Authors: Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, Craig L, Lumsden M.
Journal: British Journal of Obstetrics and Gynecology 2011;118:936–944.
Study From: North Glasgow University Hospitals, Glasgow, UK
Problem: Women with uterine fibroids now have a number of treatment options available. Very few studies have compared the results of treatment with different options.
Study: This study was designed to compare the results for women who had uterine artery embolization with women who had surgery (myomectomy or hysterectomy) five years after treatment. Women filled out quality-of-life questionnaires and the authors recorded any complications from treatment or the need for women to have additional treatment for fibroids during the 5 years of follow-up.
Results: 106 women were randomized to UAE and 51 to surgery (42 had abdominal hysterectomy and 9 had abdominal myomectomy). Symptom reduction and patient satisfaction with both treatments were very high and there were no significant differences between the UAE and surgery groups.
Rates of adverse events were similar in both groups. In the surgery groups there were 5 wound problems (either infections or blood collections), 2 surgeries with excessive blood loss, and 2 anesthetic complications. In the UAE group there were 2 women with pain and infection needing readmission to the hospital, 4 with fibroid expulsion, 1 pelvic abscess requiring hysterectomy, 2 with persistent pain requiring hysterectomy and 1 woman with heavy bleeding that required blood transfusion.
The need for further treatment during the 5 years was 32% for UAE and 4% for surgery. In the UAE group, 4 women had repeat UAE and 13 women had hysterectomies. In the surgery group, 1 woman had a hysterectomy due to technical difficulties (I imagine due to surgeon inexperience?) during her myomectomy.
Authors’ Conclusions: UAE is a satisfactory alternative to surgery for fibroids. The less invasive nature of UAE needs to be balanced against the need for further treatment in almost a third of patients. The choice should lie with the informed patient.
Dr. Parker’s Comments: This study shows that most women will do well with either UAE or surgery as treatment for fibroids. Although not discussed in this paper, the recovery from UAE is usually much easier than from abdominal surgery and a bit easier than from laparoscopic or robotic surgery. On the other hand, this study found that more women required additional procedures after UAE than after surgery.
The author’s last sentence is a guiding principle: “the choice of treatment should lie with the informed patient”. For any patient, each of these treatment options is going to have pros and cons. I see my job as a physician as one figuring out what the pelvic examination plus imagining studies (MRI or ultrasound) reveals about the sizes and positions of the fibroids. Then my role is helping each woman understand which symptoms are caused (or not caused) by her fibroids. I then describe the different treatment options and how they might help her situation. Then, the decision of which option to choose, including watchful waiting, is up to the patient.
