Improvement of Uterine Contractility and Quality Life After Uterine Fibroid Embolization

1. Review the three types of uterine peristalsis through a pictorial review demonstrated by Cine-MRI.


2. Demonstrate uterine fibroid embolization (UFE) 's impact on uterine peristalsis and quality of life.

Fibroids may alter uterine peristalsis, affecting sperm transport, implantation, and pregnancy maintenance {1-18}. Kunz et al. classified uterine peristalsis into three types: Type A (upward waves), Type B (downward waves), and Type C (low-intensity arrhythmias) {9, 19}.

• Type A waves occur pre-ovulation and aid in sperm transport {8, 9, 16, 17}.


• Type B waves occur during menstruation and help expel the endometrial lining {8, 9, 16, 17}.


• Type C waves occur during the secretory phase and may assist with embryo implantation {8, 9, 16, 17}.

Several studies link uterine peristalsis dysfunction with fibroids {2, 3, 14, 16, 23, 24}.

Clinical Findings/Procedure Details:

In 2018, Fornazari et al. studied the impact of UFE on uterine peristalsis using CINE-MRI and assessed quality of life (QoL) using the Uterine Fibroid Symptom – QoL (UFS-QoL) questionnaire {23}. Changes in uterine contraction patterns were evaluated before and six months after UFE, with CINE-MRI performed 14 days after the first day of the last menstrual period. UFS-QoL was applied at the time of the first CINE-MRI and one-year post-UFE during follow-up.

Peristalsis was categorized as ordered, disordered, or absent:

• Ordered: rhythmic, wave-like contractions (ascending or descending).


• Disordered: random, sporadic, or arrhythmic contractions.


• Absent: no contractility observed.

In a sample of 26 symptomatic patients (average age 36), 50% showed improved uterine contractility, shifting from disordered to ordered waves, and all patients without initial contractility demonstrated peristaltic activity post-UFE. Only three patients continued to show no contractility.

The study concluded that UFE is associated with improved uterine contractility in women with symptomatic fibroids. Improved QoL scores were observed post-UFE, especially in sexual function {24}.

Conclusion and/or Teaching Points:

There is clear evidence of a negative relationship between uterine diseases and uterine peristalsis. Additionally, there is substantial evidence of contractility improvement following UFE. Given these findings, we propose that CINE-MRI should be more widely utilized, particularly to strengthen collaboration with gynecologists and fertility specialists and to highlight the benefits of UFE.