Value of hysteroscopy prior to uterine artery embolisation for fibroids: a hospital based retrospective study

This study was undertaken to evaluate the value of routine hysteroscopy prior to uterine artery embolisation (UAE) for symptomatic uterine fibroids. The study design used is hospital-based retrospective study, and the setting is in a large teaching hospital. We analysed the hospital record of 115 women who were scheduled to undergo UAE at our institution between January 2008 and April 2011. All women had outpatient hysteroscopic assessment of uterine cavity prior the decision to carry out UAE. The mean uterine size on palpation was 15.4 (standard deviation (SD) 3.5) weeks gestation equivalent. Hysteroscopy was successfully completed in 112 (97.4 %). In the women who were hysteroscoped, 50 (44.6 %) had no submucous fibroids; 50 (44.6 %) had type II fibroids, and 12 (10.7 %) were found to have type I or 0 fibroids. All 12 women with type 0 or I submucous fibroids were offered hysteroscopic ( n = 11) or vaginal ( n = 1) myomectomy prior to UAE, but only four agreed. Of these four cases, two cancelled their planned UAE because of symptomatic improvement. The remaining two women, as well as the eight, who declined surgery, underwent UAE. There were no cases of infection, spontaneous expulsion of a fibroid or the need for surgical intervention in this group. This pilot study shows that hysteroscopy prior to UAE changes management in only a small proportion of cases. Selective hysteroscopy, following MRI scanning, may be a more logical protocol to identify women with intracavitary fibroids, who may benefit from hysteroscopic or vaginal myomectomy.