Decrease In Uterine Volume Research Articles

Alternative treatments of adenomyosis - an update in procedural management and clinical outcomes.

Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes. Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy. This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.

The Ozkan Technique in Current Use in Uterus Transplantation: From the First Ever Successful Attempt to Clinical Reality.

Uterus-related infertility affects 3-5% of all young women, including Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, hysterectomy, or severe Asherman syndrome. For these women with uterus-related infertility, uterus transplantation is now a viable option. We performed the first surgically successful uterus transplant in September 2011. The Donor was a 22-year-old nulliparous woman. After five failed pregnancy attempts (pregnancy losses), ET attempts were discontinued in the first case, and a search for underlying etiology was performed, including static and dynamic imaging studies. Perfusion computed tomography revealed an obstructed blood outflow, particularly in the left anterolateral part of the uterus. In order to correct blood flow obstruction, a revision surgery was planned. By laparotomy, a saphenous vein graft was anastomosed between the left utero-ovarian and left ovarian vein. Perfusion computed tomography performed after the revision surgery confirmed the resolution of venous congestion and a decrease in uterine volume as well. Following surgical intervention, the patient was able to conceive after the first embryo transfer attempt. The baby was delivered with cesarean section at 28 weeks' gestation due to intrauterine growth restriction and abnormal Doppler ultrasonography findings. Following this case, our team performed the second uterus transplantation in July 2021. The recipient was a 32-year-old female with MRKH syndrome, and the donor was a 37-year-old multiparous braindead woman due to intracranial bleeding. After the transplant surgery, the second patient experienced menstrual bleeding six weeks after the operation. Seven months after the transplant, in the first ET attempt, pregnancy was achieved, and she delivered a healthy baby at 29 weeks of pregnancy. Uterus transplantation from a deceased donor is a feasible option for treating uterus-related infertility. When confronted with recurrent pregnancy losses, vascular revision surgery via arterial or venous supercharging could be an option in order to deal with focal underperfused areas defined by imaging studies.

Comparison of polyvinyl alcohol particles and tris-acryl gelatin microspheres embolic agents used in uterine artery embolization: A systematic review and meta-analysis.

To identify the preferred agent by comparing the therapeutic efficacy, degree of infarction, and side effects of polyvinyl alcohol particles (PVA) and tris-acryl gelatin embolization (TAGM) agents in uterine artery embolization. We included available articles comparing PVA with TAGM embolization agents in the management of fibroids. The primary outcomes included the decrease in uterine volume (%), decrease in dominant tumor volume (%), fibroid infarction rate, complete infarction fibroid, complications, pain score after 24 h, procedure time (minutes), duration of hospital stay, fluoroscopy time (minutes), and the change in symptom severity score. Eight articles that met our inclusion criteria were included in this study. Our analysis yielded an overall superiority of PVA compared to TAGM regarding complete fibroid infarction rate at the first 24 h. However, TAGM was better than PVA concerning <90% infarction rate outcome. While both embolization techniques showed similar effects regarding the change in symptom severity score, the percentage of decrease in uterine volume, percentage of decrease of dominant tumor volume, 90-99% infarction rate, complete infarction rate when assessed after the first 24 h, pain score after the first 24 h, procedure time, fluoroscopy time, minor, and major complications. Both PVA and TAGM embolization agents are effective and safe modalities in treating patients with fibroids, with no significant variation of both agents in most outcomes.

Life Quality in Premenopausal Women after Embolization of Uterine Myomas.

Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).

Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography

Introduction: Central precocious puberty (CPP) is defined as the development of secondary sexual characteristics in girls before the age of 8 years due to the activation of the hypothalamus-pituitary-gonadal (HPG) axis, and long-acting GnRH analogues (GnRHa) are used in its standard treatment. The gold standard method for evaluating the efficiency of treatment is to demonstrate the suppression of the LH response with the GnRH stimulation test. Pelvic ultrasonography (US) is an easily accessible, safe, free of ionizing radiation and non-invasive imaging method, which is used for the evaluation of internal genital organs, monitoring of sexual development, and excluding ovarian mass. This study aimed to evaluate the effect of GnRHa treatment on internal genital organs and to determine the role of pelvic ultrasonography in treatment follow-up. &#x0D; Material and Method: Between January 2017 and May 2021, 50 girls who were started on GnRHa treatment due to the diagnosis of CPP or rapidly progressing puberty were followed up, and who underwent pelvic US imaging at the beginning of treatment and in the 1st year of treatment were included in the study. The clinical and sonographic findings were compared before and after the treatment.&#x0D; Results: Of the 50 patients in the study, 52% (n=26) were being followed up with CPP, and 48% (n=24) with rapidly progressive puberty. In the first year of GnRHa treatment, while the suppression of the HPG axis was detected in 82% (n=41) of the cases with the GnRHa test, there was no suppression in 18% (n=9). A decrease in ovarian volume was observed in 73.2% (n=30) of 41 patients with suppression of the HPG axis, a decrease in uterine volume in 65.9% (n=27), and a decrease in uterine anterior-posterior size in 61% (n=25). While endometrial thickness could be measured in 64% (n=32) of the cases before treatment, measurable endometrial thickness was detected in only 6% (n=3) of the cases in the 1st year of treatment. &#x0D; Conclusion: We detected in this study that GnRHa treatment in girls with a diagnosis of CPP/rapid puberty caused a significant regression in ovarian and uterus dimensions and endometrial echo selectability. Our results, in line with the literature, support that pelvic ultrasonography is an appropriate modality for monitoring the suppression of the HPG axis during CPP treatment and may reduce the need for repeated GnRH stimulation tests.

The prevention of recurrence of uterine fibroids after conservative myomectomy

The objective: to conduct a comparative analysis of the efficacy and tolerability of antigestagens (mifepristone) and gonadotropin-releasing hormone agonists (aGnRH) as part of adjuvant therapy for the prevention of the recurrence of uterine fibroids after conservative myomectomy in women of reproductive age.Materials and methods. The study included 99 patients of reproductive age (19–42 years old) with uterine myoma. The women were divided into three groups (n=33 each), which were balanced by age and the number of myomatous nodes. From the 8th day after surgical treatment, the patients of the 1st group were prescribed the antigestagen mifepristone at a dose of 50 mg daily for 4 months, the 2nd group – aGnRH (triptorelin) 3.75 mg intramuscularly once every 28 days for 6 months. The third, control group included women who had contraindications to adjuvant therapy or refused to take hormonal drugs. The effect of treatment on the uterus size was studied by ultrasound examination on the 8th day and in 1 and 4 months after surgery, the control of the recurrence was performed every 3 months for 3 years after surgery. The fact of myoma recurrence was established when at least one myomatous node more than 1 cm in diameter appeared.Results. From the second month of the therapy, 78.8% of patients in the 2d group had estrogen-deficient symptoms. In patients in the 1st group, minor side effects were registered only in 15.1%, in the 3rd group – 3–6% (p&lt;0.05). After the completion of the therapy, the menstrual cycle restored in 3.3±1.5 weeks in the 1st and 6.2±1 weeks in the 2nd group of patients. All women in the control group had regular menstruations every month. In 1 month after surgical treatment, compared with the 8th day after operation, the volume of the uterus decreased by 14±2% in women in all three groups, in 4 months a further decrease was observed only in the 1st and 2nd groups, in the control group the indicators remained at the same level as in the first month after surgery. There was no recurrence of myoma during the first year after conservative myomectomy in patients of the 1st and 2nd groups, the further the cumulative risk was almost the same and after 24 months it was 12.5±5.2% and 13.7±8%, respectively. The cumulative recurrence rate in the 3d group was 9.1±5.6% after 6 months, 33±8.1% after 12 months, and 41.6±9.2% – 24 months. The pregnancy occurred mostly in the interval from 1 to 1.5 years after the operation, the average interval between the operation and fertilization was 13.7±5 months.Conclusions. Adjuvant therapy with mifepristone or aGnRH after conservative myomectomy leads to an equal reduction in the risk of myoma recurrence – in 4.25 times. The cumulative incidence of fibroid recurrence in 3 years after surgery is the lowest in the group of women taking mifepristone, and is the highest one in patients without adjuvant therapy. With a similar efficacy to GnRH agonists, the antiprogestins have less side effects and good tolerance, faster recovery of the menstrual function, reverse of hormonal parameters and a decrease in uterine volume. Therefore, in order to restore reproductive function and prevent early recurrence of uterine fibroids, women after conservative myomectomy can be recommended to take the adjuvant therapy with antiprogestins or GnRH agonists, the choice of which should be differentiated and individual.

Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant.

To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor. Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor. Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume. Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g. Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies.

Ovarian arteries embolization in women with persistent symptoms following uterine arteries embolization for uterus fibroids

In patients with persisting symptoms after uterine arteries embolization (UAE), ovarian arteries embolization (OAE) may play a role to improve symptoms and decrease subsequent surgery rates. In a retrospective cohort, we aimed to investigate the efficacy and safety of OAE in females with recurrent or persistent symptoms following UAE. We performed a retrospective analysis of prospectively collected cases at a single reference academic hospital; we identified patients who benefited from OAE for persisting symptoms following UAE from 2008 to 2021. Outcome variables included the rates of subsequent surgery, a quality-of-life questionnaire with the UFS-QOL tool, the MRI reduction in uterine and fibroids volumes and the fibroid devascularization rate. Among 1300 women treated with UAE during the study period, 18 eventually received OAE and were included (mean age 44 ± 4.3 SD). There was no OAE procedural complication. There was a decrease in uterine volume and a complete devascularization of the dominant fibroid in 10/11 (90.9%) patients who underwent 12months MRI. Three women underwent subsequent hysterectomy. Among 10/18 patients who answered the quality-of-life questionnaire after a mean follow-up of 70months, eight reported an improvement or stability of symptoms. OAE for persisting symptoms after UAE was associated with improvement or stability of quality-of-life in most study subjects and less than a fifth of the cohort underwent hysterectomy after OAE. This study highlights the role of OAE as an adjunct to UAE.

Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis.

To evaluate the efficacy and feasibility of levonorgestrel-releasing intrauterine device (LNG-IUD) use longer than 5 years in women with adenomyosis.Data were retrospectively collected from patients who were treated with LNG-IUD longer than 5 years at the Chungnam National University hospital for adenomyosis diagnosed with ultrasonography from January 2006 to November 2013.A total of 131 patients who were diagnosed with adenomyosis had treated with LNG-IUD longer than 5 years. The mean duration of keeping 1 device without replacement was 58.35 ± 15.98 months, and total duration of LNG-IUD treatment was 83.86 ± 23.88 months. A total of 51 patients stopped using LNG-IUD after 5 years and the mean age at the time of LNG-IUD removal was 52.46 ± 6.9. LNG-IUD treatment had a significant effect on both menorrhagia and dysmenorrhea starting from the first month of insertion (P < .01), which persisted until 6 years when the effect started to plateau. The decrease in uterine volume was not consistent during the treatment period. The uterine volume decreased significantly only in the first and second year of LNG-IUD treatment and then from eighth to tenth year of LNG-IUD treatment (P < .05). Adverse events after insertion of LNG-IUD decreased significantly after 5 years.LNG-IUD treatment longer than 5 years is an effective and feasible method for patients diagnosed with adenomyosis.

Changes in ultrasound uterine morphology and endometrial thickness during ovarian aging and possible associated factors: findings from a prospective study

The aim of the study was to provide reference values for sonographic measurements of uterine morphology, quantify changes in uterine morphology across the menopausal transition, and identify possible factors associated with sonographic findings in uterine morphology. This is a longitudinal cohort study conducted in middle-aged Chinese women. Using transvaginal ultrasound, we measured morphologic parameters of the uterus (volume and endometrial thickness) under standardized conditions every year for over a decade. Uterine volume begins to decrease before the final menstrual period and declines rapidly thereafter. Compared with a baseline measurement taken in the year of the final menstrual period, uterine volume decreased by 20% and 35% at the first year and second year of postmenopause, respectively. The rate of decrease was slower in the third year. Compared with endometrial thickness in the year of the final menstrual period, the figures for 2 and 3 years before the final menstrual period were 5% and 10% higher, while they decreased by 9% and 18% at the first and second year after the final menstrual period. Similarly, the endometrial thickness became relatively stable 3 years after the final menstrual cycle. These observations were fairly consistent across all women without uterine fibroids. Endometrial thickness was significantly positively associated with body mass index (P = 0.049) after adjusting for time and menopausal stage. The figures for uterine volume and endometrial thickness decrease around menopause using ultrasound measurments with large reductions in the first and second year after the final menstrual period. A higher body mass index is associated with increased endometrial thickness.

Evaluation of Uterine Artery Embolization on Myoma Shrinkage: Results from a Large Cohort Analysis.

Objective:There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess the effect of UAE on myoma shrinkage.Materials and Methods:The study included 337 women in reproductive age affected by a single symptomatic intramural myoma and declined surgery, undergoing UAE. The uterus and myoma diameters and volumes were determined on ultrasonographic scans before and 3, 6, and 12 months after the procedure.Results:The mean uterine volume before intervention was 226.46 ± 307.67 mm3, whereas myoma volume was 51.53 ± 65.53 mm3. Further myoma progression was registered in only four patients. In remaining women, uterus volume in average decreased for 149.99 ± 156.63 mm3, whereas myomas decreased for 36.57 ± 47.96 mm3. The mean volume reduction rate of the uterus was 49.54 ± 35.62 and for myoma was 57.58 ± 30.71. A significant decrease in both uterine and myoma volume was registered in every stage of the follow-up. The highest average decrease in uterine volume was in the first 3 months and myoma volume between 3 and 6 months following UAE. After 12 months follow-up, successful outcome (volume regression >50% respect to the baseline) was registered for uterus in 97.4% and for myoma in 67.9% of investigated patients.Conclusion:UAE was proven to allow a good success rate and can be considered as an effective alternative procedure for myoma treatment.

LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN ADENOMYOSIS; PREDICTORS FOR RESPONSE AND CLINICAL OUTCOME

Objectives: The aim is to detect clinical and ultrasonographic characters that predict the response of adenomyosis to levonorgestrel-releasing intrauterine system (LNG-IUS) and to evaluate the clinical efficacy and the time needed to show a response.Methods: A prospective single-arm study conducted in the Obstetrics and Gynaecology Department Al-Yarmouk Teaching Hospital in Baghdad/Iraq from August 2015 to March 2018. Women with symptomatic adenomyosis with age 39 years and above and who completed their families had been enrolled in this study. LNG-IUS was used as a treatment; the outcome measure was to evaluate its effect in improving the symptoms and the time needed to show a clinical response. Multivariate analysis was used to assess the contribution of the clinical and ultrasonographic parameters to the prediction of the response to LNG-IUS.Results: Over the mean duration of follow-up period of the study (22.7±9.9 months), there was a significant improvement in menstrual blood loss, dysmenorrhea, and hemoglobin (Hb) with significant decrease in uterine volume (p˂0.001). The time to show response was as early as 3 months and the first 6 months is the best time to predict failure. Initial menstrual blood loss and Hb were good predictors to show response while uterine volume an excellent one (positive predictive value 80% and negative predictive value 97.2%).Conclusion: Levonorgestrel-releasing intrauterine device is an effective treatment of symptomatic adenomyosis in term of time to response and duration of response. The presenting Hb, menstrual blood loss, and uterine volume are useful predictors of response.

Levonorgestrel-releasing intrauterine system versus low-dose combined oral contraceptive for treatment of adenomyosis uteri: a randomized clinical trial

Introduction: This study compares the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a low-dose combined oral contraceptive (COC) in reducing adenomyosis-related pain and bleeding. Materials and methods: A randomized clinical trial included 62 participants complaining of pain and bleeding that was associated with adenomyosis. Participants were randomly assigned to either LNG-IUS or COC treatment. The outcomes included the improvement of pain using a visual analogue scale, menstrual blood loss using a menstrual diary and estimated uterine volume by ultrasound for 6 months of treatment. We also compared uterine arteries and intramyometrial Doppler indices before and 6 months after treatment with both LNG-IUS and COCs. Results: Both treatments significantly reduced pain after 6 months of use; however, the reduction was greater in the LNG-IUS group (from 6.23±0.67 to 1.68±1.25) compared with the COCs group (from 6.55±0.68 to 3.90±0.54). Both treatment arms significantly decreased the number of bleeding days, uterine volume and Doppler blood flow in the uterus from before to after treatment. These effects were more significant in the LNG-IUS arm compared with the COC arm. Conclusion: Both LNG-IUS and COCs decreased the pain and menstrual bleeding that is associated with adenomyosis. However, LNG-IUS is more effective than the COCs in reducing pain and menstrual blood loss. This effect may be secondary to the decrease in uterine volume and the increase in blood flow resistance. © 2015 Elsevier Inc. All rights reserved.

Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri: a randomized clinical trial

IntroductionThis study compares the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a low-dose combined oral contraceptive (COC) in reducing adenomyosis-related pain and bleeding. Materials and methodsA randomized clinical trial included 62 participants complaining of pain and bleeding that was associated with adenomyosis. Participants were randomly assigned to either LNG-IUS or COC treatment. The outcomes included the improvement of pain using a visual analogue scale, menstrual blood loss using a menstrual diary and estimated uterine volume by ultrasound for 6 months of treatment. We also compared uterine arteries and intramyometrial Doppler indices before and 6 months after treatment with both LNG-IUS and COCs. ResultsBoth treatments significantly reduced pain after 6 months of use; however, the reduction was greater in the LNG-IUS group (from 6.23±0.67 to 1.68±1.25) compared with the COCs group (from 6.55±0.68 to 3.90±0.54). Both treatment arms significantly decreased the number of bleeding days, uterine volume and Doppler blood flow in the uterus from before to after treatment. These effects were more significant in the LNG-IUS arm compared with the COC arm. ConclusionBoth LNG-IUS and COCs decreased the pain and menstrual bleeding that is associated with adenomyosis. However, LNG-IUS is more effective than the COCs in reducing pain and menstrual blood loss. This effect may be secondary to the decrease in uterine volume and the increase in blood flow resistance.

The effectiveness of combined abdominal myomectomy and uterine artery embolization

ObjectiveTo evaluate the efficacy of abdominal myomectomy after uterine artery embolization (UAE-AM) among patients with myomas. MethodsIn a retrospective study, chart data were reviewed for patients attending a center in California, USA, who underwent UAE-AM between 1999 and 2012. Patients had been offered the combined procedure if the diameter of the myoma was at least 4cm, they wished to preserve fertility, or they were candidates for a traditional abdominal myomectomy. Estimated blood loss, fluoroscopy times, and hospital stay were recorded. Follow-up data on uterine volume and fibroid size had been collected via magnetic resonance imaging or ultrasonography approximately 3–6months after UAE-AM. ResultOverall, 20 patients underwent UAE-AM. Approximately 6months after the procedure, the mean decrease in uterine volume was 77.33%±14.25% and that in myoma diameter was 46.45%±25.61%. Six women subsequently became pregnant; one patient had two separate pregnancies. No patient required a conversion to hysterectomy or blood transfusion, and no recurrences were reported. ConclusionUAE-AM was found to be an effective option available to women with large myomas who wished to preserve their uterus. With the combination procedure, patients had favorable outcomes with no fibroid recurrence.

Add-back therapy with GnRH analogues for uterine fibroids.

Add-back therapy with GnRH analogues for uterine fibroids.

OP20.06: Changes in sonographic findings of adenomyosis after treatment with aromatase inhibitor

To investigate the changes in the sonographically detectable alterations of the myometrium caused by adenomyosis after treatment with aromatase inhibitor. This prospective study included symptomatic women with adenomyosis. The diagnosis of adenomyosis was suspected on the basis of transvaginal ultrasonography (TVS) and confirmed by magnetic resonance imaging. Patients received oral letrozole (2.5 mg/day, Femara; Novartis Farma) for 6 months. Patients underwent TVS before starting the treatment, after 3 and 6 months of treatment. During TVS the following parameters were examined: uterine diameters and volume, thickening of the transition zone, regularity of the endometrial-myometrial junction, presence and size of myometrial cystic anechoic areas, thickness of uterine wall, asymmetrical myometrial thickening (not cause by the presence of myomas), presence of subendometrial hyperechoic linear striation, parallel shadowing and characteristics of localized adenomyomas. 34 patients were included in the study; 4 patients (11.8%) discontinued the therapy because of adverse effects. After 3 months of treatment there was a significant decrease in uterine volume (p < 0.05); a further decrease was observed after 6 month of treatment (p < 0.001 compared with baseline; p < 0.05 compared with 3-month treatment; 6-month decrease in uterine volume: 56.2%). The treatment caused a significant decrease in: size of anechoic area (p < 0.01), thickness of uterine wall (p < 0.05), larger diameter of localized adenomyomas (p < 0.01) and total adenomyoma volume (p < 0.001, decrease in total adenomyoma volume: 53.7%). The treatment improved pain symptoms. In patients with adenomyosis, letrozole causes a significant decrease in uterine and adenomyoma volume, which is associated with changes in some ultrasonographic characteristics of adenomyosis.

Uterine artery Doppler flow velocity waveform analysis following uterine fibroid embolisation

The objective was to evaluate the relation of uterine artery Doppler flow pulsatility index (PI) with total uterine volume reduction following bilateral embolisation of uterine fibroids by injection of polyvinyl alcohol particles. Doppler flow velocity was examined before and within 8 days after embolisation (n = 13). Uterine size was assessed by magnetic resonance imaging (MRI) before, and at 3 and 6 months after, the procedure. Mean PI values (mean of right and left side) obtained before embolisation were negatively related to uterine size (r = −0.68, p = 0.010) but not to uterine volume reduction after the procedure. Mean PI values after the procedure were related to the percentage decrease in uterine volume both at 3 (r = 0.74, p = 0.004) and 6 months (p = 0.73, p = 0.005). Doppler ultrasound measures of the uterine arteries may be used to evaluate reduction of uterine size following fibroid embolisation.

Role of Low-Dose Mifepristone for Managing Uterine Leiomyoma

Objective: The aim of this research was to assess the decrease in uterine volume and fibroid volume in patients with uterine leiomyoma who were receiving low-dose mifepristone for 3 months as well as evaluating relief in symptoms produced by this medication. Design: This was a prospective study carried out in a tertiary-care center. Materials and Methods: Fifty women (ages 30–50) with symptomatic uterine leiomyoma were given 10 mg of mifepristone per day for 3 months. The patients' decrease in menstrual and pressure symptoms and reduction in uterine and fibroid volume, measured by transvaginal sonography, were assessed at the end of 3 months of treatment and after 3 months of stopping treatment. Results: There was a significant reduction in the patients' uterine and fibroid volume at the end of 3 months. The mean reductions in uterine and fibroid volume after 1 month were up to 9.6% and 11.1%, respectively; after the second month, they were respectively, 18.3% and 21.4%; and after the third month, they were respectively, 27.8% and 32.1% (p<0.001). Three months after stopping treatment there was a slight increase in these parameters (p<0.001), but uterine and fibroid volume were still 26.25% and 27.24%, respectively, lower than baseline. There was significant reduction of menorrhagia, dysmenorrhea, and pressure symptoms of bladder frequency and pelvic pain at the end of 3 months (p<0.001), which increased slightly (p<0.05) after 6 months. According to the results of endometrial sampling, no patient had any complex hyperplasia or any atypical hyperplasia. The side-effects of the medication were minimal. Conclusions: Low-dose mifepristone had a shrinking effect on the patients' fibroid growths. It produced a definite reduction in the the patients' symptoms with few side-effects. (J GYNECOL SURG 30:70)

3:48 PM; Abstract No. 138; FEATURED ABSTRACT - Quantitative semi-automatic 3D assessment of uterine fibroids after intra-arterial embolization - a feasibility study

were still experiencing menses and all reported significantly less menstrual bleeding. 12 women (60%) reported pre-procedural bulk symptoms and 10/12 (83%) described these as improved. 16/20 (60%) had post procedural MRI with an average decrease in uterine volume of 39%. 17/20 (85%) women were satisfied with the procedure and would undergo UAE again. Complications included one patient who developed tuboovarian abscesses and experienced large volume fibroid expulsion requiring drainage of abscesses and a vaginal myomectomy. Small volume fibroid expulsion not requiring further treatment occurred in 2 women (10%) and 3 women (15%) experienced post-procedure pain requiring treatment with IV narcotics in the emergency room. Conclusion: UAE outcomes in patients with megauterus are comparable to prior studies. Megauterus alone should not be a contraindication to UAE and may not be a key factor in predicting successful outcome of UAE.