Hysteroscopy after uterine fibroid embolization in women of fertile age.
OBJECTIVE
Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization.


METHODS
Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle.


RESULTS
Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed.


CONCLUSIONS
The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.
Mara
Michal
M
Department of Obstetrics and Gynecology, Endoscopic Training Center, First Faculty of Medicine of Charles University, Prague, Czech Republic. michal.mara@quick.cz
Fucikova
Zuzana
Z
Kuzel
David
D
Maskova
Jana
J
Dundr
Pavel
P
Zizka
Zdenek
Z
D000328:Adult; D000367:Age Factors; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*; D014599:Uterus / Q000473:pathology*