Fibroids in Over 50 and Post Menopausal Patients
It is a myth that fibroids automatically reduce after the menopause even if the patient is not on hormone replacement therapy. Most will stay the same size even if not on HRT. This myth has led many women to avoid fibroid treatment before the menopause in the vain hope that the fibroids will shrink after the menopause.
Below we report our results of an analysis of a series of women over 50 years old having uterine artery embolization for fibroids 15 of whom were post menopausal.
24 women over 50 years old with uterine fibroids receiving uterine artery embolization were identified in this single-centred study. One patient did not want to take part in this review. Median age was 59 years with the youngest being 52 and the oldest 72.
From a pre-operative questionnaire that the patients filled in before the initial consultation the vast majority complained of pressure and discomfort symptoms (20). Other common complaints were urinary symptoms (7) and dyspareunia (4). 15 out of 23 patients were post-menopausal while the others were still experiencing bleeding. This was regular in 6 of them, irregular in 2 cases and continuous for 1 patient. The bleeding was affecting the quality of life in 5 patients out of 23. 2 out of 23 patients included in the study failed to fill in a pre-operative questionnaire.
4 patients had undergone uterine surgery in order to improve their symptoms and this included 3 transcervical resections of fibroids and 2 uterine artery embolizations. 1 patient had tried both procedures in the past. Interestingly all the patients except one had information about uterine artery embolization from their gynaecologist and only a single patient researched this procedure on the internet prior to the consultation with the specialist. A transvaginal ultrasound and an MRI Pelvis were performed for all the patients prior to the procedure.
The volume of the uterus ranged from 900ml (smallest) to 4004ml (largest). The majority of embolizations were performed for a uterus between 1,000ml and 3,000ml (16/23). 4 out of 23 patients had a uterus with a volume above 3 litres. In terms of overall reduction of uterine size 8 weeks following uterine artery embolization 12 out of 23 patients had a reduction between 50% and 64%. 35% of patients (8/23) experienced a reduction of over 65% of overall uterine volume. Only on 2 occasions was the reduction in size below 50%
At 8 weeks a patient questionnaire was filled in by all except 4 of the 23 patients. 100% of patients found the information given prior to the procedure complete and 84% (16/19) found the embolization less arduous than expected. The pain was described as better than expected for 10 out of the 19 patients (52%) whereas 7 patients found it worse than expected.All the treated patients were happy with the two day hospital stay and 13% of patients (68%) experienced a bruise at the incision site.
In the majority of cases (13/19) the days where regular analgesia was required were less than 5 and in only 2 cases did the patients take oral analgesia for more than 10 days. 3 patients out of 17 experienced post-embolization syndrome which was treated in all cases with simple Paracetamol and Ibuprofen. 15 patients resumed regular activity after less than 3 weeks.
A side effect of uterine artery embolization is vaginal discharge. This was experienced by 14 out of 19 patients. In 4 patients the discharge was still ongoing at the time of the 8 week review and was offensive in 2 cases of out of 14. Passage of fibroid material happened in 2 cases.
Six months to one year following the procedure the uterine volume was checked again with an MRI Pelvis.13 out of 23 patients had a reduction of between 50% and 64%. 8 out of 23 patients i.e. 35% of the total, experienced a reduction of over 65% of overall uterine volume. Only in 1 case was the reduction in size below 50%. Following this procedure we contacted the patients and we asked them if, in retrospect, they would recommend this procedure. 20 out of 23 stated that they would recommend it.
In terms of improvement of symptoms (0-5). 12/23 had a total resolution of symptoms. No change in 1 case. Varying improvement from 1-4 in 10 patients. Only 1 out of 24 patients underwent a further procedure following her UAE as symptoms persisted despite embolization. This lady subsequently had her uterus removed by laparoscopic hysterectomy.