[Amenorrhea after uterine fibroid embolization: a report of six cases]

Uterine fibroid embolization is an effective treatment alternative for uterine fibroids. However, amenorrhea after uterine fibroid embolization occurs in some patients. This study was to investigate the causes of amenorrhea after uterine fibroid embolization.

Bilateral transcatheter uterine artery embolization was performed in 487 patients with uterine fibroids. Pingyangmycin (6-16 mg) dispersed in lipiodol (8-15 mL) was used as embolic agent in 104 patients; polyvinyl alcohol (80-150 mg) was used in 158 patients; absorbable gelatin sponge (1-2 g) was used in 225 patients. All patients had been followed up for 1 year to observe amenorrhea occurrence.

Uterine fibroid embolization was effective in 483 (98.97%) patients, but failed in five (1.03%) patients. Amenorrhea after embolization was found in six (1.23%) patients. Of the six patients, three were in lipiodol plus pingyangmycin group with lipiodol deposited in the ovarian region, one was in polyvinyl alcohol group and the other two were in absorbable gelatin group. Except for one patient in absorbable gelatin group, the rest five patients had estradiol (E2) decreasing and follicle stimulating hormone (FSH) rising due to ovarian function failure. In absorbable gelatin group, multiple ultrasonography examinations revealed that the endometrium was only 3 mm thick in one amenorrhea patient who had normal levels of E2 and FSH, and hysteroscope examination confirmed endometrial atrophy in this patient.

Routine embolic agents have the chance in inducing amenorrhea after uterine fibroid embolization. The occurrence rate of amenorrhea after uterine fibroid embolization is about 1.23%. Ovarian function failure and endometrial atrophy are the most related factors.