264 Obstetrics and Gynecology Board Review •••
❍ When using GnRH agonists to “shrink” leiomyomas, when does the maximum effect occur?
Nonpulsatile GnRH agonist therapy has been shown to decrease leiomyoma size by 30% to 50% with the maximal
effect noted in 2 to 3 months.
❍ For the symptomatic treatment of uterine leiomyomas, what is the rate of resolution of symptoms following
abdominal myomectomy?
Overall 81% with a range of 40% to 93%.
❍ What is the risk of reoperation following abdominal myomectomy?
11% for a single myoma.
26% for multiple myomas.
18% overall risk of reoperation following abdominal myomectomy.
❍ What is the risk of undergoing unexpected hysterectomy at the time of abdominal myomectomy?
<1% for the experienced surgeon, and higher rates appear for the inexperienced surgeon.
❍ What are side effects of uterine artery embolization (UAE)?
Pelvic infection.
Premature menopause.
Vaginal expulsion of necrotic fibroids.
Severe pelvic pain requiring analgesia.
❍ Who is a candidate for UAE?
Patients whose symptoms are directly related to fibroids.
Patients who have been ruled out for malignancy.
Absence of endometrial hyperplasia or neoplasm on pippelle for patients with intermenstrual bleeding.
❍ What are the contraindications to UAE?
Pregnancy, pedunculated fibroid, active pelvic infection, active vasculitis, history of pelvic irradiation, evidence of
pelvic malignancy, life-threatening contrast allergy, uncontrollable coagulopathies, and severe renal insufficiency.
❍ What percentage of patients undergoing UAE will pass fibroid sloughing through the vagina?
5%.
❍ What percentage of patients undergoing UAE begin menopause following the procedure?
5%.
❍ What is the success rate of UAE?
85% to 94%.