Uterine Artery Embolization for Heavy Menstrual Bleeding

Moss, Jonathan; Christie, Andrew

doi:10.2217/whe.15.78

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…Although rapidly adopted by enthusiasts, the introduction of UAE has varied widely across the globe ( Moss and Christies, 2016 ). This technique was first used in 1995 ( Ravina et al ., 1995 ) to treat uterine fibroids in women wishing to preserve their uterus.…”

Section: Alternatives To Surgical Interventionmentioning

confidence: 99%

Uterine fibroid management: from the present to the future

Donnez

Dolmans

2016

Hum. Reprod. Update

538

506

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Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid ‘radical’ surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.

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Section: Alternatives To Surgical Interventionmentioning

confidence: 99%

Uterine fibroid management: from the present to the future

Donnez

Dolmans

2016

Hum. Reprod. Update

538

506

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“…However, these patients did not appear to experience hot flushes, night sweats, insomnia, anxiety and other perimenopausal symptoms. In addition, studies have shown that hysteromyomectomy does not affect the blood supply of ovaries [15], and has less impact on accessories, so the short-term and long-term impact on ovarian function is not obvious. Our results also showed that AFC and AMH did not change significantly in this group within 18 months after operation, that is, ovarian function was not significantly affected.…”

Section: Discussionmentioning

confidence: 99%

The impact of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis: a clinical study

Xiao¹,

Mou²,

Gu³

et al. 2021

Clinical and Experimental Obstetrics & Gynecology

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Background: Previous studies had shown that major uterine wall resection and reconstruction of the uterus (MURU) was safe and e fective in the treatment of adenomyosis. However, MURU results in loss of a significant amount of myometrial and some endometrial tissues, which may have an impact on uterine hemodynamics and ovarian function. Therefore, it is necessary to study the changes of uterine hemodynamics and ovarian function in patients a ter MURU, in order to provide an evidence-base for its clinical application. Objective: To explore the e fects of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis. Study design: The maximum thickness of unilateral uterine muscle wall or the maximum diameters of adenomyosis focus were measured by ultrasonography. Patients with adenomyosis were divided into three groups: mild, moderate or severe. Fi ty cases of adenomyosis without fertility requirement were treated with MURU (observation group), and levonorgestrelreleasing system (LNG-IUS) was placed in uterine cavity during the operation. Fi ty patients with intramural myoma of the uterus were selected for hysteromyomectomy (control group). The changes of arterial pulsation index (PI) and resistance index (RI) of uterine artery, as well as antral follicle count (AFC) and serum antimullerian hormone (AMH) were observed before operation and 1 month, 3 months, 6 months, 12 months and 18 months post-operation. Results: No complications were observed in both groups, no significant di ference in uterine hemodynamics and ovarian function were found between the two groups (P > 0.05). During intragroup comparison, there were no significant changes in PI and RI before and a ter operation in the two groups, and no significant changes in AFC and AMH were detected in both groups before and a ter operation (P > 0.05). Conclusions: MURU did not significantly a fect the uterine hemodynamics and ovarian function in patients with adenomyosis, but the longterm e fects need to be further investigated.

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Section: Researchmentioning

confidence: 99%

“…Incorporation of UAE into routine clinical practice is widely endorsed and its role in heavy menstrual bleeding has been investigated recently. [13] Previously, a local study by Prollius et al[10] reported a mean reduction in uterine volume of 188 cm 3 in 51 women on follow-up at 12 months. There are limited local data on the long-term effect of UAE on symptomatic fibroid volume reduction using follow-up ultrasound imaging.…”

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confidence: 99%

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

et al. 2017

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RESEARCHBackground. Symptomatic uterine fibroids have a significant impact on women's health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels (p=0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus. The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital Uterine fibroids, also known as leiomyomas, are the most commonly occurring benign tumours of the uterus.[1] Symptomatic fibroid tumours have a major negative impact on the woman's quality of life and reproductive potential.[2] Great health disparities exist worldwide, with African black women experiencing earlier debilitating symptoms and more varied responses to treatment compared with their white counterparts. [3,4] The economic burden of treating symptomatic women is substantial. A recent total cost estimate (direct and indirect) by Soliman et al.[5] in a 2015 systematic review, ranges from USD11 717 -USD25 023 per patient per year after diagnosis or surgery. The true economic impact on South African (SA) public health systems is likely to be higher than the average estimates owing to high disease burden, limited access to treatment, longer waiting times for surgery, low hysterectomy uptake and the presence of severe symptoms among African black women. [4] Surgical management (hysterectomy or myomectomy) has traditionally been the mainstay of treatment (Fig. 1). Recently, umbilical artery embolisation (UAE) and magnetic resonanceguided high-intensity focused ultrasound (MR-g HIFU) has emerged as both an attractive and effective treatment.[6] UAE has proven to be safe and an e...

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Uterine Artery Embolization for Heavy Menstrual Bleeding

Cited by 15 publications

References 20 publications

Uterine fibroid management: from the present to the future

Uterine fibroid management: from the present to the future

The impact of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis: a clinical study

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

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