Fibroids treated with uterine artery embolization: do imaging findings correlate with patient outcomes?

OBJECTIVE: To evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). MATERIALS AND METHODS: Sixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. RESULTS: Changes in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P > 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P < 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P < 0.05). CONCLUSION: We found poor correlation between imaging findings and patient- perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE.

Effect of oral contraceptives and intrauterine devices on midcycle myometrial contractions.

OBJECTIVE: To determine the effects of oral contraceptives and intrauterine devices (IUDs) on midcycle myometrial contractions. DESIGN: Prospective cohort study. SETTING: Academic tertiary care center. PATIENT(S): Thirty four patients who received oral contraceptives, 20 patients with an IUD, 28 controls, and 6 patients who were evaluated before and after oral contraceptive use. INTERVENTION(S): All groups underwent endovaginal ultrasonography to visualize myometrial contractions at midcycle. MAIN OUTCOME MEASURE(S): Contractions were analyzed for direction, frequency, amplitude, and distance traveled. RESULT(S): Fifty percent of women taking oral contraceptives had no contractions, whereas all controls had contractions. Women taking oral contraceptives also had decreased frequency, amplitude, and distance traveled of contractions compared with controls. Women evaluated before and after taking oral contraceptives had decreased frequency, amplitude, and distance traveled of contractions. Women with an IUD had significantly more asymmetrical uncoordinated contractions, with decreased frequency and distance traveled, compared with controls. CONCLUSION(S): Oral contraceptives dramatically suppressed midcycle contractility. Since the normal midcycle peak of estrogen is suppressed by oral contraceptives, these contractions may be regulated by cyclic estrogen and progesterone. Uncoordinated contractions in IUD bearing women indicate that the foreign body reaction of the IUD affects the normal physiology of these contractions.

Effect of prostaglandin and antiprostaglandin on midcycle myometrial contractions.

To prospectively determine the effects of prostaglandin E(2) and an antiprostaglandin, ibuprofen, on midcycle myometrial contractions, 20 healthy women underwent endovaginal ultrasound to record contractions after receiving these medications. Prostaglandin E(2) stimulated, while ibuprofen inhibited contractions, revealing the important role prostaglandins have on midcycle contractions.