Risk factors for recurrence of uterine fibroids

Abstract

The objective: a study of the risk factors and the frequency of recurrence of uterine fibroids (UF) after conservative myomectomy. Materials and methods. A clinical and statistical retrospective analysis of the long-term outcomes of surgical treatment of 40 patients in reproductive age (from 19 to 42 years) with UF was carried out based on the data of case histories, outpatient cards and data from a questionnaire/telephone survey. All women had a complicated gynecological and reproductive history. In the postoperative period, the patients received hormonal therapy with progestogens (in cyclic regime) and oral contraceptives for 6–12 months. For the diagnosis of UF recurrence, clinical examination, bimanual examination, transvaginal echography were performed every 3 months during the first 3 years, then every six months. The fact of UF recurrence was ascertained of the appearance at least of one myomatous node more than 1 cm in diameter. Results. The long-term results were studied in 36 out of 40 patients after conservative myomectomy. At the time of assessment, the average age of patients after surgery was 39.7±6.17 years, 4 (11 %) women of them were in active reproductive age, 11 (33.3 %) – late reproductive age, and 10 (27.7 %) – premenopausal period. The mean period of observations was 6.22±1.71 years. Recurrence of UF was diagnosed in 22 (55 %) patients, 3 (7.5 %) of them required repeated surgery (2 women after supravaginal amputation of the uterus, 1 – transcervical resection of the submucous node).The cumulative (accumulated) percentage of UF recurrence within 7 years after surgery was 67.4±8 % with the maximum increase of recurrence frequency in the 2nd and 3rd years after surgery (up to 31.7 6 % and 51.2±7 %, respectively). After conservative myomectomy, pregnancy occurred in 11 (27.5 %) women, including 2 out of 5 persons with infertility before surgery, and 4 out of 9 patients who had miscarriage in anamnesis. The maximum number of pregnancies (5) occurred in the interval from 1 to 1.5 years after surgery. Pregnancy ended in timely delivery in 7 patients, spontaneous abortion – 3 (7.5 %), induced abortion – 1 (2.5 %). All 7 pregnant women were delivered by caesarean section.Conclusions. A retrospective analysis of long-term outcomes of organ-preserving surgical treatment of patients of reproductive age with uterine fibroids determined a high frequency of myoma recurrence after conservative myomectomy, reaching 67.4±8 % in7 years after the operation. The greatest increase in recurrence was observed in the 2nd and 3rd years after surgery. The statistically significant risk factors for the development of recurrence of the disease were the number of myomatous nodes and the patient’s age (30–40 years). The use of hormonal therapy (norethisterone or oral contraceptives) after surgery did not lead to a decrease in the rate of recurrence of uterine fibroids. And although conservative myomectomy made it possible to increase the frequency of pregnancy in operated patients, the level of reproductive losses after surgery remained high (36.3 %).