Uterine artery embolization or myomectomy for uterine fibroids

Research output: Contribution to journalArticlepeer-review

Authors

  • Isaac Manyonda
  • Anna-maria Belli
  • Mary-ann Lumsden
  • Jonathan G Moss
  • Olivia Wu
  • Fusun Sirkeci
  • Jane P. Daniels
  • Klim Mcpherson

Colleges, School and Institutes

External organisations

  • University of Nottingham
  • Nottingham University Hospital (City Campus)

Abstract

BACKGROUND
Uterine fibroids are the most common tumor in women of reproductive age, and are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and reduced quality of life. For women seeking to retain their uterus and who do not respond to medical treatment, myomectomy and uterine artery embolization are therapeutic options.
METHODS
We conducted a multicenter, open, randomized trial of myomectomy versus uterine artery embolization for women who had symptomatic uterine fibroids and wanted to avoid hysterectomy. Myomectomy could be open abdominal, laparoscopic or hysteroscopic. The primary outcome was quality of life, using the Uterine Fibroid Symptom Quality of Life questionnaire (UFS-QOL, range 0-100 [higher indicating better quality of life]) at 2 years, adjusting for baseline score.
RESULTS
254 women from 29 UK hospitals were randomized, 127 to myomectomy (of whom 105 underwent myomectomy) and 127 to uterine artery embolization (98 underwent embolization). Information on the primary outcome was available in 81% (206 women). In intention-to-treat analysis, UFS-QOL scores at 2 years were 84.6 (standard deviation [SD] 21.5) in the myomectomy group, versus 80.0 (SD 22.0) in the uterine artery embolization group (mean adjusted-difference using complete case analysis 8.0; 95% confidence interval [CI] 1.8-14.1; p=0.01); mean adjusted-difference with missing responses imputed 6.5 points, 95%CI, 1.1-11.9). Peri- and post-operative complications from all initial procedures occurred in similar percentages of women in both groups (29% versus 24%, respectively).
CONCLUSION
Among women with symptomatic uterine fibroids, myomectomy resulted in better fibroid-related quality of life at 2 years, compared with uterine artery embolization.
(Funded by the UK National Institute for Health Research; ISRCTN70772394)

Details

Original languageEnglish
Pages (from-to)440-451
JournalThe New England Journal of Medicine
Volume383
Issue number5
Publication statusPublished - 30 Jul 2020