Uterine artery embolisation to treat symptomatic uterine fibroids

doi:10.1136/bmj.39251.440069.AD

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A Watkinson, professor of radiology1,
A Nicholson, consultant radiologist2

¹Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter EX2 5DW
²St James's Hospital, Leeds Teaching Hospitals, Leeds LS9 7TF

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

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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: