Compared with uterine-artery embolization, myomectomy increased postoperative quality of life for women with uterine fibroids who preferred to preserve their uterus but had not respond to medical treatment, according to a study published in the New England Journal of Medicine.
Between February 6, 2012 and May 21, 2015, 254 women at 29 hospitals in the United Kingdom were randomly assigned into the myomectomy group (n=127) and the uterine-artery embolization group (n=127). Open abdominal, laparoscopic, and hysteroscopic myomectomies were all included. Premenopausal women aged ≥ 18 years who were not pregnant were eligible to participate; women with pelvic inflammatory disease, substantial adenomyosis, suspected or diagnosed cancer, or had undergone either of the procedures previously were excluded. Researchers accounted for fibroid size, number of fibroids, and whether the patient hoped to become pregnant in the future; they then balanced these factors between the 2 randomly assigned groups.
The primary outcome of this study was patient scores 2 years post-procedure on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire. Compared with the baseline, both groups experienced an increase in UFS-QOL scores over time, but the scores in the myomectomy group demonstrated a greater magnitude of increase. At 2 years, the mean adjusted difference with complete case analysis was 8.0 points (95% CI; 1.8 to 14.1, P =.01).
Researchers also analyzed UFS-QOL scores at 6 months and 1 year; at both times, patients favored myomectomy. The mean difference in symptom severity domain at 6 months was −6.1 points (95% CI, −11.4 to−0.9), and −3.8 points (95% CI, −9.4 to 1.8) at 1 year.
When asked if they would recommend their procedure to a friend at 2 years, 93% of the women in the myomectomy group said that they would compared with 84% of women in the uterine-artery embolization group. Likewise, 78% percent of women in the myomectomy group said they would be willing to undergo their procedure again compared with 74% in the uterine-artery embolization group.
Perioperative and postoperative complications were higher in the myomectomy group (29%) compared with the uterine-artery embolization group (24%) Women in the myomectomy group also experienced longer hospital stays (median length 4 days) compared with the uterine-artery embolization group (median length 2 days).
Of the 111 women in the myomectomy group for whom data was available at 2 years, 7% required an additional fibroid-related procedure compared with 16% of the 110 women in the uterine-artery embolization group.
“The substantially higher number of surgical reinterventions in the uterine-artery embolization group than in the myomectomy group during 2 years of follow-up may be explained in part by the lower quality of life reported in the uterine artery embolization group,” researchers said.
Participants were instructed to record their estimated menstrual blood loss and were allowed to choose any brand of sanitary protection they preferred as well as any pharmacologic cointerventions. There was no significant difference in menstrual bleeding between the 2 groups. Additionally, researchers did not find a significant difference in follicle-stimulating hormone levels between the 2 groups.
Manyonda I, Belli AM, Lumsden MA, et al. Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med. 2020;383(5):440-451.