Challenges in the Management of Postmenopausal Uterine Artery Venous Malformation

Uterine arteriovenous malformation (UAVM) is an infrequent occurrence among postmenopausal women. Our review of the literature revealed only a few documented cases of UAVM in this demographic. Treatment options for these patients encompass uterine artery embolization (UAE), medical management, and hysterectomy. We encountered a case involving a 54-year-old woman, postmenopausal for 9 years, who presented with a history of postmenopausal bleeding over the preceding 3 months. Imaging studies confirmed the presence of UAVM. Despite an attempted UAE, the procedure proved unsuccessful, leading to the decision to perform a hysterectomy with meticulous attention to minimizing blood loss. Notably, UAE may not consistently achieve favorable outcomes in addressing UAVM in postmenopausal women, thereby underscoring the consideration of hysterectomy as a safe alternative - treatment option without any excessive intraoperative bleeding.