Long Term Health-Related Quality of Life and Symptom Severity Following Hysterectomy, Myomectomy, or Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids

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American journal of obstetrics and gynecology


BACKGROUND: Few studies have directly compared different surgical procedures for uterine fibroids with respect to long-term health-related quality of life outcomes and symptom improvement.

OBJECTIVE: We examined differences in change from baseline to 1, 2 or 3-year follow-up in health-related quality of life and symptom severity among patients who underwent abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization.

STUDY DESIGN: The COMPARE-UF Registry is a multi-institutional prospective observational cohort study of women undergoing treatment for uterine fibroids. A subset of 1,384 women ages 31-45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy(n=522), or uterine artery embolization (n=176) were included in this analysis. We obtained demographics, fibroid history, and symptoms by questionnaires at enrollment and at 1-, 2-, and 3-years post-treatment. We used the Uterine Fibroids Symptom and Quality of Life (UFS-QoL) questionnaire to ascertain symptom severity and health-related quality of life scores among participants To account for potential baseline differences across treatment groups, a propensity score model was used to derive overlap weights and compare total HR-QoL and symptom severity (SS) scores post-enrollment with a repeated measures model. For this HRQOL tool, a specific minimal clinically important difference (MCID) has not been determined, but based on previous research, a difference of 10 points was considered a reasonable estimate of MCID. Use of this difference was agreed upon by the Steering Committee at the time the analysis was planned.

RESULTS: At baseline, women undergoing hysterectomy and uterine artery embolization reported the lowest health-related quality of life scores and highest symptom severity scores compared to those undergoing abdominal myomectomy or laparoscopic myomectomy (p<0.001). Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years (SD: 6.7, p<0.001). The most common fibroid symptoms were menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group (UFS-QoL: delta= (+) 49.2; symptom severity: delta= (-)51.3). Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life ( delta= (+)43.9, (+)32.9, (+)40.7, respectively) and symptom severity (delta= (-)41.4, (-) 31.5, (-) 38.5, respectively) at 1 year, and the improvement persisted from baseline for uterine sparing procedures during 2(nd) (UFS-QOL: delta= (+)40.7, (+)37.4, (+)39.3 SS: delta= (-) 38.5, (-) 32.0, (-) 37.7 and 3(rd) year (UFS-QOL: delta= (+) 40.9, (+)39.9, (+)41.1and SS: delta= (-) 33.9 , (-)36.5, (-) 33.0, respectively), post-treatment intervals, however with a trend towards decline in degree of improvement from years 1 and 2. Differences from baseline were greatest for hysterectomy; however, this may reflect the relative importance of bleeding in the UFS-QoL, rather than clinically meaningful symptom recurrence among women undergoing uterus-sparing treatments.

CONCLUSION: All treatment modalities were associated with significant improvement in health-related quality of life and symptom severity reduction 1-year post-treatment. However, abdominal myomectomy, laparoscopic myomectomy and uterine artery embolization indicated an a gradual decline in symptom improvement and health-related quality of life by 3(rd) year post-procedure.

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ePub ahead of print