Uterine Artery Embolization and Intrauterine Device in Fibroid Uterus: A Matter of Debate

Abstract Objective: Conflicting opinions about the relevance of uterine artery embolization (UAE) in the presence of in situ intrauterine devices (IUDs) exist among interventional radiologists. Thus, this study aimed to compare the radiological and clinical outcomes of UAE in the presence and absence of IUDs. Patients and Methods: This prospective study enrolled 86 females with IUD who were candidates for UAE for symptomatic fibroids (study group). For comparison, we selected 86 females without IUD candidates for the UAE during the same period (control group). Magnetic resonance imaging was scheduled for all patients pre- and 3-month post-UAE. Post-UAE radiological and clinical outcomes were compared between the two groups. Uterine Fibroid Symptom and Health-Related Quality of Life scores were compared between the two groups. Results: The two groups had no significant variations concerning the dominant fibroid infarction rate ( P > 0.05). The uterine and dominant fibroid volume did not differ significantly between both the groups ( P = 0.63 and 0.54, respectively). The percentage of volumetric reduction in the uterus and dominant fibroid was not significantly different between the two groups ( P = 0.99 and 0.74, respectively). No major complications or intrauterine infections were observed in either group. The mean change in symptoms and mean quality of life scores did not differ significantly between the two groups at 12-month post-UAE ( P = 0.06). Conclusions: UAE for uterine fibroids in the presence and absence of IUD contributes to an equal improvement in fibroid response to treatment, relieves the severity of symptoms, and enhances health status with no significant risk of increased incidence of complications. Clinical Relevance Statement: The presence of IUDs did not affect the performance of the UAE, with no significant risk of increased incidence of postprocedural complications, particularly uterine infection.