Which to choose myomectomy or uterine artery embolization?

 

Which to choose myomectomy or uterine artery embolization?

Review of a recent study published in the New
England Journal of Medicine

Uterine fibroids are common tumors which are often associated with
• Heavy menstrual bleeding
• Anemia
• Pelvic pain
• Infertility
• Reduced quality of life


For women with symptomatic fibroids who want to avoid a hysterectomy (removal of the uterus), two alternative options are myomectomy and uterine artery embolization (UAE).
• Myomectomy: A surgery done to remove fibroid(s) from the uterus, leaving the uterus intact. The surgery is performed by a gynecological surgeon.
• Uterine Artery Embolization: A procedure done to block the blood flow to the main uterine blood vessel. By limiting the blood flow the fibroid(s) shrink. This procedure is done by an interventional radiologist.

Myomectomy v Uterine Artery Embolization

Treatment Options: Myomectomy Uterine Artery Embolization (UAE)
Uterus remains intact Yes Yes
Requires surgery Yes No

 

Multi-center study design: (done in the United Kingdom)
• Date of study: 2/2012 - 5/2015
• Number of participants: 254 women
• Age range of participants: 34-48 years
• Race & Ethnicity: Black, Mixed, Other, South Asian, White
• Those having a fibroid > 7 cm: 50%
• Those having 4 or more fibroids: 34%
• Study Groups: 127 women offered myomectomy, 127 women offered UAE


The primary goal: To compare the fibroid-related quality of life satisfaction of the groups 2 years after treatment. The women completed the Uterine Fibroid Symptom and Health Related Quality of Life Questionnaire (UFS-QOL) which asked about symptoms, concerns, activities, energy/mood, control, self-consciousness, and sexual function in determining a score.

While both groups reported improved quality of life 2 years after treatment, the myomectomy group reported a greater improvement compared to the UAE group.

 

Caveat: Fibroids can recur after myomectomy with reported recurrence rates as high as 57% at 60 months post-surgery.

Author
Sharan Abdul-Rahman, MD

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