Hysterectomy improves uterine fibroid symptoms

Hysterectomy improves uterine fibroid symptoms | Image Credit: © RFBSIP - © RFBSIP - stock.adobe.com.

According to a recent study published in the American Journal of Obstetrics & Gynecology, hysterectomy, myomectomy, and uterine artery embolization(UAE) are all effective treatments for improving the quality of life and symptom severity (SS) in patients with symptomatic uterine fibroids (UFs).

About 30% of women in the United States are diagnosed with symptomatic UFs by age 50 years, with incidence ranging from 2.8 per 1000 person-years for all diagnoses to approximately 2 per 1000 person-years for women receiving hysterectomy. Black women are disproportionately affected by UFs, with over 80% being diagnosed by age 50 years.

Symptoms of UFs which impact a woman’s quality of life include dyspareunia, sexual dysfunction, pelvic pressure, abnormal uterine bleeding, and infertility. Treatment options include medical management and surgical treatments, and may be chosen based on symptom severity, patient preference, and provider experience.

Surgical options including myomectomy and hysterectomy comprise 90% to 95% of UF procedures, with hysterectomies reported as the most common surgery in women. Investigators conducted a study to evaluate patient outcomes after these procedures.

From November 11, 2015, to December 29, 2019, 2858 premenopausal women were enrolled in the Comparing Options for Management: Patient-Centered Results for Uterine Fibroids registry, which recorded treatment outcomes for UFs. Patients were aged 18 to 54 years, had 1 or more documented UF, and presented for a UF procedure at a participating US site.

Eligibility criteria for the analysis included being aged over 30 years and receiving laparoscopic hysterectomy (LR-H), abdominal hysterectomy (AH), laparoscopic myomectomy (LR-M), abdominal myomectomy (AM), or UAE. Women attempting pregnancy or receiving a different treatment were excluded from the analysis.

Questionnaires and electronic medical records were evaluated for patient data. Data collected included sociodemographic characteristics, contraceptive use, parity, menstrual characteristics, age at fibroid diagnosis, fibroid volume, number of fibroids, previous treatment, anemia history, and other medical conditions.

The Uterine Fibroid Symptom and Quality of Life (UFS-QoL) was used to assess quality of life and symptom severity among patients. The UFS-QoL included 29 quality of life questions and 8 symptom questions, evaluated on a 5-point Likert score.

Domains of quality of life included concern, activities, energy, control, self-consciousness, and sexual function. Outcomes were measured with health-related quality of life (HR-QoL) and SS scores.

There were 1384 participants included in the final analysis, all of which had at least 1 follow-up visit. LR-H was received by 522 patients, LR-M by 272, AM by 237, AH by 177, and UAE by 176. Younger patients more often received fertility-sparing surgery, while those with a large fibroid or uterine volume more often received a myomectomy.

Anemia was reported by 54.9% of patients and blood transfusion by 9.4%. Women with anemia more commonly received UAE. A history of UF treatment was reported by nearly 1 in 5 women receiving a hysterectomy.

At baseline, the lowest UFS-QoL scores and highest SS scores were reported by women receiving hysterectomy and UAE. All modalities led to improved UFS-QoL and SS scores, with the LR-H group seeing the greatest improvements.

While all procedures showed improved UFS-QoL and SS scores at 1 year, hysterectomy showed more durable symptom relief and greater UFS-QoL over other modalities. AM, LR-M, and UAE also showed improved HR-QoL at year 1, year 2, and year 3.

These results indicated symptom relief and improved HR-QoL in patients receiving hysterectomy, myomectomy, or uterine artery embolization. Overall, hysterectomy displayed the most durable and long-term relief for patients.

Reference

Anchan RM, Spies JB, Zhang S, et al. Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids. Am J Obstet Gynecol. 2023;229(275):E1-E17. doi:10.1016/j.ajog.2023.05.020