Better QoL with myomectomy than uterine-artery embolization for fibroids

Women with symptomatic uterine fibroids who underwent myomectomy were more likely to experience a better quality of life (QoL) than those who had uterine-artery embolization, according to the FEMME* trial.

“The mean scores on the health-related QoL domain of the UFS-QoL** questionnaire at 2 years were substantially higher than the baseline scores in both groups, but the magnitude of improvement was greater in the myomectomy group than in the uterine-artery embolization group,” said the researchers.

Researchers gathered data from 29 hospitals in the UK and analysed 254 women with symptomatic uterine fibroids who were randomly assigned in a 1:1 ratio to undergo either myomectomy (mean age 42.7 years) or uterine-artery embolization (mean age 40.2 years). UFS-QoL questionnaires were used to assess fibroid-related QoL at 2 years (81 percent completed the questionnaire). [N Engl J Med 2020;383:440-451]

At 2 years, women who underwent myomectomy had better QoL, as shown by a higher mean score of the UFS-QoL health-related QoL domain (84.6 vs 80.0; mean adjusted difference with complete analysis and with missing responses imputed, 8.0 and 6.5 points, respectively) than women who underwent uterine-artery embolization.

The higher mean score of UFS-QoL health-related QoL domain was also observed in the myomectomy group vs the uterine-artery embolization group at 6 months (80.5 vs 73.9) and 1 year (84.7 vs 75.7).

Women in the myomectomy group had a greater decrease in UFS-QoL symptom severity domain score at 6 months and 2 years (estimate mean score difference, -6.1 and -3.8, respectively) than the uterine-artery embolization group.

Moreover, the need for additional procedures was lower among women in the myomectomy than the uterine-artery embolization group (7 percent vs 16 percent). “[This] substantially high number of surgical reinterventions in the uterine-artery embolization group … may be explained in part by the lower QoL reported,” the researchers noted.

“The overall incidence of perioperative and postoperative complications was similar in the two groups,” they said.

“In conclusion, this multicentre trial showed the superiority of myomectomy over uterine-artery embolization with respect to health-related QoL,” said the researchers.

“This trial was larger than previous trials that compared uterine-artery embolization with any surgery and provides information on patient-focused outcomes,” they added.

*FEMME: A randomized trial of treating fibroids with either embolisation or myomectomy to measure the effect on quality of life among women wishing to avoid hysterectomy

**UFS-QoL: Uterine Fibroid Symptom and Quality of Life