Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids

Abstract

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. 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. 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. 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 2nd (UFS-QOL: delta= (+)40.7, (+)37.4, (+)39.3 SS: delta= (-) 38.5, (-) 32.0, (-) 37.7 and 3rd 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. 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 3rd year post-procedure.