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Surgery still best treatment for fibroids

BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:231

Uterine artery embolisation is a quicker and simpler alternative to surgery for some women with symptomatic fibroids. But one in five women who choose embolisation will need further treatment later to control their symptoms, a trial has found.

Researchers randomised 157 premenopausal women. The 106 women who had uterine artery embolisation had less pain, had shorter hospital stays (one day v five days), and returned to work sooner (20 days v 62 days) than the 51 who had myomectomy or abdominal hysterectomy. One year after treatment symptoms were better in the surgical group, although both groups had improved from baseline and had comparable quality of life scores. Nine out of 10 said they would recommend either treatment to a friend.

Twenty per cent (21/106) of women who had embolisation needed repeat treatment or a hysterectomy during a median follow-up of 32 months. One in three had minor complications such as the post embolisation syndrome characterised by pain and fever. One in five of the surgical group also had minor complications (P=0.06). A similar proportion of both groups had a major complication (16/106 v 10/51), but the surgical complications occurred earlier, usually before discharge. The effects of uterine artery embolisation on fertility, pregnancy, and childbirth remain unknown.


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