Decrease In Uterine Volume Research Articles

Laparoscopic radiofrequency fibroid ablation: phase II and phase III results.

Background and Objectives:To review phase II and phase III treatments of symptomatic uterine fibroids (myomas) using laparoscopic radiofrequency volumetric thermal ablation (RFVTA).Methods:We performed a retrospective, multicenter clinical analysis of 206 consecutive cases of ultrasound-guided laparoscopic RFVTA of symptomatic myomas conducted on an outpatient basis under two phase II studies at 2 sites (n = 69) and one phase III study at 11 sites (n = 137). Descriptive and exploratory, general trend, and matched-pair analyses were applied.Results:From baseline to 12 months in the phase II study, the mean transformed symptom severity scores improved from 53.9 to 8.8 (P < .001) (n = 57), health-related quality-of-life scores improved from 48.5 to 92.0 (P < .001) (n = 57), and mean uterine volume decreased from 204.4 cm3 to 151.4 cm3 (P = .008) (n = 58). Patients missed a median of 4 days of work (range, 2–10 days). The rate of possible device-related adverse events was 1.4% (1 of 69). In the phase III study, approximately 98% of patients were assessed at 12 months, and their transformed symptom severity scores, health-related quality-of-life scores, mean decrease in uterine volume, and mean menstrual bleeding reduction were also significant. Patients in phase III missed a median of 5 days of work (range, 1–29 days). The rate of periprocedural device-related adverse events was 3.5% (5 of 137). Despite the enrollment requirement for patients in both phases to have completed childbearing, 4 pregnancies occurred within the first year after treatment.Conclusions:RFVTA does not require any uterine incisions and provides a uterine-sparing procedure with rapid recovery, significant reduction in uterine size, significant reduction or elimination of myoma symptoms, and significant improvement in quality of life.

OC13.01: Sonographic findings in adenomyosis after insertion of levonorgestrel intrauterine device

The aim of this study (2006–2011) was to assess whether the sonographically detectable morphological alterations of the myometrium induced by adenomyosis changed after insertion of the LNG-IUD. 120 premenopausal symptomatic patients (menorrhagia, severe dysmenorrhea) with minimum five sonographic findings (globular shaped uterus, myometrial cysts (2–6 mm), inhomogeneous myometrium, indistinct borders to a myometrial mass, indistinct endometrial stripe, subendometrial linear striations, hyperechoic myometrial nodules, asymmetric thickening of the anterior or posterior uterine wall, minimal mass effect on the endometrium or serosa) of adenomyosis were enrolled into the study. Before and at 3, 6 and 12 months after insertion of the LNG-IUD all the patients underwent transvaginal sonography which evaluated uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, thickness of uterine wall and asymmetric myometrium, presence of myometrial hyperechoic striation. Color Doppler can be utilized in all cases to help distinguish between leiomyomas and adenomyosis. 23 patients become amenorrheic at 6 months and at 12 months—43 patients become amenorrheic. 50 patients had a significant reduction in menstrual bleeding at 12 months. 4 patients need to extract the LNG-IUD because of important bleeding. Dysmenorrhea was significantly alleviated in all 78 patients. We observed a significant decrease in uterine volume (170.3 ± 10.4 mL vs. 104.5 ± 8.2 mL) and reduction in asymmetric wall thickness (29.3 ± 1.9 mm vs. 17.2 ± 2.8 mm). However sonographic signs of adenomyosis such as myometrial cystic areas and hyperechoic striation did not disappear. The accuracy of transvaginal ultrasound in the detection of adenomyosis is highly operator dependent. After insertion of a LNG-IUD in patients with adenomyosis, uterine volume decreased, the myometrial wall shrank and symptoms were significantly alleviated. However sonographic signs of adenomyosis did not seem to disappear completely.

Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: Preliminary experience

To evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids. Mid-term clinical outcome (mean, 25 months) of 12 premenopausal women (mean age, 38 years) with multiple and large symptomatic fibroids who desired to retain their uterus and who were treated using combined UAE and surgical myomectomy were retrospectively analyzed. In all women, UAE alone was contraindicated because of large (>10 cm) or subserosal or submucosal fibroids and myomectomy alone was contraindicated because of too many (>10) fibroids. UAE and surgical myomectomy were successfully performed in all women. Myomectomy was performed using laparoscopy (n=6), open laparotomy (n=3), hysteroscopy (n=2), or laparoscopy and hysteroscopy (n=1). Mean serum hemoglobin level drop was 0.97 g/dL and no blood transfusion was needed. No immediate complications were observed and all women reported resumption of normal menses. During a mean follow-up period of 25 months (range, 14-37 months), complete resolution of initial symptoms along with decrease in uterine volume (mean, 48%) was observed in all women. No further hysterectomy was required in any woman. In premenopausal women with multiple fibroids, the two-step procedure is safe and effective alternative to radical hysterectomy, which allows preserving the uterus. Further prospective studies, however, should be done to determine the actual benefit of this combined approach on the incidence of subsequent pregnancies.

Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging

Background This study was conducted to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on adenomyotic lesions diagnosed and monitored by magnetic resonance imaging (MRI). Study Design LNG-IUS was inserted during menstrual bleeding in 29 women, 24 to 46 years of age, with MRI-diagnosed adenomyosis associated with menorrhagia and dysmenorrhea. Clinical evaluations were carried out at baseline and at 3 and 6 months postinsertion. MRI was performed at baseline and at 6 months postinsertion and was used to calculate junctional zone thickness (in mm), to define the junctional zone borders, to identify the presence of high-signal foci on T 2-weighted images and to calculate uterine volume (in mL). Results A significant reduction of 24.2% in junctional zone thickness was observed (p<.0001); however, no significant decrease in uterine volume was observed (142.6 mL vs. 136.4 mL; p=.2077) between baseline and the 6-month evaluation. A significant decrease in pain score was observed at 3 and 6 months after insertion (p<.0001); however, six women continued to report pain scores >3 at 6 months of observation. At 3 months of use, the most common bleeding pattern was spotting, and at 6 months of observation, oligomenorrhea was the most common pattern observed, although spotting was present in one third of the women. Conclusions The insertion of an LNG-IUS led to a reduction in pain and abnormal bleeding associated with adenomyosis. MRI was useful for monitoring response of adenomyotic lesions to the LNG-IUS.

OP17.04: Accuracy of transvaginal sonography in the diagnosis of deep posterior endometriosis

adenomyosis were enrolled into the study. All the patients underwent before and at least three months after insertion of the LNG-IUS, a detailed transvaginal sonography which evaluates: uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, asymmetric myometrium, presence of myometrial hyperechoich striation, vascularization of the myometrial lesions and accurate mapping of the localisation of the myometrial alterations. A comparison between dimensions and presence of these different signs of adenomyosis before and after insertion of LNG-IUS was performed. Results: Seven patients (58.3%) become amenorrhoic and the other patients referred a significantly reduction in menstrual bleeding. Dysmenorrhea was completely relieved or significantly alleviated in all patients. We observed a significant decrease in uterine volume (716.9 ± 213.8 ml vs. 520.6 ± 148.3 mL). However sonographic signs of adenomyosis such as myometrial cystic areas, asymmetric myometrium, or presence of myometrial hyperechoich striation does not disappear, some decrease in size but not significantly. Conclusion: After insertion of the LNG-IUS in patients with adenomyosis, uterine volume decrease and symptoms relieved or were significantly alleviated. However sonographic sign of adenomyosis seems not to disappear completely. A long term followup during and after treatment could be useful to understand the therapeutic role on adenomyosis of LNG-IUS.

The effect of the levonorgestrel intrauterine system on uterine artery blood flow 1 year after insertion

To assess whether the morphological alterations of the endometrium induced by the levonorgestrel intrauterine system affect the uterine artery vasculature. Forty-eight premenopausal women attending our gynecology clinic because of menorrhagia were enrolled into the study. Clinical measures of menstrual bleeding, endometrial thickness and Doppler flow of the uterine artery (resistance (RI) and pulsatility (PI) indices) were evaluated before and 1 year after insertion of the levonorgestrel intrauterine system. Thirty-three (69%) women were available for re-evaluation at the end of the first year and the continuation rate was 76% (n = 25). A paired samples t-test and the Mann-Whitney U-test were used for comparison of values between groups. The mean age of the thirty-three patients was 44.3 +/- 7.6 years. Nine patients (27.3%) were amenorrheic and three patients were in menopause at the end of the year. After excluding the women in menopause, the increase in mean RI 1 year after insertion was statistically significant (0.86 +/- 0.07 vs. 0.81 +/- 0.08; P = 0.046), as was the decrease in uterine volume (736.9 +/- 276.9 mL vs. 972.75 +/- 465.71 mL; P = 0.029). The mean endometrial thickness decreased 1 year after insertion, but not significantly (4.6 +/- 1.6 mm vs. 6.6 +/- 3.5 mm; P = 0.07) and there was no statistically significant difference in mean PI between the groups (2.00 +/- 0.63 and 2.03 +/- 0.64 pre- and post-insertion, respectively; P = 0.83). The increase in mean RI of the uterine artery and the decrease in uterine volume 1 year after insertion of the levonorgestrel intrauterine system may be related to its progestational effect. This increase in RI may have a role in cessation of menstruation.

200: Fibroid Treatment by Temporary Uterine Artery Occlusion Using a Doppler Guided Clamp

To assess the effectiveness of temporary uterine artery occlusion in reducing uterine and fibroid volume in patients with symptomatic fibroids. An ethics committee approved study to evaluate the technical success of a transvaginal uterine artery occlusion system (technical success=vessels occluded for duration of target time). All patients have been offered hysterectomy as part of this study but we have follow-up on a series of 22 patients who have elected not to have a second procedure. A university medical center. A consecutive series of 22 patients with symptomatic uterine fibroids treated from June 2004 through March 2005. All patients were prescreened with MR imaging to verify fibroid number, position, and overall uterine volume. The uterine arteries of these patients are then temporarily occluded for a period of four to seven hours with a transvaginal Doppler guided clamp. Success of occlusion is verified using the integrated Doppler and confirmed with angiography. Of the 22 patients in this series, 9 have returned for follow-up MR imaging. The range of follow-up is 4.2 to 7.8 months post procedure. Of these 9 patients, 7 demonstrate decreasing uterine and fibroid volumes. Average uterine volume decrease is 18.4% and average fibroid volume decrease 55.6%. This easy to use device has demonstrated success in reducing uterine and fibroid volumes in these patients and more importantly has delayed any further interventions required for relief for symptoms.

Rapid Reduction of Leiomyoma Volume During Treatment With the GnRH Antagonist Ganirelix

Twenty premenopausal women with symptomatic fibroids, who were scheduled for surgery, participated in a prospective, open-label study evaluating the rapidity and maximum reduction of leiomyomata volume possible using daily treatments with 2 mg of the GnRH antagonist ganirelix. Before starting and after completing treatment, and at weekly intervals during treatment, the size and location of leiomyomas were evaluated using an ultrasound scan (USS), and blood samples were taken for a serum hormone analysis. In addition, magnetic resonance imaging (MRI) was performed before treatment and after maximum reduction. Maximum reduction was considered to have occurred when four consecutive USS measurements found less than a 10% decrease. Treatment consisted of daily subcutaneous injections of 2 mg ganirelix given in the upper leg by the study subjects themselves. Treatment continued until maximum reduction in leiomyomata and uterine volume was achieved, but for no more than 12 weeks. Nineteen women completed the treatment regimen. Initial USS assessment found leiomyoma volumes ranging from 2.9 to 1085.2 mL, and baseline MRI measurements ranged from 3.6 to 1015.5 mL. Corresponding uterine volume measurements were 50.3 to 1085.2 mL with USS and 64.3 to 1612.7 mL with MRI. There were 7 submucosal, 10 intramural, 1 transmural, and 9 subserosal leiomyomas identified in the 19 women. Six were located on the anterior wall, 12 on the posterior wall, and 9 in the fundus. USS assessments found a median decrease of -42.7% (range, -77.0% to 14.1%) in leiomyoma volume and a decrease of -46.6% (range, -78.6% to -6.1%) in uterine volume. Baseline and end point MRI measurements showed a median decrease in leiomyoma volume of -29.2% (range, -62.2% to 35.6%) and a median decrease in uterine volume of -25.2% (range, -63.6% to 28.9%). The median length of treatment was 19 days (range, 1-65 days) to achieve maximum leiomyoma reduction and 17 days (range, 8-52 days) for maximum reduction in uterine size. In the serum hormone analyses, serum LH and E 2 were undetectable at the first weekly assessment and remained too low to measure throughout the trial. Median FSH values dropped to below 2 IU/L by the third weekly assessment and stayed there. Progesterone concentrations were low throughout the study. Reported side effects included hot flushes, which were experienced by 75% of patients, and headaches, which occurred in 45% of study subjects. Eight women reported symptoms in the first week but most appeared in the third week. Only two of the 19 women had no adverse events.

Outcome of Uterine Embolization and Hysterectomy for Leiomyomas: Results of a Multicenter Study

This multicenter prospective study compared uterine embolization with hysterectomy in the treatment of women with symptomatic leiomyomas. One hundred two patients were treated with embolization and 50 underwent hysterectomy. Clinical and demographic data, menstrual flow, menorrhagia, general health, and quality-of-life assessments were recorded for each patient. Follow up consisted of office visits with 1 to 3 weeks of treatment, at 3 months, and 6 months. Patients were mailed a questionnaire for evaluation at 12 months. Participants were between 30 and 50 years of age. Embolization patients were more often black, more likely to have had prior treatment for leiomyomas, and had more leiomyomas. The mean uterine volume for these patients was nearly twice that of hysterectomy patients. Embolization procedures took an average of 60 minutes. The average hospital stay was less than 1 day (mean 0.83 days), and the time to return to work was an average of 11 days after treatment. For hysterectomy patients, the mean operating time was 97 minutes, mean hospital stay was 2.3 days, and mean time to return to work was 33 days (P <0.001 for all 3 comparisons). Patients who had embolization had a 55.6% reduction in blood loss at the 3 months follow-up visit and a 58.1% reduction at 6 months (P <0.001 for change). Menorrhagia scores followed a similar pattern. Three hysterectomy patients had minimal cyclic bleeding after surgery. No other differences in symptoms were seen between the 2 groups at 6 months. At 12 months, 98% of hysterectomy patients had improved pelvic pain compared with 84% of embolization patients. Hysterectomy patients also reported a reduction in pelvic pressure more often than those who had embolization (98% vs. 84%). Urinary symptoms were similar in both groups. No differences were seen between the 2 groups in physical and mental health summaries and patient self-assessments of overall health status, which all showed improvement at 6 months and 12 months. Overall, patients who had the lowest baseline scores for these measures reported the greatest improvement at 6 months. The embolization group experienced a mean decrease in uterine volume of 26% at 3 months and 33.1% at 6 months (P <0.001 for both). Leiomyomata volume decreased by 45.8% and 54%, respectively (P <0.001 for both). At 3 and 6 months, 94% of hysterectomy patients expressed at least moderate satisfaction with symptom improvement; by 12 months, 97% were satisfied. Comparable scores for embolization patients were 89%, 88%, and 90%, respectively. Complications from treatment were more frequent among patients who had hysterectomy. Within the follow-up period, febrile morbidity was seen in 24% of hysterectomy patients and 12.7% of embolization patients (P <0.01). Eight percent and 3%, respectively, were readmitted to the hospital, 8.0% and 2.0% had additional unintended surgery, and 8.0% and 0.0% experienced blood loss requiring 2 or more units of blood (P <0.01). Overall morbidity was 34% in hysterectomy patients and 15% in embolization patients (P <0.01). Seven patients in the embolization group were amenorrheic at 12 months.

Transarterielle Embolisation bei Uterus myomatosus: klinische Erfolgsrate und kernspintomographische Ergebnisse

To analyze the clinical success rate and the findings of magnetic resonance imaging (MRI) after uterine artery embolization of symptomatic leiomyomas (fibroids) of the uterus. This is a prospective single-center case study of 80 consecutively treated patients, followed for 3 - 6 months (group I), 7 - 12 months, (group II), and 13 - 25 months (group III). MRI was used to determine the uterine volume and size of the dominant leiomyoma. Symptoms and causes requiring repeat interventions were analyzed. Significant (p < 0.01) volume reduction of the uterus (median: 34.95 % confidence interval [CI]: 30.41 - 41.76 %) and dominant leiomyoma (median: 52.07 %, CI: 47.71 - 61.57 %) was found. The decrease in uterine volume (I-III: 22.68 %, 33.56 %, 47.93 %) and dominant leiomyoma volume (I-III: 41.86 %, 62.16 %, 73.96 %) progressed with the follow-up time. Bleeding resolved significantly (p < 0.0001) in all three follow-up groups (groups I-III: 92.86 %, 95.23 %, 96.67 %). Furthermore, urinary frequency (groups I-III: 70 %, 75 %, 82.35 %) and sensation of pelvic pressure (groups I-III: 42.86 %, 60 %, 93.75 %) improved, which was statistically significant in group III (p < 0.01). The number of leiomyomas correlated (p < 0.05) with improvement of the bleeding and the pelvic pressure. Repeat therapy was necessary for complications in four patients (5 %) and for therapeutic failure in three patients (3.8 %). Permanent amenorrhea was observed in four patients (5 %) of age 45 years or older. Uterine artery embolization of uterine leiomyomas has a high clinical success rate with an acceptable incidence of complications and repeat interventions.

Hysteroscopic removal of intrauterine retained fetal bones

Fetus papyraceus is a well-recognized complication of missed abortion or intrauterine fetal death. However, prolonged intrauterine retention of parts of the fetal skeleton is not adequately reported in the literature. Prolonged retention of intrauterine bone is a recognized cause of secondary infertility. Literature regarding endometrial ossification contains more than 80 cases, with 80% occurring after pregnancy. Common symptoms include menorrhagia, menometrorraghia, pelvic pain and infertility. Several theories have been proposed to explain osseous tissue within the uterine cavity. The most widely accepted is that ossification represents retained fetal bones following spontaneous, missed, incomplete or therapeutic abortion, suggesting that the fetus achieved at least 12 weeks gestation in order for endochondral ossification to occur. In contemporary gynecology, transvaginal sonographic diagnosis of retained fetal bones is made and the bones removed with the help of a resectoscope. Hysteroscopy is invaluable in achieving a cure for these patients without resorting to more aggressive surgery. Gonadotropin-releasing hormone analogues (GnRHa) have many new uses in gynecology. Several clinical studies have demonstrated a mean decrease in uterine volume after about 3–6 months of therapy. These patients might be candidates for GnRHa therapy so that a smaller corpus with an atrophic endometrium might aid in hysteroscopic retrieval of the retained bony fragments.

Patient satisfaction and disease specific quality of life after uterine artery embolization

Objectives This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after uterine artery embolization (UAE) and to consider the impact of these changes on satisfaction with the procedure. Study design A validated, fibroid specific, symptom, and HRQOL questionnaire was mailed to 80 women who had undergone UAE from 1998 through 2002. Pre- and postprocedure symptom severity and HRQOL scores were obtained. The primary outcome measure was change in fibroid symptoms and HRQOL after UAE. Secondary outcomes included objective measures of patient satisfaction, and the decrease in uterine volume after UAE. Results Questionnaires were completed by 64 women (80.0%) at a mean of 32.1 months from UAE (range: 57.5-6 months). After UAE, mean uterine volume decreased by 26.3% (95% CI 19.6-33.0), and 17 of 79 women (21.5%) underwent an additional procedure after a mean of 18.6 months. Symptom severity scores decreased by a mean of 35.2% (95% CI 29.3-41.1) and HRQOL scores increased by a mean of 35.7% (95% CI 28.9-42.4). Satisfaction with UAE was correlated with the change in symptom severity and HRQL scores ( P < .0001 and P = .0004, respectively) and the decrease in uterine volume after UAE ( P = .0196). Conclusion Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL, associated with high levels of satisfaction with the procedure, even when subsequent therapies are pursued.

Uterine artery embolization for the treatment of uterine leiomyomata

Objectives: To evaluate the results of the uterine artery embolization (UAE) for the treatment of uterine fibroids. Methods: Twenty-six patients with ultrasonographic diagnosis of uterine leiomyomata were submitted to UAE with polyvinyl alcohol particles. Imaging and clinical follow-up was performed before the procedure, at 3 months, and 1 year after. Results: All procedures but one were technically successful. Control of menorrhagia and pelvic pain were reported after UAE by 87.5% and 84.2% of patients, respectively. The initial medium uterine volume was 385 cm3, after 3 months 255 cm3 and after 1 year 202 cm3. The mean uterine volume decrease was 29% after 3 months and 41% after 1 year of follow-up (P<0.001). Clinical and biochemical findings consistent with ovarian failure were observed in three patients (12% of the patients). Conclusions: UAE represents a new therapeutic approach in the treatment of uterine leiomyomata. The procedure appears effective in controlling symptoms and represents an alternative to hysterectomy.

Relationship between platelet-derived growth factor expression in leiomyomas and uterine volume changes after gonadotropin-releasing hormone agonist treatment

The unopposed estrogen effect is the main cause of leiomyoma growth and is at the basis of the clinical use of gonadotropin-releasing hormone (GnRH) agonists. Platelet-derived growth factor (PDGF) has been indicated as the main growth factor involved, in vitro in the proliferation response of leiomyoma smooth muscle cells to estrogen stimulation. The aim of this article is to evaluate the mitogenic action of PDGF in vivo by studying the relationship between PDGF expression in leiomyomas and post-GnRH analogue treatment changes in uterine volume. Thirty-nine patients suffering from uterine leiomyomas were treated with leuprorelin acetate depot 3.75 mg for three cycles; 31 untreated patients were enrolled as control group. Uterine volume was determined twice by ultrasonography in each patient, the first time at admission and the second time after treatment in the study group and after 3 months in the control group. The change in the uterine volume was then evaluated. Patients underwent surgery, and PDGF immunohistochemical detection was performed on the obtained fibroid samples. Uterine volume decreased significantly after treatment, whereas just a poor modification was found in the controls. The decrease in the uterine volume was found to be statistically related to PDGF expression. Thus PDGF levels decreased in treated patients as compared with controls. The decreased PDGF production in leiomyomas after GnRH analogue treatment and the relationship between decreased PDGF expression and greater shrink age in uterine volume suggest that PDGF might have a mitogenic action on leiomyomas in vivo. HUM PATHOL 33:220-224. Copyright 2002, Elsevier Science (USA). All rights reserved.

Uterine artery embolization for the treatment of uterine fibroids: An outpatient procedure

Objective: Our objectives were to establish an outpatient program for uterine artery embolization of fibroids and to monitor the following: percentage of patients who required immediate hospitalization or admission within 2 weeks, outcomes in terms of the degree of ultrasound regression of the fibroids, patient satisfaction, reduction of pressure symptoms, and reduction of bleeding. Study Design: Patients were screened by a gynecologist with the use of a designed care algorithm; they then underwent uterine embolization, performed by an interventional radiologist. Patients were evaluated at 6 weeks and 6 months after the procedure, and ultrasound studies were performed both before and at 2 to 6 months after the procedure. Results: Of 35 patients, 29 (83%) went home on the day of the procedure, whereas 6 were observed overnight. Three (9%) patients required admission within 1 week. Of 26 patients, 24 (92%) were satisfied with the reduction of bleeding, and 14 of 18 (78%) were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. Conclusions: Uterine artery embolization for the treatment of uterine fibroids might be done on an outpatient basis with a low rate of same-day admissions and delayed admissions. Patient satisfaction was high, and uterine artery embolization might become an accepted option for the treatment of uterine fibroids. (Am J Obstet Gynecol 2001;184:1556-63.)

PII: S0029-7844(00)00615-3

Objective: To examine the use of uterine artery embolization as an alternative primary treatment for the large fibroid uterus.Methods: Patients with a large fibroid uterus (at least 13 weeks in size) were randomized into two groups to undergo uterine artery embolization with Gelfoam or PVA, via a transfemoral arterial approach. Response was measured in change in fundal height and in subjective improvement in symptoms.Results: During a 2-year period from 1997 to 1999, 29 women whose primary complaints included menorrhagia/metorrhagia (13/29), pelvic pain (8/29), increased abdominal girth (4/29), urinary frequency (2/29), and dyspareunia (2/29) were enrolled in the study. As a result of embolization, there was a mean decrease in uterine volume of 46% and a mean decrease in the volume of the dominant myoma of 52%. No significant association between primary complaint and preprocedural or postprocedural fundal height was observed. More than 86% of patients reported a subjective improvement in symptoms. This was found to be significantly associated with postembolization fundal height (P = 0.008), as well as with change in fundal height (P = 0.023). Subjective improvement also was associated with lower preembolization fundal height (P = 0.07). There was no significant relationship between primary complaint and subjective improvement in symptoms.Conclusions: Uterine artery embolization is a useful tool for the treatment of large fibroids, providing women with relief of symptoms.

The effects of RU 486 and leuprolide acetate on uterine artery blood flow in the fibroid uterus: A prospective, randomized study

OBJECTIVE: Our purpose was to examine the effects of RU 486 and leuprolide acetate on uterine artery blood flow and uterine volume. STUDY DESIGN: Patients were randomly assigned to group A (eight patients) receiving 25 mg of RU 486 daily for 3 months or group B (six patients) receiving 3.75 mg of leuprolide acetate monthly for 3 months. Uterine artery blood flow change was determined by resistive index by means of vaginal color Doppler ultrasonography. Uterine volume was measured before and during the study with abdominal ultrasonography. RESULTS: Both groups showed an increase in resistive index. Patients receiving RU 486 had uterine artery blood flow decreased by 40%, and those receiving leuprolide acetate had a 21% decrease. We noted a sigificant decrease in uterine volume compared with pretreatment in both groups at 3 months. There was no significant decrease between groups. CONCLUSION: Both RU 486 (25 mg daily) and leuprolide acetate (3.75 mg monthly) are effective in decreasing blood flow to the uterus (increasing resistive index) and decreasing uterine volume at 3 months. A significant decrease in uterine artery blood flow may provide a mechanism for the decrease in uterine size and the decrease in uterine blood loss at the time of surgery. (AM J Obstet Gynecol 1994;170:1623-8.)

The effects of RU 486 and leuprolide acetate on uterine artery blood flow in the fibroid uterus: A prospective, randomized study

Our purpose was to examine the effects of RU 486 and leuprolide acetate on uterine artery blood flow and uterine volume. Patients were randomly assigned to group A (eight patients) receiving 25 mg of RU 486 daily for 3 months or group B (six patients) receiving 3.75 mg of leuprolide acetate monthly for 3 months. Uterine artery blood flow change was determined by resistive index by means of vaginal color Doppler ultrasonography. Uterine volume was measured before and during the study with abdominal ultrasonography. Both groups showed an increase in resistive index. Patients receiving RU 486 had uterine artery blood flow decreased by 40%, and those receiving leuprolide acetate had a 21% decrease. We noted a significant decrease in uterine volume compared with pretreatment in both groups at 3 months. There was no significant decrease between groups. Both RU 486 (25 mg daily) and leuprolide acetate (3.75 mg monthly) are effective in decreasing blood flow to the uterus (increasing resistive index) and decreasing uterine volume at 3 months. A significant decrease in uterine artery blood flow may provide a mechanism for the decrease in uterine size and the decrease in uterine blood loss at the time of surgery.

Uterine remodelling following conservative myomectomy. Ultrasonographic evaluation.

Uterine leiomyomata develop during the reproductive years and may interfere with fertility through mechanisms as yet not fully understood. A developing intramural or large submucosal leiomyoma causes hypertrophy of the myometrium. Conservative myomectomy, as opposed to hysterectomy, is the preferred surgical procedure for patients who wish to preserve their fertility. Ten patients were ultrasonographically evaluated at monthly intervals following myomectomy and the changes in uterine (myometrial) volume were assessed. There was a gradual decrease in uterine volume in all patients during the six months following removal of intramural and submucosal leiomyomata. The most remarkable decrease in size occurred during the initial two to three months for the majority of the patients. The impact of this process on fertility should be further evaluated. One of the intriguing questions is whether the period of uterine shrinkage represents the time of the healing process during which conception should be prevented.

A randomized trial evaluating leuprolide acetate before hysterectomy as treatment for leiomyomas

Fifty premenopausal patients requiring hysterectomy as treatment for symptomatic uterine leiomyomas, which were the size of 14 to 18 weeks' gestation, were randomized into two groups to determine whether preoperative gonadotropin-releasing hormone agonist would increase the feasibility of vaginal rather than abdominal hysterectomy. The control group (group A; n = 25) did not receive preoperative gonadotropin-releasing hormone agonist, but patients in Group B (n = 25) received 2 months of gonadotropin-releasing hormone agonist before undergoing hysterectomy. Patients in the two groups were similar with respect to age, gravidity, parity, pretreatment uterine size, and hemoglobin and hematocrit levels. Patients in group B had an increase in hemoglobin levels (10.75 to 12.12 gm/dl, p less than 0.05) and a decrease in uterine volume (1086.7 to 723.4 ml, p less than 0.05) after 8 weeks of agonist therapy and were more likely to undergo vaginal hysterectomy (76.0% vs 16%). Patients in group B also had shorter hospitalizations (5.2 vs 3.8 days, p less than 0.05). We conclude that the administration of gonadotropin-releasing hormone agonist for 2 months followed by vaginal hysterectomy is preferable to abdominal hysterectomy in selected patients with uterine leiomyomas.