Uterine artery embolization for symptomatic fibroids: long-term changes in disease-specific symptoms and quality of life

Abstract

To investigate the long-term changes in health-related quality of life (HRQOL) after uterine artery embolization (UAE) for symptomatic fibroids, we conducted a prospective cohort study. Eighty-two women completed the validated uterine fibroid symptom and QOL (UFS-QOL) questionnaire before UAE. Short-term results after a median of 8 months (range: 3-20) have been published previously. Patients were asked to complete the questionnaire again after a median of 6.3 years (range: 5-7.6). Secondary outcome measures were the frequency of additional surgical or endovascular procedures due to treatment failure and the menstrual status. A total of 4/82 patients (5%) were lost to follow-up. Of the remaining 78 patients, 11 underwent surgery or repeat UAE (hysterectomy n = 6, myomectomy n = 1, UAE n = 4) at a median of 13 months (range: 5-70) after UAE. Two patients failed clinically but did not undergo a second intervention. The overall treatment failure rate 6 years after UAE was 17%. Clinical long-term follow-up regarding symptom control and quality of life was available in the remaining 65 patients. Symptom severity scores decreased from a median of 37.50 (quartile range, QR: 28.13-53.13) to 0.00 (QR: 0.00-10.94) (P < 0.001), whereas the HRQOL total score increased from a median of 64.66 (QR: 46.34-79.10) to 100.00 (QR: 96.12-100.00) (P < 0.001). Both scores also improved significantly compared with short-term results (P = 0.006 and P = 0.041). Permanent amenorrhea was observed in five patients at a median of 18 months (range: 10-46) after UAE and at a mean patient age of 50 years. UAE leads to durable relief of fibroid-related symptoms and sustained improvement in HRQOL. After 6 years, clinical failure can be expected in 17%, and most of these patients require secondary invasive treatment.