Practice Rational imaging

Uterine artery embolisation to treat symptomatic uterine fibroids

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39251.440069.AD (Published 04 October 2007) Cite this as: BMJ 2007;335:720
  1. A Watkinson, professor of radiology1,
  2. A Nicholson, consultant radiologist2
  1. 1Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter EX2 5DW
  2. 2St James's Hospital, Leeds Teaching Hospitals, Leeds LS9 7TF
  1. Correspondence to: A Watkinson Anthony.Watkinson{at}rdeft.nhs.uk

    Women may now have another effective, safe, and minimally invasive treatment option for treating fibroids

    The patient

    A 34 year old woman presented to her gynaecologist with menorrhagia associated with dysmenorrhoea and urinary frequency. She was nulliparous but had been trying to become pregnant for several years.

    Learning points

    • Uterine artery embolisation is a safe and effective minimally invasive technique for treating symptomatic uterine fibroids

    • Recent NICE guidelines support its use as an alternative to myomectomy or hysterectomy in women with symptomatic fibroids larger than 3 cm who wish to preserve fertility

    • The risk of hysterectomy or repeat uterine artery embolisation for treatment failure is around 10% at one year and 20-25% within five years

    • The risk of hysterectomy for complications is 2.9% at 12 months

    • The risk of premature ovarian failure is around 1-2% in most series but increases with age; it can approach 25% in women over 45

    What is the next investigation?

    Transabdominal or transvaginal ultrasound is the most commonly performed imaging test for investigating menorrhagia with dysmenorrhoea or pressure related symptoms. If the results suggest uterine fibroids and uterine artery embolisation is a treatment option, we recommend magnetic resonance imaging with gadolinium (dimeglumine gadopentetate) enhancement (fig 1) because it has advantages before and after treatment (table).1 2 3

    Fig 1 Gadolinium enhanced axial T1 weighted magnetic resonance imaging of the pelvis before embolisation. The uterus is enlarged, mainly as a result of a 14.2 cm intramural vascular fibroid, which shows pronounced enhancement

    View this table:

    Comparison of pelvic ultrasound and magnetic resonance imaging (MRI) for uterine pathology

    Outcome

    Imaging confirmed the presence of an enlarged multilobulated fibroid uterus—the largest fibroid was intramural and measured 14.2 cm. Treatment options included:

    • Medical treatment (tranexemic acid with or without gonadotrophin analogue)

    • Mirena coil

    • Endometrial ablation techniques

    • Myomectomy

    • Hysterectomy

    • Uterine artery embolisation

    • Magnetic resonance guided focused ultrasound surgery.

    Medical …

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