Evaluation of the effect of uterine artery embolisation on menstrual blood loss and uterine volume A. Khaund, a J.G. Moss, b N. McMillan, c M.A. Lumsden d Objective To evaluate the effect of uterine artery embolisation (UAE) on menstrual blood loss (MBL) and uterine volume in women with symptomatic uterine fibroids. Design Prospective observational study. Setting West of Scotland gynaecology and radiology departments. Population Fifty women (mean age 43 years) with symptomatic fibroids undergoing UAE between January 1999 and June 2003. Methods Women collected sanitary protection from one menses pre-embolisation and at regular intervals thereafter. This allowed objective measurement of MBL using the alkaline haematin technique. Uterine volume was calculated using magnetic resonance imaging (MRI) before and six months following embolisation. Interventional radiologists performed bilateral UAE. The Wilcoxon’s signed rank test was used for statistical analysis of data. Main outcome measures Post-embolisation MBL and uterine volume changes. Results Median pretreatment MBL was 162 mL (mean 234, range 9 – 1339). The median MBL decreased to 60 mL at 3 months (n ¼ 34, range 0–767, P < 0.001), 70 mL at 6–9 months (n ¼ 34, range 0–1283, P < 0.001), 37 mL at 12 –24 months (n ¼ 25, range 0 – 265, P < 0.001), 18 mL at 24 – 36 months (n ¼ 17, range 0–205, P < 0.001) and 41 mL at 36–48 months (n ¼ 6, range 0–66, P < 0.05). The median reduction in uterine volume was 40% (n ¼ 46, 95% CI 33.0–49.7, P < 0.001). Conclusions UAE causes a statistically significant reduction in objectively measured MBL. UAE is also associated with a statistically significant reduction in uterine volume at six months. There was no relationship between the changes in uterine volume and MBL. INTRODUCTION Uterine leiomyomata are the most common benign tumours of the female genital tract arising from neoplas- tic transformation of smooth muscle cells. 1 They occur in 25% of women during reproductive life and as many as 40% of women beyond the age of 50 years who are still menstruating. 2 While many women with fibroids are asymptomatic, those who do come to our attention typically present with bulk-related symptoms (e.g. urinary frequency and constipation), reproductive dysfunction and in particu- lar, excessive menstrual blood loss (MBL). Traditionally, treatment for symptomatic fibroids has been surgical although medical therapies have been used as a short term measure. These treatments, however, are not without drawbacks, and alternative management op- tions are being sought. Uterine artery embolisation (UAE) is a well established, minimally invasive radiological tech- nique that has been used for more than two decades in the management of acute pelvic haemorrhage. Its use, how- ever, in the treatment of symptomatic fibroids was first reported in 1995 by the French gynaecologist, Ravina et al. 3 Since then, preliminary observational studies carried out in both Europe and the United States suggest that UAE is effective in relieving fibroid-associated symptoms in 80–94% of women. 4–13 To date, none of these studies include objective measurements of MBL pre- and post- embolisation but instead, rely on subjective assessment of symptoms. Since the correlation between objective and subjective assessment of MBL is poor, it is important to obtain objective information where possible. 14,15 The definition of objective menorrhagia is an MBL exceeding 80 mL/cycle. 16 To make such a diagnosis ac- curately, precise measurement of MBL is required. We BJOG: an International Journal of Obstetrics and Gynaecology July 2004, Vol. 111, pp. 700–705 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog a Department of Gynaecology, North Glasgow University Hospitals, Glasgow Royal Infirmary, UK b Department of Radiology, North Glasgow University Hospitals, Gartnavel General Hospital, UK c Department of Radiology, North Glasgow University Hospitals, Western Infirmary, UK d Division of Developmental Medicine, Department of Obstetrics and Gynaecology, Queen Elizabeth Building, North Glasgow University Hospitals, Glasgow Royal Infirmary, UK Correspondence: Professor M. A. Lumsden, Division of Developmental Medicine, North Glasgow University Hospitals, Glasgow Royal Infirmary, Queen Elizabeth Building, 10, Alexandra Parade, Glasgow G31 2ER, UK. DOI:10.1111/j.1471-0528.2004.00158.x