#VisualAbstract: Myomectomy associated with better fibroid-related quality of life versus uterine-artery embolization

1. While women in both groups experienced dramatic gains in fibroid-related quality of life, the magnitude of the increase was greater in the myomectomy group versus the embolization group.

2. Surgical reintervention was necessary in a greater percentage of the embolization group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Uterine fibroids are the most common tumor type among women of reproductive age and are associated with considerable morbidity if left untreated. Surgical intervention has historically been the mainstay of the management of fibroids, but uterine-artery embolization has more recently become known as a viable treatment alternative that is performed under local anesthesia, resulting in shorter hospital stays and faster recovery. However, studies comparing the efficacy of these two measures have yielded inconclusive results, indicating the need for further research. This study involving women with symptomatic uterine fibroids in the United Kingdom utilized a 100-point disease-specific questionnaire to evaluate fibroid-related quality of life following either procedure. At 2 years, those who underwent myomectomy had a score that was 6 to 8 points better, on average, than those who underwent uterine-artery embolization after adjusting for the baseline score. Perioperative or postoperative complications occurred in roughly one-quarter of women in both groups, but only 1 intraoperative complication occurred in each group. Nearly 10% more women in the embolization group required additional procedures compared to the myomectomy group, but no differences between groups were observed in menstrual bleeding or in the levels of biomarkers of ovarian reserve. This study had good generalizability owing to its multicenter design and broad inclusion criteria, but it was limited by its reliance on imputation due to a relatively high attrition rate and a substantial amount of missing data from patients who did respond to the questionnaire.

Click here to read the study, published today in NEJM

Relevant Reading: Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids

In-Depth [randomized controlled trial]: This open-label study was conducted at 29 hospitals in the UK between February 2012 and May 2015. 254 women were randomly assigned in a 1:1 ratio to receive either uterine-artery embolization or myomectomy for one or more fibroids. At baseline, the two groups were well-matched for demographic and clinical characteristics including the severity and distribution of fibroids. Following the procedure, participants were asked to submit responses to the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire at 6 months, 1 year, and 2 years. Improvement in fibroid-related quality of life was significantly greater in the myomectomy group at all three time points (difference at 6 months, 7.4 points; 95% CI at 6 months, 0.5 to 14.2; difference at 1 year, 10.8 points; 95% CI at 1 year, 4.2 to 17.5; difference at 2 years, 8.0; 95% CI at 2 years, 1.8 to 14.1). Perioperative and postoperative complications occurred in 27 of 113 women (24%) in the uterine-artery embolization group and in 34 of 118 women (29%) in the myomectomy group (relative risk, 1.2; 95% CI, 0.8 to 1.9; P=0.40), and additional fibroid-related procedures were performed in 18 women (16%) in the embolization group and 8 women (7%) in the myomectomy group. Overall, these findings suggest that myomectomy offers sustained health-related quality of life benefits over uterine-artery embolization.

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