Does UFE Put Me at Risk for Early Menopause?
Alicia Armeli

A common question among women exploring uterine fibroid embolization (UFE) as treatment for uterine fibroids is whether or not they’re at risk for early menopause following the procedure. Although infrequent, early menopause is a possibility, but the risk lies almost exclusively among women who are over the age of 45.1

There are a few factors that contribute to early menopause post-UFE, which by definition is when menopause happens before the age of 40. One such factor is called non-target or inadvertent embolization, a rare complication that can happen during the UFE procedure. According to a literature review published in the Journal of Vascular and Interventional Radiology, non-target embolization of the ovarian blood vessels at the time of UFE is believed to be one cause of premature ovarian failure.1

During UFE, a doctor called an interventional radiologist makes a nick in the patient’s upper thigh or wrist and inserts a tiny tube called a catheter. With the help of real-time imaging, the catheter is guided through the arteries that lead to the uterine arteries supplying fibroids with blood. By embolizing the uterine arteries—a process that involves injecting tiny particles called embolic material through the catheter—blood flow to the fibroids is blocked, causing them to shrink and symptoms to subside. Safe and effective, UFE has a nearly 90% cure rate.2

Post-UFE data show that most patients treated with the procedure resume normal periods. According to the national FIBROID data registry, only 7% of women 1-year post-UFE experience ovarian failure and no longer menstruate.3 However, among these women, another correlation was seen. Eighty-six percent of women who lost menstruation were older than 45.3

Why is this the case? Uterine-ovarian vessel cross-connections called anastomoses have been recognized where blood flows between the uterus and the ovaries.4 During UFE, if inadvertent or non-target embolization of the ovarian arteries happens, it may be that older women are already more susceptible to any damage caused. In comparison, any disruption in ovarian blood flow among younger women under the age of 45 was seen to be only temporary.1

Women over the age of 45 with utero-ovarian anastomoses were also more likely to have increased levels of follicle-stimulating hormone (FSH) after UFE, which is indicative of declining ovarian reserve or being closer to menopause.1 However, this same outcome has also been seen after uterine surgery like hysterectomy, which may indicate other factors beyond the UFE procedure itself.1

Early menopause is a risk after UFE but is more likely for women older than 45. Based on current data, UFE doesn’t significantly affect the ovarian reserve of younger women. However, because the uterine and ovarian arteries can be intricately connected and this could affect the outcome of UFE, it’s suggested that women seek out experienced interventional radiologists well trained in the UFE technique and be examined for any unique vascular variations.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

 

REFERENCES

  1. Kaump, G. & Spies, J. (2013). The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol, Apr; 24(4): 459-467.
  2. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
  3. Spies, J., Myers, E., Worthington-Kirsch, R., et al. (2005). The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol, Dec; 106(6): 1309-1318.
  4. Razavi, M., Wolanske, K., Hwang, G. et al. (2002). Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology, Sep; 224(3): 707-712.