Gynecological Assessment Prior to Uterine Artery Embolization

Abstract

Benign uterine fibroids, or leiomyomas, are the most common benign tumors found in women in a gynecologic practice. Approximately 50–80 % of women have fibroids. Most women with fibroids are asymptomatic. Women with symptomatic fibroids may present with heavy menstrual bleeding, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. However, these symptoms can mimic other gynecologic and non-gynecologic conditions. It is imperative that physicians take an excellent history and perform a thorough pelvic examination prior to recommending uterine fibroid embolization for therapy. The patient’s desire for future pregnancy should be ascertained. As a part of the evaluation it is important that the patient does not have other indications for surgical intervention such as the presence of an adnexal mass, abnormal pap test, or endometrial malignancy/endometrial hyperplasia that would be treated with surgical intervention or other necessary therapy. Hysterectomy has long been utilized as a definitive method to treat fibroids in women. Medical therapy often requires long term use of single or multiple medical therapies to alleviate fibroid-related symptoms. Uterine fibroid embolization (UFE) using particulate emboli to occlude the uterine arteries, thereby disrupting the blood supply to fibroids and leading to devascularization and infarction, has been reported to be effective in alleviating fibroid-related symptoms. Excellent gynecological assessment is essential prior to referring a patient for uterine fibroid embolization.