The Effects of Uterine Artery Embolisation and Surgical Treatment on Ovarian Function in Women With Uterine Fibroids

Rashid, S., Khaund, A., Murray, L.S., Moss, J. G., Cooper, K., Lyons, D., Murray, G. D. and Lumsden, M. A. (2010) The Effects of Uterine Artery Embolisation and Surgical Treatment on Ovarian Function in Women With Uterine Fibroids. Obstetrical and Gynecological Survey, 65(8), pp. 500-501. (doi: 10.1097/OGX.0b013e3181f07b0b)

Abstract

The standard treatment for uterine fibroids has been either hysterectomy or myomectomy. In the mid 1990s, uterine artery embolization (UAE) was introduced as an alternative nonsurgical technique for the treatment of fibroids. UAE significantly decreases fibroid-related symptoms and numerous studies have demonstrated its efficacy. Although the morbidity of this procedure is low and complication rates are comparable or less than those associated with surgery, there have been reports of the occurrence of pelvic infection and premature ovarian failure. Some studies have shown that patients treated with UAE develop amenorrhea (with rates varying from 1%-8% and as high as 14%) and have increased follicle-stimulating hormone (FSH) levels (within the menopausal range). This suggests that ovarian dysfunction may occur as a consequence of UAE. This study compared the effects of UAE and surgery on both ovarian function and menstrual cycle characteristics in women with uterine fibroids. The impact of age on ovarian function was also studied. Data were obtained for a subgroup of women from a multicenter randomized controlled trial comparing UAE with surgical treatment for uterine fibroids. Of the 157 patients enrolled in this trial, 106 were randomized to UAE, and 51 to surgery. The final cohort used for data analysis was comprised of 96 patients (73 treated with UAE and 23 with surgery). All surgical patients had ovarian conservation at the time of surgery. To assess ovarian function, levels of serum FSH were measured on day 3 of the menstrual cycle before treatment, and at 6 and 12 months post-treatment. Menstrual cycle characteristics (duration of menses and the length of the cycle) were self-evaluated with use of menstrual diaries. The primary study outcome measures were ovarian failure defined by an FSH level of > 40 IU/L, and change in duration of menstrual bleeding and length of cycle. Age-related changes in ovarian function were evaluated in 2 age groups: those older and younger than 45 years of age. No significant difference was found between the 2 treatment groups in the rate of ovarian failure at 12 months (UAE: 11% versus surgery: 18%; P = 0.44). Age of the women had no effect on these results. The duration of menstrual flow (assessed by the number of days of bleeding) decreased significantly from baseline to 12 months (mean decrease: 1.7 days [standard deviation: 3.8] at a 95% confidence interval: 0.8-2.6). No statistically significant change occurred in the mean cycle length at 12 months (0.7 days [standard deviation: 4.9] 95% confidence interval: 0.5-1.9). These findings provide no evidence that UAE accelerates deterioration in ovarian function at 1 year, in comparison with surgery. The observed reduction in the number of days of bleeding at 1 year after UAE is a beneficial effect.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lumsden, Professor Mary
• Authors: Rashid, S., Khaund, A., Murray, L.S., Moss, J. G., Cooper, K., Lyons, D., Murray, G. D., and Lumsden, M. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Obstetrical and Gynecological Survey
• ISSN: 0029-7828