Do Ovary-Sparing Hysterectomies Put Me at Risk for Early Menopause?
Alicia Armeli

Removing the ovaries during hysterectomy among women who are at a low-risk for ovarian cancer has been linked to an increased risk of heart disease, neurological disease, and death.1 To avoid these consequences, performing ovary-sparing hysterectomies when possible is becoming more common. And yet, women who have ovary-sparing hysterectomies may still be at a higher risk for early menopause, according to a secondary analysis from the Prospective Research on Ovarian Function (PROOF) study.1

In the original report, the PROOF study found that premenopausal women who underwent ovary-sparing hysterectomy for treatment of noncancerous conditions experienced menopause 1.9 years earlier than women of similar age but who had reproductive organs—including both ovaries—that remained intact.1

To reexamine the link between hysterectomy and ovarian function, researchers from the Mayo Clinic and Duke University conducted a secondary analysis.1 In each group of women, they looked at antimüllerian hormone levels (a marker of ovarian reserve) at baseline and then the absolute change and percentage change in the hormone levels between baseline and a 1-year follow-up.

Results published in Obstetrics & Gynecology showed that median antimüllerian hormone levels were similar between the hysterectomy group (148 women) and the comparative group (172 women) at baseline.1 But at 1-year follow-ups, hysterectomized women had a significant decrease in antimüllerian hormone (-40.7% versus -20.9%) and a higher proportion had levels that were undetectable (12.8% versus 4.7%). Women who underwent hysterectomy also had antimüllerian hormone levels that averaged 0.77 of that observed in the comparative group. These differences were weaker among white women but were still significant among black women. Similar results were seen among women with low or high ovarian reserves at baseline.

The researchers concluded that although women undergoing hysterectomy have similar antimüllerian hormone levels at baseline, they experience a greater percentage decrease in levels after 1-year in comparison to women whose reproductive organs remain intact. This suggests, “hysterectomy may lead to ovarian damage that is unrelated to baseline ovarian reserve.”1

Results from other studies have aligned with these findings, showing that women who have ovary-sparing hysterectomies reach menopause on an average of 1.9-4 years earlier than women with intact reproductive organs.1

Why does this occur? The authors explain that hysterectomy could disrupt ovarian blood flow or remove hormone signals from the uterus, resulting in the speeding up of follicular depletion and earlier menopause. “In essence, after surgery, a woman’s ovarian age may be advanced to that of a woman with a naturally diminished ovarian pool of similar, lower antimüllerian hormone levels.”1

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. Trabuco, E., Moorman, P., Algeciras-Schimnich, A., et al. (2016). Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol, May; 127(5): 819-827.

 

 

US study suggests fibroid embolization “vastly underutilised” compared with hysterectomy

A large US nationwide study shows that the uterine fibroid embolization is vastly underutilised, compared to hysterectomy—especially in rural and smaller hospitals.

In fact, there were more than 65 times as many hysterectomies performed than embolizations, despite data showing that the minimally invasive procedure results in substantially lower costs and shorter hospital stays than the surgical option, the study reveals.

The research was presented today at the Society of Interventional Radiology’s 2017 annual scientific meeting (4–9 March, Washington, DC, USA).

https://interventionalnews.com/us-study-suggests-fibroid-embolization-vastly-underutilised-compared-with-hysterectomy/

What is Fibroid Expulsion?
Alicia Armeli

Over the past three decades, uterine fibroid embolization (UFE) has become a popular treatment option for women with symptomatic uterine fibroids who want to avoid hysterectomy. Considered safe and effective, UFE has a long-term success rate of around 90%. 1

UFE treats fibroids by blocking the blood that flows to them, resulting in these noncancerous tumors gradually shrinking, thereby easing symptoms. For some women, fibroid expulsion—or the fibroid tumor detaching from the uterus and passing from the body—is an unusual occurrence post-UFE. According to a study published in the Journal of Vascular and Interventional Radiology, fibroid expulsion happens in almost 5% of women.2

“Fibroid expulsion can happen weeks to years after the procedure,” explains Richard Shlansky-Goldberg, MD, Interventional Radiologist and Professor of Radiology, Obstetrics & Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia, Pa., and lead researcher of the study. “Fibroid expulsion can lead to a lot of volume loss. For example, some patients who have only a single fibroid may end up being fibroid-free.”

The retrospective study included 759 women who underwent UFE between July 1999 and June 2009.2 Of these women, 37 (4.9%) experienced fibroid expulsion within an average of about 3 ½ months. Five percent of these women didn’t experience any symptoms, whereas 95% of the cases were symptomatic. The researchers found that the majority of women who experienced symptoms of fibroid expulsion (89%) had “bulk expulsion” or the passing of large pieces or entire fibroid tumors. The remaining (11%) had “sloughing expulsion,” which refers to the gradual shedding or dissolving of the fibroid tumor that then passes from the body as vaginal discharge.

“Fibroids that have a higher likelihood of expulsion include pedunculated fibroids, which are those located inside the uterine cavity and are attached to the uterine wall by a stalk,” Dr. Shlansky-Goldberg says. “This also includes submucosal fibroids or those just underneath the uterine lining and transmural fibroids or those that extend through the uterine wall to the outside of the uterus.”

Women may be able to pass fibroid tissue completely on their own. In other cases, gynecological help to remove partially expulsed fibroids is necessary. Shlansky-Goldberg and his team found that 49% of fibroid expulsion cases happened at home or during an office/emergency room transvaginal myomectomy (TVM)—a type of minimally invasive removal of fibroids through the vaginal canal.2 Twenty-seven percent needed operative TVM and 8% had hysteroscopic fibroid resection—a procedure that places a scope inside the uterus and navigates fibroid removal through the scope.2

If fibroid tissue doesn’t fully pass from the body and can’t be surgically removed through the vagina, there’s a risk of infection. This can happen if the fibroid tissue doesn’t detach enough from the uterus to be expulsed or a woman’s cervix may not dilate enough to allow the tissue to pass. This can lead to the need for a hysterectomy—the surgical removal of the uterus—but is a relatively rare complication. Women who have given birth tend to do better with expelling the fibroid than women who haven’t given birth.1

In this study, urgent hysterectomy occurred in only 11% or only 4 women of the 37 who experienced expulsion. Even fewer women, 4% or 2 women, experiencing fibroid expulsion chose hysterectomy for reasons such as bothersome chronic vaginal discharge.2

But for the majority, discharge and mild cramping only lasts a few weeks to months, according to Dr. Shlansky-Goldberg. “Most women are happy that the fibroid is out. After it’s done, many patients will see a dramatic reduction in the size of their uterus with some uteri becoming a normal size without fibroids,” he continues. “My first patient who experienced expulsion hugged me afterward because—by losing the bulk of the fibroid—she was able to fit into jeans that she was unable to fit into for the last several years.”

Uterine fibroids affect up to 80% of women by age 50 and can have severe symptoms like heavy periods, pelvic pain, and infertility.3 UFE is one of the treatment options available. But since no two women’s fibroid experiences are the same, Dr. Shlansky-Goldberg encourages collaboration of care between interventional radiologists and gynecologists—especially when patients have a higher likelihood or already experienced fibroid expulsion.

“Our protocol is for patients to first contact their interventional radiologist so an MRI can be done and a diagnosis of fibroid expulsion can be made,” he says. “With this information, an interventional radiologist can together formulate a plan with the patient’s gynecologist to ensure that the best care is given to the patient.”

REFERENCES

  1. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
  2. Shlansky-Goldberg, R., Coryell, L., Stavropoulos, W., et al. (2011). Outcomes following fibroid expulsion after uterine artery embolization. J Vasc Interv Radiol, Nov; 22: 1586-1593.
  3. Office on Women’s Health, US Department of Health and Human Services. (2017). Uterine fibroids. Retrieved January 28, 2017, from https://www.womenshealth.gov/a-z-topics/uterine-fibroids

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, 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.

ABOUT THE DOCTOR Richard Shlansky-Goldberg is an interventional radiologist and professor of Radiology, Obstetrics and Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia, Pa. Recognized by Best Doctors in America, as Castle Connolly’s America’s Top Doctors, and showcased in Philadelphia Magazine’s Top Docs issue—Dr. Shlansky-Goldberg specializes in helping women with uterine fibroids find relief. Collaborating with the department of obstetrics and gynecology at the University of Pennsylvania allows him to ensure every woman knows and understands all her treatment options, ensuring the best patient care possible.

Uterine Fibroid Embolization Treatment
#LoveYourUterus