The following is a summary of “Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids,” published in the SEPTEMBER 2023 issue of Obstertrics and Gynecology by Anchan, et al.
Uterine fibroids are a common health issue among women, and various surgical procedures are used for treatment. However, limited research compares these procedures in terms of long-term health-related quality of life (HRQoL) outcomes and symptom improvement. For a study, researchers sought to investigate differences in changes in HRQoL and symptom severity over time among patients who underwent different surgical treatments for uterine fibroids, including abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization.
The study used data from the COMPARE-UF registry, a multi-institutional prospective observational cohort study involving women undergoing uterine fibroid treatment. A subset of 1,384 women between the ages of 31 to 45 who had undergone one of the specified treatments were included in this analysis. Information about demographics, fibroid history, and symptoms was collected through questionnaires at various time points over three years. Symptom severity and HRQoL were assessed using the UFS-QoL (Uterine Fibroid Symptom and Quality of Life) questionnaire. Propensity score modeling was employed to adjust for potential baseline differences, and a repeated measures model was used to compare HRQoL and symptom severity scores.
At baseline, women who underwent hysterectomy and uterine artery embolization reported the lowest HRQoL scores and the highest symptom severity scores compared to those who underwent abdominal or laparoscopic myomectomy (P<.001). The most common fibroid symptoms included menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half of the participants (54.9%) reported anemia, and 9.4% had a history of blood transfusion. Across all treatment modalities, there was a significant improvement in HRQoL and symptom severity scores from baseline to one year, with laparoscopic hysterectomy showing the greatest improvement (Uterine Fibroids Symptom and Quality of Life: delta= [+] 49.2; symptom severity: delta= [−] 51.3). Abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvements in HRQoL (delta= [+]43.9, [+]32.9, [+]40.7, respectively) and symptom severity (delta= [−]41.4, [−] 31.5, [−] 38.5, respectively) at one year. These improvements persisted for uterine-sparing procedures during the second and third years post-treatment but showed a trend toward a decline in improvement compared to years one and two. The greatest differences from baseline were observed for hysterectomy, primarily related to bleeding symptoms in the Uterine Fibroids Symptom and Quality of Life questionnaire.
All treatment modalities led to significant improvements in HRQoL and symptom severity reduction one year after treatment. However, abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization showed a gradual decline in symptom improvement and HRQoL by the third year post-procedure. Hysterectomy had the greatest differences from baseline. However, this may be attributed to the relative importance of bleeding symptoms in the Uterine Fibroids Symptom and Quality of Life questionnaire rather than meaningful symptom recurrence in uterus-sparing treatments.