product

Resources

About