Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids

Abstract

Objective To report a case of permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. Design Case report. Setting Gynecologic clinic of a university hospital. Patient(s) A 44-year-old woman with menorrhagia and anemia caused by multiple fibroids. Intervention(s) Transcatheter bilateral uterine artery embolization with polyvinyl alcohol particles, with hormonal, sonographic, and hysteroscopic follow-up procedures. Main outcome measure(s) Serum follicle-stimulating hormone (FSH) and estradiol levels were measured, and sonographic appearance of the ovaries and the endometrium at baseline and 1, 3, 6, and 12 months after treatment were recorded. Hysteroscopy was performed with endometrial biopsy at baseline and 6 months after embolization. Result(s) The patient remained amenorrheic from the procedure. Serial posttreatment measurements of FSH and estradiol levels and repeated ovarian imaging showed no change in ovarian function as compared with baseline. A reduction in endometrial thickness (≤5 mm), as compared with the endometrial thickness measured at baseline (7.2 mm), was sonographically documented 1, 3, 6, and 12 months after treatment. Postprocedure hysteroscopy showed an atrophic endometrium, and endometrial biopsy confirmed endometrial atrophy. Conclusion(s) Permanent amenorrhea associated with endometrial atrophy may occur following uterine artery embolization for fibroids and, to the best of our knowledge, this is the first time this complication has been reported. Patients should be appropriately counseled about the risk of reduced fertility after embolization.